Referred to the House Committee on Ways and Means.
This bill amends section 1886(m)(6)(A) of the Social Security Act to add a new "high acuity" exemption from site-neutral payment rules for long-term care hospitals (LTCHs). A discharge meets the high acuity criterion if it is assigned to an MS-LTC-DRG with a relative weight of at least 0.8 and occurs on or after October 1, 2026.
Liberal emphasizes access plus safeguards; conservatives emphasize provider relief and access.
Relative to its intended legislative type, this bill is a narrowly scoped substantive policy change that precisely amends the Medicare payment statute to add a defined 'high acuity' exception for long-term care hospitals, including a numeric threshold and an effective date.
This bill amends section 1886(m)(6)(A) of the Social Security Act to add a new "high acuity" exemption from site-neutral payment rules for long-term care hospitals (LTCHs).
A discharge meets the high acuity criterion if it is assigned to an MS-LTC-DRG with a relative weight of at least 0.8 and occurs on or after October 1, 2026.
The change adds this criterion alongside existing ventilator and other criteria to determine when higher LTCH Medicare payments apply.
Technocratic and narrow, improving chances, but likely increases Medicare outlays without offsets and would face scrutiny in Senate and budget review.
Relative to its intended legislative type, this bill is a narrowly scoped substantive policy change that precisely amends the Medicare payment statute to add a defined 'high acuity' exception for long-term care hospitals, including a numeric threshold and an effective date.
Liberal emphasizes access plus safeguards; conservatives emphasize provider relief and access.
These are examples from the analysis, not a ranked list of the most-affected groups.
Liberal emphasizes access plus safeguards; conservatives emphasize provider relief and access.
Likely cautiously supportive because it protects access for seniors with complex care needs, but concerned about added Medicare spending and weak safeguards.
Would want monitoring, reporting, and anti-upcoding measures to ensure funds reach genuinely high-acuity patients.
Generally receptive if narrowly targeted and evidence-driven; sees an objective MS-LTC-DRG threshold as administrable.
Wants CBO scoring, oversight, and sunset/pilot language to balance access and fiscal responsibility.
Likely supportive because it restores higher Medicare payments for high-cost LTCH patients and protects provider viability and access, especially in rural areas.
Some conservatives may nonetheless want safeguards against unnecessary spending or fraud.
Reached or meaningfully advanced
Reached or meaningfully advanced
Still ahead
Still ahead
Still ahead
Technocratic and narrow, improving chances, but likely increases Medicare outlays without offsets and would face scrutiny in Senate and budget review.
The bill has not accumulated any surfaced votes yet.
Liberal emphasizes access plus safeguards; conservatives emphasize provider relief and access.
Technocratic and narrow, improving chances, but likely increases Medicare outlays without offsets and would face scrutiny in Senate and bud…
Relative to its intended legislative type, this bill is a narrowly scoped substantive policy change that precisely amends the Medicare payment statute to add a defined 'high acuity' exception for long-term care hospital…
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