I 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Catastrophic Specialty 

5 Hospital Act of 2024’’. 


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1 SEC. 2. ESTABLISHING NEW PAYMENT RULES FOR CERTAIN 

2 CATASTROPHIC SPECIALTY HOSPITALS 

3 UNDER THE MEDICARE PROGRAM. 

4 Section 1886(m) of the Social Security Act (42 

5 U.S.C. 1395ww(m)) is amended— 

6 (1) in paragraph (6)(A)(i), by inserting ‘‘and 

7 paragraph (8)’’ after ‘‘and (G)’’; and 

8 (2) by adding at the end the following new 

9 paragraph: 

10 ‘‘(8) TREATMENT OF CERTAIN CATASTROPHIC

11 SPECIALTY HOSPITALS.— 

12 ‘‘(A) IN GENERAL.—Notwithstanding sec13 tion 123 of the Medicare, Medicaid, and SCHIP 

14 Balanced Budget Refinement Act of 1999 and 

15 section 307(b) of the Medicare, Medicaid, and 

16 SCHIP Benefits Improvement and Protection 

17 Act of 2000, for cost reporting periods begin18 ning on or after the date of the enactment of 

19 this subparagraph, the system described in 

20 paragraph (1) shall not apply (and payment 

21 shall be made to a long-term care hospital with22 out regard to such system and without regard 

23 to paragraph (6)) if such long-term care hos24 pital is designated as a catastrophic specialty 

25 hospital under subparagraph (B) with respect 

26 to such period. 


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1 ‘‘(B) DESIGNATION.—The Secretary shall 

2 designate a long-term care hospital as a cata3 strophic specialty hospital with respect to a cost 

4 reporting period if such long-term care hospital 

5 meets the following criteria: 

6 ‘‘(i) Of the discharges from the hos7 pital during each cost reporting period oc8 curring during the 3-year period ending on 

9 the day before the first day of the cost re10 porting period for which such hospital 

11 seeks such designation, including dis12 charges of individuals not entitled to bene13 fits under part A, at least 80 percent were 

14 classified under an MS–LTCH–DRG relat15 ing to spinal cord injury or acquired brain 

16 injury (as specified by the Secretary) or 

17 would have been so classified had such in18 dividual been entitled to such benefits. 

19 ‘‘(ii) The hospital offered a continuum 

20 of care during such 3-year period that in21 cluded inpatient care, outpatient care, and 

22 a focus on long-term health and wellness 

23 for individuals with spinal cord injuries or 

24 acquired brain injuries. 


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1 ‘‘(iii) The hospital had, for the 1-year 

2 period beginning on the first day of such 

3 3-year period and for each subsequent 1- 

4 year period occurring during such 3-year 

5 period— 

6 ‘‘(I) at least 175 discharges of 

7 individuals (including individuals not 

8 entitled to benefits under part A) clas9 sified under an MS–LTCH–DRG re10 lating to spinal cord injury (as speci11 fied by the Secretary) or that would 

12 have been so classified had such indi13 vidual been so entitled to such bene14 fits; and 

15 ‘‘(II) at least 175 discharges of 

16 individuals (including individuals not 

17 entitled to benefits under part A) clas18 sified under an MS–LTCH–DRG re19 lating to acquired brain injury (as 

20 specified by the Secretary) or that 

21 would have been so classified had such 

22 individual been so entitled to such 

23 benefits. 

24 ‘‘(iv) At least 30 percent of inpatients 

25 discharged from the hospital during each 


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1 cost reporting period occurring during such 

2 3-year period (including both individuals 

3 entitled to, or enrolled for, benefits under 

4 this title and individuals not so entitled or 

5 enrolled) were admitted from outside of the 

6 State in which such hospital is located, as 

7 determined by the States of residency of 

8 such inpatients and based on such data 

9 submitted by the hospital to the Secretary 

10 as the Secretary may require. 

11 ‘‘(v) The hospital has exhibited, dur12 ing such 3-year period, commitment to 

13 neurorehabilitation research in specialty 

14 areas, as evidenced by one or more (as de15 termined appropriate by the Secretary) of 

16 the following: 

17 ‘‘(I) Employment of full-time 

18 dedicated neurorehabilitation research 

19 personnel who are primarily focused 

20 on spinal cord injury or acquired 

21 brain injury neurorehabilitation. 

22 ‘‘(II) Contributions to the field of 

23 neurorehabilitation via publications of 

24 such personnel in peer reviewed jour25 nals in the areas of the 


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1 neurorehabilitation of spinal cord in2 juries, acquired brain injuries, and 

3 other paralyzing neuromuscular condi4 tions. 

5 ‘‘(III) A specialty designation by 

6 an accrediting organization such as 

7 Magnet, the Joint Commission, the 

8 Commission on Accreditation of Reha9 bilitation Facilities (commonly re10 ferred to as ‘CARF’), or other spe11 cialty association, or the maintenance 

12 of a clinical training program pro13 viding fellowships, residencies, or 

14 Master of Public Health programs 

15 with a focus on acquired brain injury 

16 or spinal cord injury. 

17 ‘‘(IV) Maintenance of an ap18 proved medical residency training pro19 gram (or affiliation with such a pro20 gram) in neurology or physical medi21 cine and rehabilitation. 

22 ‘‘(C) LENGTH OF DESIGNATION.— 

23 ‘‘(i) IN GENERAL.—A designation 

24 made by the Secretary under subparagraph 

25 (B) (or a redesignation made by the SecVerDate Sep 11 2014 06:14 Sep 05, 2024 Jkt 049200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H9272.IH H9272

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1 retary under clause (ii)) with respect to a 

2 hospital and a cost report period (referred 

3 to in this clause as the ‘initial cost report4 ing period’) shall be effective for such ini5 tial cost reporting period and each suc6 ceeding cost reporting period occurring 

7 during the 3-year period beginning on the 

8 first day of such initial cost reporting pe9 riod. 

10 ‘‘(ii) REDESIGNATION.—The Sec11 retary shall, for the first cost reporting in 

12 which a designation (or redesignation) of a 

13 hospital as a catastrophic specialty hospital 

14 is due to expire under clause (i), determine 

15 whether such hospital continues to meet 

16 the criteria specified in subparagraph (B) 

17 for such cost reporting period. If the Sec18 retary determines that such hospital does 

19 continue to meet such criteria for such cost 

20 reporting period, the Secretary shall redes21 ignate such hospital as a catastrophic spe22 cialty hospital. If the Secretary determines 

23 that such hospital does not continue to 

24 meet such criteria for such cost reporting 

25 period, the Secretary shall— 


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1 ‘‘(I) provide such hospital 60 

2 days to submit additional information 

3 demonstrating such hospital’s compli4 ance with such criteria; and 

5 ‘‘(II) if such hospital fails to 

6 make such demonstration, allow such 

7 designation to expire as of the first 

8 day of such cost reporting period.’’. 

Æ 


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