H.R. 7145 — To amend title XIX of the Social Security Act to establish a definition of essential health system in statute and for other related purposes.

This section establishes a statutory definition of "essential health system" in Section 1905(ll) of the Social Security Act as a subsection (d) hospital (i.e., Medicare inpatient prospective payment system hospital) that is non-Federal governmental or private nonprofit and that met at least one of three criteria—(1) a Medicare disproportionate patient percentage of at least 35 percent, (2) a Medicare disproportionate share hospital uncompensated care payment factor of 0.0005 or more, or (3) a value for either of the prior criteria in the top 16th percentile among subsection (d) hospitals in its state—in at least two of the three most recent fiscal years, with designations effective for five years (subject to annual verification of nonprofit/governmental status and redesignation thereafter). The section further directs the Medicaid and CHIP Payment and Access Commission (MACPAC)—an independent advisory commission that reviews Medicaid and CHIP payment and access policies—to (1) submit to Congress, not later than six months after enactment and by August 1 annually thereafter, a list of essential health systems (including newly qualifying and previously designated hospitals); and (2) annually publish "essential health system index" values for all subsection (d) hospitals, comprising percentile rankings (relative to other such hospitals) for the two primary criteria in the hospital's core-based statistical area (if applicable), state, and nationally, plus a composite average of those values. Finally, this section requires MACPAC to review payment policies that use these criteria to provide targeted support for essential health systems and ensure access to the essential community services they provide.