Medicaid RAC Improvement Act of 2026
- Bill Number
- H.R. 9422
- Origin Chamber
- House
- Congress
- 119th Congress, Session 2
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-06-24: Referred to the House Committee on Energy and Commerce.
- Last Updated
- 2026-07-09T14:28:33Z
AI-Generated Summary
Purpose The legislation, titled the Medicaid RAC Improvement Act of 2026, aims to strengthen the Medicaid Recovery Audit Contractor (RAC) program by implementing recommendations from the Comptroller General. It focuses on improving oversight, expanding program scope, enhancing reporting, and identifying ways to recover overpayments while maintaining program integrity.
Key Provisions
- Improved Oversight and Communication (Section 2): Requires the Secretary of Health and Human Services to establish policies for communicating RAC exception expiration dates to states, monitoring those expirations, and requiring annual state reports on Medicaid RAC programs. Mandates annual reports to Congress detailing state-specific data on overpayments, underpayments, appeals, and initiatives to reduce improper payments. Limits RAC exceptions to December 31, 2028.
- Inclusion of Managed Care Plans (Section 3): Requires states to include reviews of claims paid by Medicaid managed care organizations, prepaid inpatient health plans, and prepaid ambulatory health plans in their RAC programs. States must ensure contracts with these entities allow for payment integrity reviews (either by the plan or a state RAC) and cooperation in recoveries.
- Additional Payment Integrity Measures (Section 4): Directs annual state reports on reviewing entities for all payment streams, including managed care payments. Requires a study on barriers to state RAC participation (such as contingency fees and startup costs) and a 5-year demonstration project to increase state involvement. Sets audit and recovery periods to the current fiscal year plus the prior 4 fiscal years.
Significant Changes to Existing Law
- Amends Section 1903 of the Social Security Act to add new oversight and reporting requirements for the Medicaid RAC program.
- Updates Section 1902(a)(42) to mandate inclusion of managed care claims in RAC reviews and to establish contract provisions for payment integrity.
- Introduces new reporting obligations and a demonstration project not previously required under existing Medicaid law.
Potential Impacts
- On government agencies: Increases administrative responsibilities for the Centers for Medicare & Medicaid Services (CMS) and state Medicaid agencies through enhanced reporting, monitoring, and potential demonstration projects.
- On citizens: May lead to more accurate Medicaid payments, reducing improper expenditures that could affect program sustainability, though it does not directly alter beneficiary eligibility or benefits.
- No direct effects on international relations are outlined.
Main Stakeholders Affected
- State Medicaid agencies and their contractors.
- Medicaid managed care organizations, prepaid inpatient health plans, and prepaid ambulatory health plans.
- The Department of Health and Human Services (including CMS).
- Recovery audit contractors.
- Congress (through required reports).
Notable Legal, Constitutional, or Political Implications The bill expands federal oversight of state Medicaid programs without altering core constitutional federal-state divisions in Medicaid administration. It introduces time-limited exceptions and demonstration authorities, potentially affecting state flexibility in program design. All changes focus on payment integrity within the existing statutory framework of the Social Security Act.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Bilirakis, Gus M. [R-FL-12]
Cosponsors (8)
Rep. Arrington, Jodey C. [R-TX-19], Rep. Cammack, Kat [R-FL-3], Rep. Carter, Earl L. "Buddy" [R-GA-1], Rep. Miller-Meeks, Mariannette [R-IA-1], Rep. Palmer, Gary J. [R-AL-6], Rep. Bean, Aaron [R-FL-4], Rep. Allen, Rick W. [R-GA-12], Rep. Smucker, Lloyd [R-PA-11]
Recent Actions
- 2026-06-24: Referred to the House Committee on Energy and Commerce.
- 2026-06-24: Introduced in House
- 2026-06-24: Introduced in House
Bill Versions
- Medicaid RAC Improvement Act of 2026 — issued 2026-06-24 — PDF (14 pages)