[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9173 Introduced in House (IH)]
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118th CONGRESS
2d Session
H. R. 9173
To amend title XVIII of the Social Security Act to stabilize payments
to long-term care hospitals under the Medicare program and improve
patient access.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 25, 2024
Mr. Smucker (for himself, Mr. Boyle of Pennsylvania, and Mr. Joyce of
Pennsylvania) 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 stabilize payments
to long-term care hospitals under the Medicare program and improve
patient access.
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 ``Long Term Care Stabilization Act''.
SEC. 2. TEMPORARY CAP ON FIXED LOSS AMOUNT FOR SETTING PAYMENTS FOR
HIGH-COST LONG-TERM CARE HOSPITAL PATIENTS.
(a) Medicare High Cost Outlier Payments to Long-Term Care
Hospitals.--Section 1886(m)(7) of the Social Security Act (42 U.S.C.
1395ww(m)(7)) is amended--
(1) by redesignating subparagraphs (C) and (D) as
subparagraph (D) and (E), respectively;
(2) by inserting after subparagraph (B) the following new
subparagraph:
``(C) Temporary cap on fixed loss amount.--
Notwithstanding subparagraphs (A) and (B), the fixed
loss amount for high cost outlier payments made for
standard Federal payment rate discharges in fiscal
years 2025 and 2026 may not exceed $50,000.''; and
(3) in subparagraph (D), as so redesignated by paragraph
(1), by inserting ``, and any increase in payments resulting
from the application of subparagraph (C),'' after
``subparagraph (B)''.
(b) Study and Report on High Cost Outlier Payments to Long-Term
Care Hospitals.--
(1) Study.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall conduct a
study on the current methodology for making high cost outlier
payments to long-term care hospitals under the payment system
described in section 1886(m)(l) of the Social Security Act (42
U.S.C. 1395ww(m)(1)). Such study shall include an analysis of
the following:
(A) Potential legislative changes to reform the
methodology for making high cost outlier payments to
long-term care hospitals to ensure that such hospitals
are incentivized to treat Medicare beneficiaries with
high resource needs.
(B) The effect of the site neutral payment rate and
patient criteria under section l886(m)(6) of the Social
Security Act (42 U.S.C. 1395ww(m)(6)) on the data that
the Secretary uses to calculate the fixed loss amount
for high cost outlier payments to long-term care
hospitals.
(C) The changes to long-term care hospital
utilization during the COVID-19 pandemic and the impact
that such changes had on the data that the Secretary
uses to calculate the fixed loss amount for high cost
outlier payments to long-term care hospitals.
(D) The effect of inflation and increasing labor
costs on the data that the Secretary uses to calculate
the fixed loss amount for high cost outlier payments to
long-term care hospitals.
(E) The harms to long-term care hospitals and
beneficiaries, including patient access to care, as a
result of the increases to the fixed loss amounts
adopted by the Secretary in fiscal years 2023 and 2024.
(F) The potential benefits to long-term care
hospitals and beneficiaries that may result from
increasing the 99.6875 percent of 8 percent target for
high cost outlier payments set by section 1886(m)(7)(B)
of the Social Security Act (42 U.S.C. 1395ww(m)(7)(B)).
(2) Report.--Not later than 1 year after the date of the
enactment of this Act, the Secretary shall submit to Congress a
report on the study conducted under paragraph (1), including
recommendations on changes to the methodology for making high
cost outlier payments to longterm care hospitals under the
payment system described in section 1886(m)(l) of the Social
Security Act (42 U.S.C. 1395ww(m)(1)).
SEC. 3. TEMPORARY PAYMENT AT THE STANDARD FEDERAL RATE FOR CERTAIN
LONG-TERM CARE HOSPITAL DISCHARGES WITH SEVERE WOUNDS.
(a) In General.--Section 1886(m)(6) of the Social Security Act (42
U.S.C. 1395ww(m)(6)) is amended--
(1) in subparagraph (A)(i), by striking ``and (G)'' and
inserting ``(G), and (H)''; and
(2) by adding at the end the following new subparagraph:
``(H) Temporary exception for certain severe wound
discharges from long-term care hospitals in fiscal
years 2025 through 2027.--
``(i) In general.--For a discharge in a
cost reporting period beginning on or after
October 1, 2024, and before October 1, 2027,
subparagraph (A)(i) shall not apply (and
payment shall be made to a long-term care
hospital without regard to this paragraph) if
such discharge is with respect to an individual
treated by a long-term care hospital for a
severe wound.
``(ii) Severe wound defined.--In this
subparagraph, the term `severe wound' means a
stage 3 wound, stage 4 wound, unstageable
wound, non-healing surgical wound, infected
wound, fistula, osteomyelitis, or a wound with
morbid obesity, as identified by the applicable
code on the claim from the long-term care
hospital.
``(iii) Wound defined.--In this
subparagraph, the term `wound' means an injury
involving division of tissue or rupture or the
integument or mucous membrane with exposure to
the external environment.''.
(b) Study and Report on an Exception to the Long-Term Care Hospital
Site Neutral Payment Rate for Certain Severe Wound Discharges.--
(1) Study.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall conduct a
study that examines whether the temporary exception to the site
neutral payment rate for long-term care hospitals for certain
severe wound discharges under section 1886(m)(6)(H) of the
Social Security Act, as added by subsection (a)(2) (in this
paragraph referred to as the ``severe wound temporary
exception''), should be made permanent. Such report shall
include an analysis of the following:
(A) The costs and benefits of the severe wound
temporary exception, including the impact on patient
outcomes and hospital readmissions for patients with
severe wounds.
(B) A minimum of 18 months of claims data to
determine how the severe wound temporary exception
affects payments to long-term care hospitals under the
payment system described in section 1886(m)(l) of the
Social Security Act (42 U.S.C. 1395ww(m)(1)).
(C) Taking into account data collected before the
effective date of the severe wound temporary exception
and during the period when such exception is in effect,
the impact of the severe wound temporary exception on
the costs of an episode of care for patients with
qualifying severe wounds treated in long-term care
hospitals, including the difference in costs of severe
wound patient episodes of care that include admissions
to long-term care hospitals pursuant to a severe wound
temporary exception compared to similar episodes of
care for patients with severe wounds who are not
admitted to long-term care hospitals.
(D) Potential savings to the program under title
XVIII of the Social Security Act that may result from
making permanent the severe wound temporary exception.
(E) A review of comments and other feedback that
the Secretary shall obtain from long-term care
hospitals and other stakeholders pursuant to a request
for information published in the Federal Register
regarding the severe wound temporary exception and the
beneficiaries who are treated in long-term care
hospitals pursuant to such exception.
(2) Report.--Not later than October 1, 2026, the Secretary
shall submit to Congress a report on the study conducted under
paragraph (1), including a recommendation on whether the severe
wound temporary exception should be made permanent.
(3) Definition.--For purposes of this subsection, the term
``episode of care'' means the length of stay of the applicable
beneficiary in the longterm care hospital or subsection (d)
hospital, plus the 90 days following the discharge of the
beneficiary from the hospital.
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