Bill Details
View committees (1)
View cosponsors (8)
- Rep. Boyle, Brendan F. [D-Pennsylvania-2]
- Rep. Joyce, John [R-Pennsylvania-13]
- Rep. Miller, Carol D. [R-West Virginia-1]
- Rep. Smucker, Lloyd [R-Pennsylvania-11]
- Rep. Tenney, Claudia [R-New York-24]
- Rep. Davis, Donald G. [D-North Carolina-1]
- Rep. Carey, Mike [R-Ohio-15]
- Rep. Moran, Nathaniel [R-Texas-1]
AI Summary This summary was generated by AI from the bill text. AI can get information wrong.
This bill would change how Medicare pays long-term care hospitals by adding a new exception to site-neutral payment rules. In simple terms, it would allow some hospital stays for very sick patients to keep getting the special long-term care hospital payment rate instead of being paid under a lower, more standard rate. The goal is to help protect access to care for seniors and other patients in critical condition who need this type of hospital treatment.
- The bill creates a new “high acuity” test for long-term care hospital discharges.
- A discharge would qualify if it is placed in a Medicare severity long-term care diagnosis-related group with a relative weight of at least 0.8.
- This new rule would apply only to discharges on or after October 1, 2026.
- The bill also updates existing Medicare language so this new high acuity test is treated like the current exceptions for site-neutral payments.
Official Summaries
Securing Access to Care for Seniors in Critical Condition Act of 2025
This bill exempts discharges from long-term care hospitals (LTCHs) from the Medicare site-neutral payment rate if the discharge meets specified high acuity criteria and occurs on or after October 1, 2026. (The site-neutral rate is the lower of Medicare’s acute care hospital payment rate under the inpatient prospective payment system or 100% of the cost of the stay. LTCH stays that do not qualify for the specialized LTCH payment rate under Medicare are instead paid at the site-neutral rate.)
Current Full Text
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1924 Introduced in House (IH)]
<DOC>
119th CONGRESS
1st Session
H. R. 1924
To amend title XVIII of the Social Security Act to establish a new
criterion for the nonapplication of site-neutral payments to long-term
care hospitals under the Medicare program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 6, 2025
Mr. Hern of Oklahoma (for himself, Mr. Boyle of Pennsylvania, Mr. Joyce
of Pennsylvania, Mrs. Miller of West Virginia, Mr. Smucker, and Ms.
Tenney) introduced the following bill; which was referred to the
Committee on Ways and Means
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to establish a new
criterion for the nonapplication of site-neutral payments to long-term
care hospitals under the Medicare program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Securing Access to Care for Seniors
in Critical Condition Act of 2025''.
SEC. 2. ESTABLISHING A NEW CRITERION FOR THE NONAPPLICATION OF SITE-
NEUTRAL PAYMENTS TO LONG-TERM CARE HOSPITALS UNDER THE
MEDICARE PROGRAM.
Section 1886(m)(6)(A) of the Social Security Act (42 U.S.C.
1395ww(m)(6)(A)) is amended--
(1) in clause (ii)(I), by striking ``or the ventilator
criterion under clause (iv)'' and inserting ``, the ventilator
criterion under clause (iv), or the high acuity criterion
described in clause (v)''; and
(2) by adding at the end the following new clause:
``(v) High acuity criterion.--The criterion
specified in this clause (in this paragraph
referred to as the `high acuity criterion') for
a discharge from a long-term care hospital in a
fiscal year is that--
``(I) the discharge was assigned to
a Medicare-Severity-Long-Term-Care-
Diagnosis-Related-Group (MS-LTC-DRG)
with a relative weight for such fiscal
year that was equal to or greater than
0.8; and
``(II) the discharge occurred on or
after October 1, 2026.''.
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