# 119-hr-4269: Ensuring Outpatient Quality for Rural States Act

119-hr-4269, Ensuring Outpatient Quality for Rural States Act, is a 119th Congress bill sponsored by Rep. Tokuda, Jill N. [D-HI-2] (D-HI); status introduced; PRIA reads it as touching household money (as of 2026-04-21).

- Canonical: https://policyrisk.com/legislation/119-hr-4269
- As of: 2026-04-21
- Plain-text twin of the page above; the HTML and this file carry the same facts.

## Facts
- Bill: 119-hr-4269
- Congress: 119
- Title: Ensuring Outpatient Quality for Rural States Act
- Status: introduced
- Introduced: 2025-06-30
- Sponsor: Rep. Tokuda, Jill N. [D-HI-2] (D-HI)
- Cosponsors: 2
- Policy area: Health
- Touches household money: yes
- Last recorded action: 2026-04-21

## Summary

**A targeted cost-of-living adjustment to the non-labor portion of Medicare outpatient payments for hospitals in Alaska and Hawaii.** This bill would let the Medicare Secretary adjust the non-labor part of hospital outpatient department payments to reflect unique local costs in Alaska and Hawaii, using the existing adjustment method and starting for services on or after January 1, 2026. - Hospitals in Alaska and Hawaii: The Secretary may raise the non-labor portion of Medicare payments for hospital outpatient department services to account for state-specific cost differences. - Timing and scope: The authority applies only to covered outpatient department services furnished on or after January 1, 2026, and only to the non-labor portion of those payments. *This change allows the Secretary to increase non-labor outpatient payments for hospitals in Alaska and Hawaii and may increase Medicare spending because adjustments are not required to be budget neutral.*

## Cosponsors (2)

- Rep. Begich, Nicholas J. [R-AK-At Large] (R-AK), 2025-06-30T00:00:00.000Z
- Rep. Case, Ed [D-HI-1] (D-HI), 2025-07-02T00:00:00.000Z

## Provisions PRIA read

- Higher Medicare outpatient pay in Alaska and Hawaii: benefit, low. If enacted, Medicare could raise some hospital outpatient payments in Alaska and Hawaii. The HHS Secretary could raise the non-labor part of rates, using the current cost-of-living method. Increases could happen without offsetting cuts elsewhere. This would start for services on or after January 1,…

## Related bills

- 119-hr-9877: Health Equity and Accountability Act of 2026
- 119-hr-4669: FEMA Act of 2025
- 119-hr-3151: SHIPS for America Act of 2025
- 119-hr-7977: Energy Bills Relief Act
- 119-hr-7481: Department of Homeland Security Appropriations Act, 2026
- 119-hr-7973: Momnibus Act

## Sources
- [119-hr-4269 on Congress.gov](https://www.congress.gov/bill/119th-congress/house-bill/4269)

## Related
- [119-hr-9877: Health Equity and Accountability Act of 2026](https://policyrisk.com/legislation/119-hr-9877)
- [119-hr-4669: FEMA Act of 2025](https://policyrisk.com/legislation/119-hr-4669)
- [119-hr-3151: SHIPS for America Act of 2025](https://policyrisk.com/legislation/119-hr-3151)
- [119-hr-7977: Energy Bills Relief Act](https://policyrisk.com/legislation/119-hr-7977)
- [119-hr-7481: Department of Homeland Security Appropriations Act, 2026](https://policyrisk.com/legislation/119-hr-7481)
- [119-hr-7973: Momnibus Act](https://policyrisk.com/legislation/119-hr-7973)
- [All bills in Congress](https://policyrisk.com/legislation)

Source: PRIA, https://policyrisk.com/legislation/119-hr-4269 (as of 2026-04-21).