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
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.
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.