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

Identify and Support Safety-Net Hospitals

If enacted, the bill would define which hospitals are "essential health systems." A hospital would qualify if it is a subsection (d) hospital, is non‑Federal government or private nonprofit, and meets at least one test in 2 of the last 3 fiscal years. The three tests are: a Medicare disproportionate patient percentage of at least 35%; an uncompensated care payment factor of at least 0.0005; or a state‑adjusted rank in the top 16th percentile for those measures. The HHS Secretary would use data from the Medicare inpatient prospective payment system final rules for the three most recent fiscal years. Designation would last five years if the hospital keeps meeting the tests each year, and redesignation would occur in five‑year cycles. MACPAC would publish an annual list and an index showing each hospital's percentile rank locally, by State, and nationally, plus a composite average. MACPAC would deliver the first list within six months after enactment and then by August 1 each year. MACPAC would also be authorized to consider payment policies that use these criteria to support these hospitals and protect access.