This bill amends Medicare's payment rules for long-term care hospitals by creating a new exception to site-neutral payments for patients with high-acuity medical conditions. Under current law, Medicare pays long-term care hospitals the same rates as other facilities for most patients, but this bill adds a new "high acuity criterion" that would exempt certain critically ill patients from these standardized payments. Specifically, patients assigned to high-complexity diagnosis-related groups with a relative weight of 0.8 or higher would qualify for the exemption, allowing these hospitals to receive higher payments for treating the most severely ill seniors. The new criterion would take effect on October 1, 2025. This change primarily affects long-term care hospitals and the Medicare seniors they serve who require extended hospitalization for serious conditions like ventilator dependence or other complex medical needs.
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