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U.S. Rep. Roger Williams, R-Austin, joined U.S. Rep. Eddie Bernice Johnson, D-Dallas, on Monday in introducing the MFAR Transparency Act to delay the implementation of the Medicaid Fiscal Accountability Rule and to direct the U.S. Government Accountability Office to conduct a study on the financial impacts on each state. The bill would also identify necessary information for reporting to comply with laws and regulations pertaining to funding of Medicaid payments.

“Blindly implementing the MFAR would lead to devastating hospital closures and disproportionately harmful outcomes in rural and underserved regions of Texas,” Williams said. “The financial impacts would cause local governments to increase taxes in order to make up for lost dollars, resulting in a reduction of our ability to provide essential health services for Texans,” Williams said. “By delaying the rule and thoroughly analyzing the consequences of its implementation, we will be able to ensure patients continue receiving the highest quality of care possible. I’m proud to lead the effort on behalf of our Texas health systems and the patients they serve.”

Johnson agreed.

“During this public health crisis, it is of utmost importance that we safeguard and strengthen the health systems that our communities are depending upon,” Johnson said. “That is why we must ensure that states does not lose out on critical Medicaid federal funding or essential health services due to the implementation of the Medicaid Fiscal Accountability Rule. 

“I am proud to lead this effort with my Texas colleague Congressman Roger Williams, and we must be committed to protecting our hospitals and community health services during this COVID-19 pandemic.”

Texas Hospital Association President/CEO Ted Shaw applauded Williams’ and Johnson’s efforts.

“The proposed rule would devastate Texas’ already fragile hospital and health care infrastructure and cut critically needed access to health care services,” Shaw said.

Don McBreath of the Texas Organization of Rural & Community Hospitals agreed.

“The proposed regulation appears to have a very negative impact on all hospitals and especially those in rural areas,” McBreath said. “[Williams’ and Johnson’s] bill will allow for decisions to be made based on hard data rather than blindly trying to save some money at the expense of Texas and hospitals, which would in turn reduce access to care.”

Danette Castle, CEO of Texas Council on Community Centers, praised Williams and Johnson for their efforts as well.

“As units of local government, Texas Community Mental Health Centers serve all 254 Texas counties and leverage funds through the state’s 1,115 Transformation Waiver supplemental payment program to increase access to services for more than 220,000 Texans with serious mental illness,” Castle said. 

The Trump Administration in November released a proposed rule called the Medicaid Fiscal Accountability Regulation or MFAR in effort to promote transparency by establishing new guidelines and reporting requirements related to supplemental payments by Medicaid providers and by changing the rules and review of supplemental payments among other matters.

Robin Rudowitz, in a January article on, wrote that, “The changes proposed are extremely technical and complex but are likely to have significant implications for provider payment rates and state financing of Medicaid by disrupting current arrangements and restricting the future use of such arrangements.”

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