Sec. 44133. Revising payments for certain State directed payments
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Subject to subsection (b), the Secretary of Health and Human Services (in this section referred to as the Secretary) shall revise section 438.6(c)(2)(iii) of title 42, Code of Federal Regulations such that, with respect to a payment described in such section made for a service furnished during a rating period beginning on or after the date of the enactment of this Act, the total payment rate for such service is limited to— in the case of a State that provides coverage to all individuals described in section 1902(a)(10)(A)(i)(VIII) of the Social Security Act ( 42 U.S.C. 1396a(a)(10)(A)(i)(VIII) ) that is equivalent to minimum essential coverage (as described in section 5000A(f)(1)(A) of the Internal Revenue Code of 1986 and determined in accordance with standards prescribed by the Secretary in regulations) under the State plan (or waiver of such plan) of such State under title XIX of such Act, 100 percent of the specified total published Medicare payment rate (or, in the absence of a specified total published Medicare payment rate, an equivalent Medicare payment rate); or in the case of a State other than a State described in paragraph (1), 110 percent of the specified total published Medicare payment rate (or, in the absence of a specified total published Medicare payment rate, an equivalent Medicare payment rate).
In the case of a payment described in section 438.6(c)(2)(iii) of title 42, Code of Federal Regulations for which written prior approval was made before the date of the enactment of this Act for the rating period occurring as of such date of enactment, or a payment so described for such rating period for which a preprint was submitted to the Secretary prior to such date of enactment, the revisions described in subsection
(a)shall not apply to such payment for such rating period and for any subsequent rating period if the amount of such payment does not exceed the amount of such payment so approved. The revisions described in subsection
(a)shall provide that, with respect to a State that begins providing the coverage described in paragraph
(1)of such subsection on or after the date of the enactment of this Act, the limitation described in such paragraph shall apply to such State with respect to a payment described in section 438.6(c)(2)(iii) of title 42, Code of Federal Regulations for a service furnished during a rating period beginning on or after the date on which such State begins providing such coverage, including with respect to a payment so described for which written prior approval was made before such date. In this section: The term equivalent Medicare payment rate means amounts calculated as payment for specific services comparable to the service furnished that have been developed under part A or part B of title XVIII of the Social Security Act ( 42 U.S.C. 1396 et seq. ). The term rating period has the meaning given such term in section 438.2 of title 42, Code of Federal Regulations. The term total published Medicare payment rate means amounts calculated as payment for specific services including the service furnished that have been developed under part A or part B of title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ). The term written prior approval has the meaning given such term in section 438.6(c)(2)(i) of title 42, Code of Federal Regulations. There are appropriated out of any monies in the Treasury not otherwise appropriated $7,000,000 for each of fiscal years 2026 through 2033 for purposes of carrying out this section.