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Read. Follow. Verify.Idaho Senate Bill 1312 Revises Medicaid Provider Reimbursement Rates and Voids Certain Administrative Rules
Last action · February 17, 2026: Reported Printed; referred to Health & Welfare
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What This Bill Proposed
MEDICAID – Amends existing law to revise provisions regarding provider payment.
Changes how medical and community care providers are reimbursed under the state Medicaid program, institutes mandatory annual cost surveys for home-based services, and sets direct-care spending requirements for providers under threat of intake closure or agreement termination.
Who It Would Have Affected
Groups the bill's text would have affected, as described in the record. Being affected is not a position for or against it.
Medicaid providers
Providers are subject to new reimbursement rate caps, mandatory spending minimums on direct care wages, and potential corrective actions or contract terminations for non-compliance.
Hospitals
In-state, out-of-state, state-owned, and critical access hospitals receive distinct, codified reimbursement percentages based on cost or Medicare equivalents.
Direct care workers
Providers are legally mandated to expend designated funding allocations directly toward worker wages and employee-related expenses.
Key Facts
- Primary care procedure code payments to Medicaid providers may be up to 100 percent of the current Medicare rate, while all other procedure codes shall be 90 percent.
- Home and community-based services without a Medicare equivalent rate must undergo annual cost surveys with at least 15 percent of responses audited.
- Providers of home and community-based services must spend at least the amount allocated to direct care worker wages and employee-related expenses on those categories.
- Failure by providers to meet direct care spending requirements may result in a corrective action plan, closure of intake, or termination of the provider agreement.
Show all 8 facts
- The Department of Health and Welfare must summarize audited cost survey work in a publicly available report no later than December 31 each year.
- In-state critical access hospitals are reimbursed at 101 percent of cost, out-of-state hospitals at 87 percent, and state-owned hospitals at 100 percent.
- Administrative rules contained in IDAPA 16.03.26, specifically Section 051 and Section 052 relating to Medicaid Plan Benefits, become null, void, and of no force and effect on July 1, 2026.
- Federally qualified health centers and organizations owned by them are exempt from financial risk in value-based payment agreements beginning with the 2024 performance period.
Frequently Asked Questions
What happens to home and community-based service providers who fail to spend required amounts on direct care worker wages?
How are in-state critical access hospitals reimbursed under the bill?
Which administrative rules are being voided by the legislation?
What else do you want to know?
News Coverage
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Votes, people, money & the original sourceWhere This Stands
This bill did not become law - Died at adjournment · in Senate committee.
Procedural history
2 actions- Feb 17, 2026CommitteeReported Printed; referred to Health & Welfare
- Feb 16, 2026IntroducedIntroduced; read first time; referred to JR for Printing
Version history
Only one version on file - nothing to compare yet. As later stages (committee substitute, engrossed, enrolled) are captured, the redline appears here.
View official text →Lobbying Activity
No state lobbying filings in our records match this bill. Federal lobbying reports (LDA) cover Congress, so they are not listed on state bills.
Full breakdown
Who this bill affects and the strongest case for and against it, written only from the bill’s own text.
Discoveries
Patterns POLISCOPE noticed across the record. These are observations to investigate, not conclusions.
Shift to Value-Based Care and Direct Care Mandates
The legislation institutes strict reporting and direct-care spending requirements for home-based providers while authorizing a transition toward value-based hospital payment methodologies.
Connected Entities
Sources
legislature.idaho.gov
Analysis Score
0–100- Significance20Lowered because this bill did not pass (its text scored 75)
- Controversy40Intensity of disagreement among stakeholders
- Entertainment5Compellingness for a non-policy-wonk reader
- Buzz30Current news / social attention level
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