H.R. 6494

Territories Health Equity Act of 2025

Sponsor: Stacey E. Plaskett

4 cosponsors
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Official summary

Written by the Congressional Research Service.

Territories Health Equity Act of 2025

This bill alters provisions relating to the treatment of U.S. territories under Medicaid, Medicare, and Medicare Advantage.

For example, the bill

  • eliminates Medicaid funding limitations for U.S. territories beginning in FY2026,
  • exempts an individual from late-enrollment penalties for Medicare medical services if the individual resided in Puerto Rico as of the date of eligibility and the individual enrolls within five years of such date, and
  • establishes minimum criteria for certain elements used in Medicare Advantage payment calculations for areas within U.S. territories.

The bill also allows residents of U.S. territories who are unable to obtain health insurance through their employer or a health insurance exchange to instead obtain coverage that is at least as broad as the coverage available to Members of Congress and their staff through the District of Columbia exchange.

Text of the bill

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I MEDICAID

II MEDICARE

A Part A

Sec. 202. Rebasing target amount for hospitals in territories

Section 1886(b)(3) of the Social Security Act (42 U.S.C. 1395ww(b)(3)) is amended by adding at the end the following new subparagraph:

Text this section adds to the law

(M)

(i) For each cost reporting period beginning on or after October 1, 2025, in the case of a hospital located in a territory of the United States, there shall be substituted for the target amount otherwise determined under subparagraph (A) the rebased target amount (as defined in clause (ii)), if such substitution results in an amount of payment under this section to the hospital for such period that is greater than the amount of payment that would be made under this section to the hospital for such period if this subparagraph were not to apply.

(ii) For purposes of this subparagraph, the term rebased target amount has the meaning given the term target amount in subparagraph (A), except that—

(I) for a cost reporting period beginning on or after October 1, 2025, and before September 30, 2030, there shall be substituted for the preceding 12-month cost reporting period the 12-month cost reporting period beginning during fiscal year 2017;

(II) for a cost reporting period beginning on or after October 1, 2030, there shall be substituted for the preceding 12-month cost reporting period the cost reporting period for which the target amount determined under subparagraph (A) is the highest among the 5 cost reporting periods for which the Secretary has the most recent settled cost reports;

(III) any reference in subparagraph (A)(i) to the first such cost reporting period is deemed a reference to the first cost reporting period following the 12-month cost reporting period beginning during fiscal year 2017; and

(IV) the applicable percentage increase shall only be applied under subparagraph (B)(ii) for cost reporting periods beginning on or after October 1, 2025.

B Part B

C Medicare Advantage (Part C)

D Part D

III MISCELLANEOUS