Adjusting long-term care hospital payment rates under the Medicare program

(a)

Extension of site neutral payment reductions

Section 1886(m)(6)(B)(iv) of the Social Security Act (42 U.S.C. 1395ww(m)(6)(B)(iv)) is amended by striking 2026 and inserting 2032. (b)

Modification of criteria for nonapplication of site neutral payment rate

(1)

Addition of high acuity criterion

Section 1886(m)(6)(A) of the Social Security Act (42 U.S.C. 1395ww(m)(6)(A)) is amended— (A)in clause (ii)(I), by striking or the ventilator criterion under clause (iv) and inserting , the ventilator criterion under clause (iv), or the high acuity criterion described in clause (v); and (B)by adding at the end the following new clause:

(v)

High acuity criterion

(I)

In general

The criterion specified in this clause (in this paragraph referred to as the high acuity criterion) for a discharge from a long-term care hospital in a fiscal year is that— (aa)the stay in the long-term care hospital ending with such discharge was immediately preceded by a discharge from a stay in a subsection (d) hospital or a stay in a critical access hospital; (bb) the individual discharged was assigned to a Medicare-Severity-Long-Term-Care-Diagnosis-Related-Group (MS-LTC-DRG) that was a specified MS-LTC-DRG (as described in subclause (II)) with respect to such fiscal year; (cc)the discharge was from a long-term care hospital— (AA)that enrolled under this title as such a hospital before the date of the enactment of this clause; (BB)whose qualifying period (as described in section 412.23(e)(4)(iv) of title 42, Code of Federal Regulations (or a successor regulation)) began before such date; (CC)that met the mid-build requirements described in subclause (III); or (DD)that had obtained an approved certificate of need from the State in which such hospital is located before such date, if required by State law; and (dd)the discharge occurred on or after October 1, 2026. (II)

Specified MS-LTC-DRG defined

For purposes of subclause subclause (I)(bb), the term specified MS-LTC-DRG means, with respect to a fiscal year, an MS-LTC-DRG— (aa) with a relative weight of 0.8 or greater; and (bb) that is not assigned on the basis of the receipt of ventilator services of at least 96 hours. (III)

Mid-build requirements described

For purposes of subclause (I)(cc), the mid-build requirements described in this clause are, with respect to a long-term care hospital, that— (aa)such hospital had a binding written agreement with an outside, unrelated party for the actual construction, renovation, lease, or demolition of such hospital in effect as of the date of the enactment of this clause and, prior to such date, had expended at least 10 percent (or, if less, $2,500,000) of the estimated cost of such construction, renovation, lease, or demolition; and (bb)the Secretary receives, not later than 60 days after such date, from the chief executive officer or chief operating officer of such hospital a written certification that the hospital met the requirement under item (aa).

(2)

Modification of ICU and ventilator criteria

Section 1886(m)(6)(A) of the Social Security Act (42 U.S.C. 1395ww(m)(6)(A)) is amended— (A)in clause (iii)(I), by inserting or, with respect to discharges from a long-term care hospital occurring on or after October 1, 2026, by a discharge from a stay in such a hospital or a stay in a critical access hospital, after in a subsection (d) hospital; and (B)in clause (iv)(I), by inserting or, with respect to discharges from a long-term care hospital occurring on or after October 1, 2026, by a discharge from a stay in such a hospital or a stay in a critical access hospital after in a subsection (d) hospital.