I 
118TH CONGRESS 
2D SESSION 
H. R. 9125 
To amend title XVIII of the Social Security Act to improve the accuracy 
and predictability of Medicare payments to long-term care hospitals. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 24, 2024 
Mrs. MILLER of West Virginia (for herself, Ms. VAN DUYNE, Mr. SMUCKER, 
Mr. SMITH of Nebraska, 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 improve 
the accuracy and predictability of Medicare payments 
to long-term care hospitals. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Patient Access to 
LTCH Care Act’’. 
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SEC. 2. ENSURING ADEQUACY OF PAYMENTS FOR HIGH- 
ACUITY LONG-TERM CARE HOSPITAL PA-
TIENTS. 
(a) IN GENERAL.—Section 1886(m)(7) of the Social 
Security Act (42 U.S.C. 1395ww(m)(7)) is amended— 
(1) in subparagraph (B)— 
(A) by striking ‘‘Notwithstanding subpara-
graph (A)’’ and inserting the following: 
‘‘(i) IN
GENERAL.—Notwithstanding 
subparagraph (A)’’; and 
(B) by adding at the end the following new 
clause: 
‘‘(ii) LIMITATION
ON
INCREASE
OF 
FIXED
LOSS
AMOUNT.—Notwithstanding 
clause (i)— 
‘‘(I) in the case that application 
of such clause would result in a fixed 
loss amount established for fiscal year 
2025 or 2026 that is greater than 
$50,000, the Secretary shall set such 
fixed loss amount for such fiscal year 
at $50,000; and 
‘‘(II) in the case that application 
of such clause would result in a fixed 
loss amount established for fiscal year 
2027 or a subsequent fiscal year that 
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is greater than 110 percent of the 
fixed loss amount established for the 
preceding fiscal year, the Secretary 
shall set such fixed loss amount for 
such fiscal year at 110 percent of the 
fixed loss amount established for the 
preceding fiscal year.’’; and 
(2) in subparagraph (C), by striking ‘‘reduc-
tion’’ and inserting ‘‘change’’. 
(b) PAYMENT ADJUSTMENT FOR COMPLEX LONG- 
TERM CARE HOSPITAL PATIENTS.—Section 1886(m) of 
the Social Security Act (42 U.S.C. 1395ww(m)) is amend-
ed by adding at the end the following new paragraph: 
‘‘(8) PAYMENT
ADJUSTMENT
FOR
PATIENTS 
WITH COMPLICATIONS OR COMORBIDITIES OR MAJOR 
COMPLICATIONS OR COMORBIDITIES.— 
‘‘(A) IN GENERAL.—For discharges occur-
ring on or after October 1, 2025, or such ear-
lier date as the Secretary may specify, the Sec-
retary shall increase payment rates under the 
system described in paragraph (1) in accord-
ance with subparagraph (B) to fully account for 
the higher costs associated with treating the 
highest complexity individuals. 
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‘‘(B) INCREASE.—In calculating payment 
rates under the system described in paragraph 
(1) for a discharge of an individual occurring 
on or after October 1, 2025 (or such earlier 
date as the Secretary may specify), the Sec-
retary shall— 
‘‘(i) in the case such individual had 
more than 5 major complications or 
comorbidities and fewer than 6 complica-
tions or comorbidities that were not major 
or had between 3 and 5 major complica-
tions and comorbidities and 5 or more 
complications and comorbidities that were 
not major (as demonstrated by claims data 
on the claim form submitted by the long- 
term care hospital), increase the payment 
weight for the applicable diagnosis-related 
group by 5 percent; and 
‘‘(ii) in the case such individual had 
more than 5 major complications or 
comorbidities and more than 5 complica-
tions or comorbidities that were not major 
(as so demonstrated), increase the pay-
ment weight for the applicable diagnosis- 
related group by 10 percent. 
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‘‘(C) ASSUMPTIONS AND ADJUSTMENTS.— 
‘‘(i) IN
GENERAL.—The Secretary 
shall annually determine the impact of 
ICD–10 coding changes on aggregate 
spending as a result of the application of 
the payment increases under subparagraph 
(A) with respect to fiscal years 2026 
through 2030. 
‘‘(ii) PERMANENT
ADJUSTMENTS.— 
The Secretary shall, at a time and in a 
manner determined appropriate by the 
Secretary, through notice and comment 
rulemaking, provide for one or more per-
manent increases or decreases to the 
standard prospective payment amount (or 
amounts) for fiscal years referenced in 
clause (i), on a prospective basis, to offset 
for increases or decreases in aggregate ex-
penditures associated with coding changes 
attributable to the application of the pay-
ment increases under subparagraph (A). 
‘‘(iii) TEMPORARY ADJUSTMENTS FOR 
RETROSPECTIVE
BEHAVIOR.—The 
Sec-
retary shall, at a time and in a manner de-
termined appropriate by the Secretary, 
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through notice and comment rulemaking, 
provide for one or more temporary in-
creases or decreases to the standard pro-
spective payment amount (or amounts) for 
fiscal years referenced in clause (i). Such 
a temporary increase or decrease shall 
apply only with respect to the fiscal year 
for which such temporary increase or de-
crease is made, and the Secretary shall not 
take into account such a temporary in-
crease or decrease in computing such 
amount under this subsection for a subse-
quent fiscal year. 
‘‘(D) NONAPPLICATION OF BUDGET NEU-
TRALITY.—The additional payments resulting 
from the application of this paragraph shall not 
be implemented in a budget neutral manner.’’. 
SEC. 3. SAFEGUARDING SERVICES FOR LONG-TERM CARE 
HOSPITAL PATIENTS WITH CERTAIN COM-
PLEX CONDITIONS. 
Section 1886(m)(6) of the Social Security Act (42 
U.S.C. 1395ww(m)(6)) is amended— 
(1) in subparagraph (A)— 
(A) in clause (i), by striking ‘‘and (G)’’ 
and inserting ‘‘(G), and (H)’’; 
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(B) in clause (iii)(I), by inserting ‘‘or, with 
respect to discharges from a long-term care 
hospital occurring on or after October 1, 2023, 
by a discharge from a stay in a critical access 
hospital,’’ after ‘‘from a subsection (d) hos-
pital’’; and 
(C) in clause (iv)(I), by inserting ‘‘for dis-
charges from a long-term care hospital occur-
ring before October 1, 2023,’’ before ‘‘the stay 
in the long-term care hospital’’. 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(H) ADDITIONAL
EXCEPTION
FOR
PA-
TIENTS
WITH
CERTAIN
COMPLEX
CONDI-
TIONS.— 
‘‘(i) IN GENERAL.—For a discharge in 
a cost reporting period beginning on or 
after October 1, 2023, subparagraph (A)(i) 
shall not apply (and payment shall be 
made to a long-term care hospital without 
regard to this paragraph) if such dis-
charge— 
‘‘(I) meets either of the criteria 
described in clause (ii); and 
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‘‘(II) does not have a principal 
diagnosis relating to a psychiatric di-
agnosis or to rehabilitation. 
‘‘(ii) CRITERIA DESCRIBED.—For pur-
poses of clause (i), the criteria described in 
this clause are, with respect to a discharge 
of an individual from a long-term care hos-
pital, the following: 
‘‘(I) The stay in the long-term 
care hospital ending with such dis-
charge was immediately preceded by a 
discharge from a stay in a subsection 
(d) hospital or a critical access hos-
pital and— 
‘‘(aa) such individual was 
treated at the long-term care 
hospital for a severe wound (as 
defined in clause (iii)); 
‘‘(bb) such discharge from 
such long-term care hospital is 
assigned to Medicare-Severity- 
Long-Term-Care-Diagnosis-Re-
lated-Group 
(MS–LTC–DRG) 
189 relating to pulmonary edema 
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