This bill modifies how Medicare pays long-term care hospitals (LTCHs), which provide extended care for seriously ill or injured patients. The legislation aims to improve payment accuracy by capping increases to the "fixed loss amount" used in payment calculations at $50,000 for fiscal years 2025-2026 and limiting future increases to 110 percent annually, while also creating new payment adjustments starting October 1, 2025, to provide higher reimbursement rates for patients with multiple serious health complications. Additionally, the bill expands protections for patients with complex conditions like severe wounds, respiratory failure, sepsis, or COVID-19, ensuring they can receive LTCH care even if they would normally not qualify under current Medicare rules. The bill directs the Secretary of Health and Human Services to monitor how coding changes affect spending through 2030 and make permanent or temporary adjustments as needed, explicitly allowing these payments to occur outside budget-neutral requirements. Overall, the legislation affects Medicare beneficiaries receiving long-term care and the hospitals that serve them by making payments more reflective of the complexity and costs of treating high-acuity patients.
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