I 

118TH CONGRESS 

2D SESSION H. R. 9173 

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. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 25, 2024 

Mr. SMUCKER (for himself, Mr. BOYLE of Pennsylvania, and Mr. JOYCE of 

Pennsylvania) 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 stabilize 

payments to long-term care hospitals under the Medicare 

program and improve patient access. 

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 ‘‘Long Term Care Sta5 bilization Act’’. 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
2 

•HR 9173 IH

1 SEC. 2. TEMPORARY CAP ON FIXED LOSS AMOUNT FOR 

2 SETTING PAYMENTS FOR HIGH-COST LONG3 TERM CARE HOSPITAL PATIENTS. 

4 (a) MEDICARE HIGH COST OUTLIER PAYMENTS TO

5 LONG-TERM CARE HOSPITALS.—Section 1886(m)(7) of 

6 the Social Security Act (42 U.S.C. 1395ww(m)(7)) is 

7 amended— 

8 (1) by redesignating subparagraphs (C) and 

9 (D) as subparagraph (D) and (E), respectively; 

10 (2) by inserting after subparagraph (B) the fol11 lowing new subparagraph: 

12 ‘‘(C) TEMPORARY CAP ON FIXED LOSS

13 AMOUNT.—Notwithstanding subparagraphs (A) 

14 and (B), the fixed loss amount for high cost 

15 outlier payments made for standard Federal 

16 payment rate discharges in fiscal years 2025 

17 and 2026 may not exceed $50,000.’’; and 

18 (3) in subparagraph (D), as so redesignated by 

19 paragraph (1), by inserting ‘‘, and any increase in 

20 payments resulting from the application of subpara21 graph (C),’’ after ‘‘subparagraph (B)’’. 

22 (b) STUDY AND REPORT ON HIGH COST OUTLIER

23 PAYMENTS TO LONG-TERM CARE HOSPITALS.— 

24 (1) STUDY.—The Secretary of Health and 

25 Human Services (in this section referred to as the 

26 ‘‘Secretary’’) shall conduct a study on the current 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
3 

•HR 9173 IH

1 methodology for making high cost outlier payments 

2 to long-term care hospitals under the payment sys3 tem described in section 1886(m)(l) of the Social Se4 curity Act (42 U.S.C. 1395ww(m)(1)). Such study 

5 shall include an analysis of the following: 

6 (A) Potential legislative changes to reform 

7 the methodology for making high cost outlier 

8 payments to long-term care hospitals to ensure 

9 that such hospitals are incentivized to treat 

10 Medicare beneficiaries with high resource needs. 

11 (B) The effect of the site neutral payment 

12 rate and patient criteria under section 

13 l886(m)(6) of the Social Security Act (42 

14 U.S.C. 1395ww(m)(6)) on the data that the 

15 Secretary uses to calculate the fixed loss 

16 amount for high cost outlier payments to long17 term care hospitals. 

18 (C) The changes to long-term care hospital 

19 utilization during the COVID–19 pandemic and 

20 the impact that such changes had on the data 

21 that the Secretary uses to calculate the fixed 

22 loss amount for high cost outlier payments to 

23 long-term care hospitals. 

24 (D) The effect of inflation and increasing 

25 labor costs on the data that the Secretary uses 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
4 

•HR 9173 IH

1 to calculate the fixed loss amount for high cost 

2 outlier payments to long-term care hospitals. 

3 (E) The harms to long-term care hospitals 

4 and beneficiaries, including patient access to 

5 care, as a result of the increases to the fixed 

6 loss amounts adopted by the Secretary in fiscal 

7 years 2023 and 2024. 

8 (F) The potential benefits to long-term 

9 care hospitals and beneficiaries that may result 

10 from increasing the 99.6875 percent of 8 per11 cent target for high cost outlier payments set 

12 by section 1886(m)(7)(B) of the Social Security 

13 Act (42 U.S.C. 1395ww(m)(7)(B)). 

14 (2) REPORT.—Not later than 1 year after the 

15 date of the enactment of this Act, the Secretary 

16 shall submit to Congress a report on the study con17 ducted under paragraph (1), including recommenda18 tions on changes to the methodology for making 

19 high cost outlier payments to longterm care hos20 pitals under the payment system described in section 

21 1886(m)(l) of the Social Security Act (42 U.S.C. 

22 1395ww(m)(1)). 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
5 

•HR 9173 IH

1 SEC. 3. TEMPORARY PAYMENT AT THE STANDARD FED2 ERAL RATE FOR CERTAIN LONG-TERM CARE 

3 HOSPITAL DISCHARGES WITH SEVERE 

4 WOUNDS. 

5 (a) IN GENERAL.—Section 1886(m)(6) of the Social 

6 Security Act (42 U.S.C. 1395ww(m)(6)) is amended— 

7 (1) in subparagraph (A)(i), by striking ‘‘and 

8 (G)’’ and inserting ‘‘(G), and (H)’’; and 

9 (2) by adding at the end the following new sub10 paragraph: 

11 ‘‘(H) TEMPORARY EXCEPTION FOR CER12 TAIN SEVERE WOUND DISCHARGES FROM LONG13 TERM CARE HOSPITALS IN FISCAL YEARS 2025

14 THROUGH 2027.— 

15 ‘‘(i) IN GENERAL.—For a discharge in 

16 a cost reporting period beginning on or 

17 after October 1, 2024, and before October 

18 1, 2027, subparagraph (A)(i) shall not 

19 apply (and payment shall be made to a 

20 long-term care hospital without regard to 

21 this paragraph) if such discharge is with 

22 respect to an individual treated by a long23 term care hospital for a severe wound. 

24 ‘‘(ii) SEVERE WOUND DEFINED.—In 

25 this subparagraph, the term ‘severe wound’ 

26 means a stage 3 wound, stage 4 wound, 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
6 

•HR 9173 IH

1 unstageable wound, non-healing surgical 

2 wound, infected wound, fistula, osteomy3 elitis, or a wound with morbid obesity, as 

4 identified by the applicable code on the 

5 claim from the long-term care hospital. 

6 ‘‘(iii) WOUND DEFINED.—In this sub7 paragraph, the term ‘wound’ means an in8 jury involving division of tissue or rupture 

9 or the integument or mucous membrane 

10 with exposure to the external environ11 ment.’’. 

12 (b) STUDY AND REPORT ON AN EXCEPTION TO THE

13 LONG-TERM CARE HOSPITAL SITE NEUTRAL PAYMENT

14 RATE FOR CERTAIN SEVERE WOUND DISCHARGES.— 

15 (1) STUDY.—The Secretary of Health and 

16 Human Services (in this section referred to as the 

17 ‘‘Secretary’’) shall conduct a study that examines 

18 whether the temporary exception to the site neutral 

19 payment rate for long-term care hospitals for certain 

20 severe wound discharges under section 

21 1886(m)(6)(H) of the Social Security Act, as added 

22 by subsection (a)(2) (in this paragraph referred to 

23 as the ‘‘severe wound temporary exception’’), should 

24 be made permanent. Such report shall include an 

25 analysis of the following: 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
7 

•HR 9173 IH

1 (A) The costs and benefits of the severe 

2 wound temporary exception, including the im3 pact on patient outcomes and hospital readmis4 sions for patients with severe wounds. 

5 (B) A minimum of 18 months of claims 

6 data to determine how the severe wound tem7 porary exception affects payments to long-term 

8 care hospitals under the payment system de9 scribed in section 1886(m)(l) of the Social Se10 curity Act (42 U.S.C. 1395ww(m)(1)). 

11 (C) Taking into account data collected be12 fore the effective date of the severe wound tem13 porary exception and during the period when 

14 such exception is in effect, the impact of the se15 vere wound temporary exception on the costs of 

16 an episode of care for patients with qualifying 

17 severe wounds treated in long-term care hos18 pitals, including the difference in costs of severe 

19 wound patient episodes of care that include ad20 missions to long-term care hospitals pursuant 

21 to a severe wound temporary exception com22 pared to similar episodes of care for patients 

23 with severe wounds who are not admitted to 

24 long-term care hospitals. 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
8 

•HR 9173 IH

1 (D) Potential savings to the program 

2 under title XVIII of the Social Security Act 

3 that may result from making permanent the se4 vere wound temporary exception. 

5 (E) A review of comments and other feed6 back that the Secretary shall obtain from long7 term care hospitals and other stakeholders pur8 suant to a request for information published in 

9 the Federal Register regarding the severe 

10 wound temporary exception and the bene11 ficiaries who are treated in long-term care hos12 pitals pursuant to such exception. 

13 (2) REPORT.—Not later than October 1, 2026, 

14 the Secretary shall submit to Congress a report on 

15 the study conducted under paragraph (1), including 

16 a recommendation on whether the severe wound 

17 temporary exception should be made permanent. 

18 (3) DEFINITION.—For purposes of this sub19 section, the term ‘‘episode of care’’ means the length 

20 of stay of the applicable beneficiary in the longterm 

21 care hospital or subsection (d) hospital, plus the 90 

22 days following the discharge of the beneficiary from 

23 the hospital. 

Æ 


kjohnson on DSK7ZCZBW3PROD with $$_JOB