[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 2628 Introduced in Senate (IS)]
<DOC>
119th CONGRESS
1st Session
S. 2628
To amend title XVIII of the Social Security Act to establish new
payment rules for certain catastrophic specialty hospitals under the
Medicare program.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 31, 2025
Mr. Warnock (for himself and Mr. Wicker) introduced the following bill;
which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to establish new
payment rules for certain catastrophic specialty 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 ``Catastrophic Specialty Hospital Act
of 2025''.
SEC. 2. ESTABLISHING NEW PAYMENT RULES FOR CERTAIN CATASTROPHIC
SPECIALTY HOSPITALS UNDER THE MEDICARE PROGRAM.
Section 1886(m) of the Social Security Act (42 U.S.C. 1395ww(m)) is
amended--
(1) in paragraph (6)(A)(i), by inserting ``and paragraph
(8)'' after ``and (G)''; and
(2) by adding at the end the following new paragraph:
``(8) Treatment of certain catastrophic specialty
hospitals.--
``(A) In general.--Notwithstanding section 123 of
the Medicare, Medicaid, and SCHIP Balanced Budget
Refinement Act of 1999 and section 307(b) of the
Medicare, Medicaid, and SCHIP Benefits Improvement and
Protection Act of 2000, for cost reporting periods
beginning on or after the date of the enactment of this
subparagraph, the system described in paragraph (1)
shall not apply and payment shall be made to a long-
term care hospital without regard to such system and
without regard to paragraph (6) if such long-term care
hospital is designated as a catastrophic specialty
hospital under subparagraph (B) with respect to such
period.
``(B) Designation.--The Secretary shall designate a
long-term care hospital as a catastrophic specialty
hospital with respect to a cost reporting period if
such long-term care hospital meets the following
criteria:
``(i) Of the discharges from the hospital
during each cost reporting period occurring
during the 3-year period ending on the day
before the first day of the cost reporting
period for which such hospital seeks such
designation, including discharges of
individuals not entitled to benefits under part
A, at least 80 percent were classified under an
MS-LTCH-DRG relating to spinal cord injury or
acquired brain injury (as specified by the
Secretary) or would have been so classified had
such individual been entitled to such benefits.
``(ii) The hospital offered a continuum of
care during such 3-year period that included
inpatient care, outpatient care, and a focus on
long-term health and wellness for individuals
with spinal cord injuries or acquired brain
injuries.
``(iii) The hospital had, for the 1-year
period beginning on the first day of such 3-
year period and for each subsequent 1-year
period occurring during such 3-year period--
``(I) at least 175 discharges of
individuals (including individuals not
entitled to benefits under part A)
classified under an MS-LTCH-DRG
relating to spinal cord injury (as
specified by the Secretary) or that
would have been so classified had such
individual been so entitled to such
benefits; and
``(II) at least 175 discharges of
individuals (including individuals not
entitled to benefits under part A)
classified under an MS-LTCH-DRG
relating to acquired brain injury (as
specified by the Secretary) or that
would have been so classified had such
individual been so entitled to such
benefits.
``(iv) At least 30 percent of inpatients
discharged from the hospital during each cost
reporting period occurring during such 3-year
period (including both individuals entitled to,
or enrolled for, benefits under this title and
individuals not so entitled or enrolled) were
admitted from outside of the State in which
such hospital is located, as determined by the
States of residency of such inpatients and
based on such data submitted by the hospital to
the Secretary as the Secretary may require.
``(v) The hospital has exhibited, during
such 3-year period, commitment to
neurorehabilitation research in specialty
areas, as evidenced by one or more (as
determined appropriate by the Secretary) of the
following:
``(I) Employment of full-time
dedicated neurorehabilitation research
personnel who are primarily focused on
spinal cord injury or acquired brain
injury neurorehabilitation.
``(II) Contributions to the field
of neurorehabilitation via publications
of such personnel in peer reviewed
journals in the areas of the
neurorehabilitation of spinal cord
injuries, acquired brain injuries, and
other paralyzing neuromuscular
conditions.
``(III) The maintenance of a
clinical training program providing
fellowships, residencies, or Master of
Public Health programs with a focus on
acquired brain injury or spinal cord
injury.
``(IV) Maintenance of an approved
medical residency training program (or
affiliation with such a program) in
neurology or physical medicine and
rehabilitation.
``(C) Length of designation.--
``(i) In general.--A designation made by
the Secretary under subparagraph (B) (or a
redesignation made by the Secretary under
clause (ii)) with respect to a hospital and a
cost reporting period (referred to in this
clause as the `initial cost reporting period')
shall be effective for such initial cost
reporting period and each succeeding cost
reporting period occurring during the 3-year
period beginning on the first day of such
initial cost reporting period.
``(ii) Redesignation.--The Secretary shall,
for the first cost reporting in which a
designation (or redesignation) of a hospital as
a catastrophic specialty hospital is due to
expire under clause (i), determine whether such
hospital continues to meet the criteria
specified in subparagraph (B) for such cost
reporting period. If the Secretary determines
that such hospital does continue to meet such
criteria for such cost reporting period, the
Secretary shall redesignate such hospital as a
catastrophic specialty hospital. If the
Secretary determines that such hospital does
not continue to meet such criteria for such
cost reporting period, the Secretary shall--
``(I) provide such hospital 60 days
to submit additional information
demonstrating such hospital's
compliance with such criteria; and
``(II) if such hospital fails to
make such demonstration, allow such
designation to expire as of the first
day of such cost reporting period.''.
<all>