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. 
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 ‘‘Long Term Care Sta-
bilization Act’’. 
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SEC. 2. TEMPORARY CAP ON FIXED LOSS AMOUNT FOR 
SETTING PAYMENTS FOR HIGH-COST LONG- 
TERM CARE HOSPITAL PATIENTS. 
(a) 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— 
(1) by redesignating subparagraphs (C) and 
(D) as subparagraph (D) and (E), respectively; 
(2) by inserting after subparagraph (B) the fol-
lowing 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.’’; and 
(3) in subparagraph (D), as so redesignated by 
paragraph (1), by inserting ‘‘, and any increase in 
payments resulting from the application of subpara-
graph (C),’’ after ‘‘subparagraph (B)’’. 
(b) STUDY AND REPORT ON HIGH COST OUTLIER 
PAYMENTS TO LONG-TERM CARE HOSPITALS.— 
(1) STUDY.—The Secretary of Health and 
Human Services (in this section referred to as the 
‘‘Secretary’’) shall conduct a study on the current 
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methodology for making high cost outlier payments 
to long-term care hospitals under the payment sys-
tem described in section 1886(m)(l) of the Social Se-
curity Act (42 U.S.C. 1395ww(m)(1)). Such study 
shall include an analysis of the following: 
(A) 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. 
(B) 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. 
(C) 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. 
(D) The effect of inflation and increasing 
labor costs on the data that the Secretary uses 
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to calculate the fixed loss amount for high cost 
outlier payments to long-term care hospitals. 
(E) 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. 
(F) The potential benefits to long-term 
care hospitals and beneficiaries that may result 
from increasing the 99.6875 percent of 8 per-
cent 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)). 
(2) 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 con-
ducted under paragraph (1), including recommenda-
tions on changes to the methodology for making 
high cost outlier payments to longterm care hos-
pitals under the payment system described in section 
1886(m)(l) of the Social Security Act (42 U.S.C. 
1395ww(m)(1)). 
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SEC. 3. TEMPORARY PAYMENT AT THE STANDARD FED-
ERAL RATE FOR CERTAIN LONG-TERM CARE 
HOSPITAL 
DISCHARGES 
WITH 
SEVERE 
WOUNDS. 
(a) IN GENERAL.—Section 1886(m)(6) of the Social 
Security Act (42 U.S.C. 1395ww(m)(6)) is amended— 
(1) in subparagraph (A)(i), by striking ‘‘and 
(G)’’ and inserting ‘‘(G), and (H)’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(H) TEMPORARY
EXCEPTION
FOR
CER-
TAIN 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, 
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unstageable wound, non-healing surgical 
wound, infected wound, fistula, osteomy-
elitis, 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 sub-
paragraph, the term ‘wound’ means an in-
jury involving division of tissue or rupture 
or the integument or mucous membrane 
with exposure to the external environ-
ment.’’. 
(b) STUDY AND REPORT ON AN EXCEPTION TO THE 
LONG-TERM CARE HOSPITAL SITE NEUTRAL PAYMENT 
RATE FOR CERTAIN SEVERE WOUND DISCHARGES.— 
(1) 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: 
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(A) The costs and benefits of the severe 
wound temporary exception, including the im-
pact on patient outcomes and hospital readmis-
sions for patients with severe wounds. 
(B) A minimum of 18 months of claims 
data to determine how the severe wound tem-
porary exception affects payments to long-term 
care hospitals under the payment system de-
scribed in section 1886(m)(l) of the Social Se-
curity Act (42 U.S.C. 1395ww(m)(1)). 
(C) Taking into account data collected be-
fore the effective date of the severe wound tem-
porary exception and during the period when 
such exception is in effect, the impact of the se-
vere wound temporary exception on the costs of 
an episode of care for patients with qualifying 
severe wounds treated in long-term care hos-
pitals, including the difference in costs of severe 
wound patient episodes of care that include ad-
missions to long-term care hospitals pursuant 
to a severe wound temporary exception com-
pared to similar episodes of care for patients 
with severe wounds who are not admitted to 
long-term care hospitals. 
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(D) Potential savings to the program 
under title XVIII of the Social Security Act 
that may result from making permanent the se-
vere wound temporary exception. 
(E) A review of comments and other feed-
back that the Secretary shall obtain from long- 
term care hospitals and other stakeholders pur-
suant to a request for information published in 
the Federal Register regarding the severe 
wound temporary exception and the bene-
ficiaries who are treated in long-term care hos-
pitals pursuant to such exception. 
(2) 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. 
(3) DEFINITION.—For purposes of this sub-
section, 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. 
Æ 
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