Section 1 Short title
This Act may be cited as the “Long Term Care Stabilization Act”.
Long Term Care Stabilization Act
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.
Sec. 2 Temporary cap on fixed loss amount for setting payments for high-cost long-term care hospital patients
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—
by redesignating subparagraphs (C) and (D) as subparagraph (D) and (E), respectively;
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.”
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)”.
Study and report on high cost outlier payments to long-Term care hospitals—
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:
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.
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.
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.
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.
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.
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)).
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
in subparagraph (A)(i), by striking “and (G)” and inserting “(G), and (H)”; and
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.”
Study and report on an exception to the long-Term care hospital site neutral payment rate for certain severe wound discharges—
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:
The costs and benefits of the severe wound temporary exception, including the impact on patient outcomes and hospital readmissions for patients with severe wounds.
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)).
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.
Potential savings to the program under title XVIII of the Social Security Act that may result from making permanent the severe wound temporary exception.
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.
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.
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.