Title: Securing Access to Care for Seniors in Critical Condition Act of 2022
Policy area: Health

Summary:
Securing Access to Care for Seniors in Critical Condition Act of 2022
This bill exempts discharges from long-term care hospitals from the Medicare site-neutral payment rate if the discharge meets specified high acuity criteria and occurs on or after October 1, 2025.

[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9658 Introduced in House (IH)]

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117th CONGRESS
  2d Session
                                H. R. 9658

  To amend title XVIII of the Social Security Act to establish a new 
criterion for the nonapplication of site-neutral payments to long-term 
               care hospitals under the Medicare program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           December 21, 2022

   Mr. Hern 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 a new 
criterion for the nonapplication of site-neutral payments to long-term 
               care hospitals under the Medicare program.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Securing Access to Care for Seniors 
in Critical Condition Act of 2022''.

SEC. 2. ESTABLISHING A NEW CRITERION FOR THE NONAPPLICATION OF SITE-
              NEUTRAL PAYMENTS TO LONG-TERM CARE HOSPITALS UNDER THE 
              MEDICARE PROGRAM.

    Section 1886(m)(6)(A) of the Social Security Act (42 U.S.C. 
1395ww(m)(6)(A)) is amended--
            (1) by striking ``or the ventilator criterion under clause 
        (iv)'' and inserting ``, the ventilator criterion under clause 
        (iv), or the high acuity criterion described in clause (v)''; 
        and
            (2) by adding at the end the following new clause:
                            ``(v) High acuity criterion.--
                                    ``(I) In general.--The criterion 
                                specified in this clause (in this 
                                paragraph referred to as the `high 
                                acuity criterion') for a discharge from 
                                a long-term care hospital in a fiscal 
                                year is that--
                                            ``(aa) the individual 
                                        discharged had a primary 
                                        diagnosis assigned to a 
                                        Medicare-Severity-Long-Term-
                                        Care-Diagnosis-Related-Group 
                                        (MS-LTC-DRG) with a relative 
                                        weight for such fiscal year 
                                        that was equal to or greater 
                                        than the specified amount for 
                                        such fiscal year; and
                                            ``(bb) the discharge 
                                        occurred on or after October 1, 
                                        2025.
                                    ``(II) Specified amount defined.--
                                For purposes of subclause (I), the term 
                                `specified amount' means, with respect 
                                to a fiscal year, an amount equal to 
                                the 80th percentile of the relative 
                                weights for Medicare-Severity-Long-
                                Term-Care-Diagnosis-Related-Groups that 
                                were assigned to primary diagnoses for 
                                all discharges occurring in the 
                                preceding fiscal year.''.
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