Sponsors (7)
This bill enhances specialized care, payment stability, and research for a small but severely affected group of Medicare beneficiaries (spinal cord/brain injuries) while increasing Medicare costs, risking uneven geographic access, and putting financial pressure on smaller local LTCHs.
Medicare beneficiaries with severe spinal cord injuries or acquired brain injuries can receive more specialized, continuous care at designated catastrophic specialty long-term care hospitals (LTCHs), improving access to focused, high-acuity rehabilitation and management.
Designated catastrophic specialty LTCHs receive predictable payment treatment for up to three years, enabling these hospitals to sustain specialized services, plan investments, and maintain capacity for complex patients.
A requirement for neurorehabilitation research and training tied to designation supports clinical advances and workforce training in spinal cord and brain injury care, potentially improving long-term outcomes and provider capacity.
Exempting designated LTCHs from standard Medicare payment rules is likely to increase Medicare spending, creating additional fiscal pressure on taxpayers and the Medicare program.
Patients who live in states without designated catastrophic specialty LTCHs may face limited access or need to travel out-of-state for care, creating burdensome travel, continuity, and support challenges for affected beneficiaries and families.
Smaller or local LTCHs that do not meet high-volume, out-of-state referral, or research criteria could lose referrals and face financial strain, risking reduced local capacity for post-acute care.
Based on analysis of 2 sections of legislative text.
Creates a Medicare payment exception allowing hospitals that meet volume, case-count, out-of-state draw, service-continuum, and neurorehabilitation research/training criteria to be paid outside standard LTCH rules.
Introduced September 30, 2025 by Barry D. Loudermilk · Last progress September 30, 2025
Creates a new Medicare payment exception that lets the Secretary designate certain hospitals as "catastrophic specialty hospitals" and pay them outside the standard long-term care hospital (LTCH) payment rules. Designated hospitals receive payments without application of the usual LTCH paragraph (1) payment system or paragraph (6) rules for cost reporting periods starting on or after enactment. The Secretary must set and apply specific designation criteria — multi-year volume, a required continuum of services, minimum case counts, a geographic draw threshold (at least 30% out-of-state admissions), and participation in neurorehabilitation research or training. Designations cover the initial cost reporting period plus the next three years, and the Secretary runs a re-designation process that includes a 60-day opportunity to cure deficiencies before losing the designation.