I 
119TH CONGRESS 
1ST SESSION H. R. 5644 
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 
SEPTEMBER 30, 2025 
Mr. LOUDERMILK (for himself, Ms. DEGETTE, Mr. AUSTIN SCOTT of Georgia, 
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 hos-
pitals under the Medicare program. 
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 ‘‘Catastrophic Specialty 
Hospital Act of 2025’’. 
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SEC. 2. ESTABLISHING NEW PAYMENT RULES FOR CERTAIN 
CATASTROPHIC 
SPECIALTY 
HOSPITALS 
UNDER THE MEDICARE PROGRAM. 
Section 1886(m) of the Social Security Act (42 
U.S.C. 1395ww(m)) is amended— 
(1) in paragraph (6)(A)(i), by inserting ‘‘and 
paragraph (8)’’ after ‘‘and (G)’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(8) TREATMENT OF CERTAIN CATASTROPHIC 
SPECIALTY HOSPITALS.— 
‘‘(A) IN GENERAL.—Notwithstanding sec-
tion 123 of the Medicare, Medicaid, and SCHIP 
Balanced Budget Refinement Act of 1999 and 
section 307(b) of the Medicare, Medicaid, and 
SCHIP Benefits Improvement and Protection 
Act of 2000, for cost reporting periods begin-
ning on or after the date of the enactment of 
this subparagraph, the system described in 
paragraph (1) shall not apply (and payment 
shall be made to a long-term care hospital with-
out regard to such system and without regard 
to paragraph (6)) if such long-term care hos-
pital is designated as a catastrophic specialty 
hospital under subparagraph (B) with respect 
to such period. 
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‘‘(B) DESIGNATION.—The Secretary shall 
designate a long-term care hospital as a cata-
strophic specialty hospital with respect to a cost 
reporting period if such long-term care hospital 
meets the following criteria: 
‘‘(i) Of the discharges from the hos-
pital during each cost reporting period oc-
curring during the 3-year period ending on 
the day before the first day of the cost re-
porting period for which such hospital 
seeks such designation, including dis-
charges of individuals not entitled to bene-
fits under part A, at least 80 percent were 
classified under an MS–LTCH–DRG relat-
ing to spinal cord injury or acquired brain 
injury (as specified by the Secretary) or 
would have been so classified had such in-
dividual been entitled to such benefits. 
‘‘(ii) The hospital offered a continuum 
of care during such 3-year period that in-
cluded inpatient care, outpatient care, and 
a focus on long-term health and wellness 
for individuals with spinal cord injuries or 
acquired brain injuries. 
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‘‘(iii) The hospital had, for the 1-year 
period beginning on the first day of such 
3-year period and for each subsequent 1- 
year period occurring during such 3-year 
period— 
‘‘(I) at least 175 discharges of 
individuals (including individuals not 
entitled to benefits under part A) clas-
sified under an MS–LTCH–DRG re-
lating to spinal cord injury (as speci-
fied by the Secretary) or that would 
have been so classified had such indi-
vidual been so entitled to such bene-
fits; and 
‘‘(II) at least 175 discharges of 
individuals (including individuals not 
entitled to benefits under part A) clas-
sified under an MS–LTCH–DRG re-
lating to acquired brain injury (as 
specified by the Secretary) or that 
would have been so classified had such 
individual been so entitled to such 
benefits. 
‘‘(iv) At least 30 percent of inpatients 
discharged from the hospital during each 
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cost reporting period occurring during such 
3-year period (including both individuals 
entitled to, or enrolled for, benefits under 
this title and individuals not so entitled or 
enrolled) were admitted from outside of the 
State in which such hospital is located, as 
determined by the States of residency of 
such inpatients and based on such data 
submitted by the hospital to the Secretary 
as the Secretary may require. 
‘‘(v) The hospital has exhibited, dur-
ing such 3-year period, commitment to 
neurorehabilitation research in specialty 
areas, as evidenced by one or more (as de-
termined appropriate by the Secretary) of 
the following: 
‘‘(I) Employment of full-time 
dedicated neurorehabilitation research 
personnel who are primarily focused 
on spinal cord injury or acquired 
brain injury neurorehabilitation. 
‘‘(II) Contributions to the field of 
neurorehabilitation via publications of 
such personnel in peer reviewed jour-
nals 
in 
the 
areas 
of 
the 
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neurorehabilitation of spinal cord in-
juries, acquired brain injuries, and 
other paralyzing neuromuscular condi-
tions. 
‘‘(III) The maintenance of a clin-
ical training program providing fellow-
ships, residencies, or Master of Public 
Health programs with a focus on ac-
quired brain injury or spinal cord in-
jury. 
‘‘(IV) Maintenance of an ap-
proved medical residency training pro-
gram (or affiliation with such a pro-
gram) in neurology or physical medi-
cine and rehabilitation. 
‘‘(C) LENGTH OF DESIGNATION.— 
‘‘(i) IN
GENERAL.—A designation 
made by the Secretary under subparagraph 
(B) (or a redesignation made by the Sec-
retary under clause (ii)) with respect to a 
hospital and a cost report period (referred 
to in this clause as the ‘initial cost report-
ing period’) shall be effective for such ini-
tial cost reporting period and each suc-
ceeding cost reporting period occurring 
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during the 3-year period beginning on the 
first day of such initial cost reporting pe-
riod. 
‘‘(ii) 
REDESIGNATION.—The 
Sec-
retary shall, for the first cost reporting in 
which a designation (or redesignation) of a 
hospital as a catastrophic specialty hospital 
is due to expire under clause (i), determine 
whether such hospital continues to meet 
the criteria specified in subparagraph (B) 
for such cost reporting period. If the Sec-
retary determines that such hospital does 
continue to meet such criteria for such cost 
reporting period, the Secretary shall redes-
ignate such hospital as a catastrophic spe-
cialty hospital. If the Secretary determines 
that such hospital does not continue to 
meet such criteria for such cost reporting 
period, the Secretary shall— 
‘‘(I) provide such hospital 60 
days to submit additional information 
demonstrating such hospital’s compli-
ance with such criteria; and 
‘‘(II) if such hospital fails to 
make such demonstration, allow such 
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designation to expire as of the first 
day of such cost reporting period.’’. 
Æ 
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