Section 1 Short title
This Act may be cited as the “Securing Access to Care for Seniors in Critical Condition Act of 2022”.
Securing Access to Care for Seniors in Critical Condition Act of 2022
A BILL
To amend title XVIII of the Social Security Act to establish a new criterion for the nonapplication of site-neutral payments to long-term care hospitals under the Medicare program.
Sec. 2 Establishing a new criterion for the nonapplication of site-neutral payments to long-term care hospitals under the Medicare program
Section 1886(m)(6)(A) of the Social Security Act (42 U.S.C. 1395ww(m)(6)(A)) is amended—
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
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 individual discharged had a primary diagnosis assigned to a Medicare-Severity-Long-Term-Care-Diagnosis-Related-Group (MS–LTC–DRG) with a relative weight for such fiscal year that was equal to or greater than the specified amount for such fiscal year; and
“(bb) the discharge occurred on or after October 1, 2025.
“(II) Specified amount defined—For purposes of subclause (I), the term “specified amount” means, with respect to a fiscal year, an amount equal to the 80th percentile of the relative weights for Medicare-Severity-Long-Term-Care-Diagnosis-Related-Groups that were assigned to primary diagnoses for all discharges occurring in the preceding fiscal year.”