[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9272 Introduced in House (IH)]

<DOC>






118th CONGRESS
  2d Session
                                H. R. 9272

   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 HOUSE OF REPRESENTATIVES

                             August 2, 2024

Mr. Loudermilk (for himself, Ms. DeGette, Mr. Crow, and Ms. Williams of 
   Georgia) 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 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 2024''.

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) A specialty designation by 
                                an accrediting organization such as 
                                Magnet, the Joint Commission, the 
                                Commission on Accreditation of 
                                Rehabilitation Facilities (commonly 
                                referred to as `CARF'), or other 
                                specialty association, or 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 report 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>