This bill amends Title XVIII of the Social Security Act to change how Medicare pays long-term care hospitals (LTCHs). It extends the date for site-neutral payment reductions from 2026 to 2032. The bill adds a new "high acuity" criterion so that some LTCH discharges are not paid under the site-neutral rate. The high acuity criterion applies to discharges on or after October 1, 2026, when all of the following are true: (1) the LTCH stay ending in the discharge was immediately preceded by a discharge from a subsection (d) hospital or a critical access hospital; (2) the patient was assigned to a specified Medicare-Severity-Long-Term-Care-Diagnosis-Related-Group (MS-LTC-DRG) that has a relative weight of 0.8 or greater and is not assigned because of receipt of ventilator services of at least 96 hours; and (3) the discharge was from an LTCH that met one of several enrollment or development conditions (enrolled before enactment, had a qualifying period that began before enactment, met defined "mid-build" requirements, or had a State certificate of need if required by State law). The bill defines mid-build requirements as having a binding written construction/renovation/lease/demolition agreement in effect at enactment and having spent at least 10 percent (or, if less, $2,500,000) of the estimated project cost, plus a required written certification from the hospital CEO or COO to the Secretary within 60 days. The bill also modifies the ICU and ventilator criteria so that, for discharges on or after October 1, 2026, a prior stay in the same LTCH or in a critical access hospital can satisfy those criteria.
No publicly available information on estimated budgetary costs or savings is included in the bill text or accompanying metadata provided.
No publicly available information in the provided text about proponents' stated reasons or arguments for the bill.
No publicly available information in the provided text about opponents' stated reasons or arguments against the bill.