[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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