Sponsors (9)
The bill preserves higher Medicare payments to LTCHs for high-acuity patients—supporting access to specialized care and provider finances—but raises Medicare program costs and risks unequal treatment and administrative gaming.
Medicare beneficiaries with complex, high-acuity conditions who qualify under the LTCH threshold will be more likely to receive continued specialized inpatient LTCH care due to higher site-specific Medicare payments.
Hospitals and long-term acute care hospitals treating sicker patients will retain higher Medicare reimbursements for qualifying discharges, supporting facility financial viability to provide complex care.
Taxpayers and the Medicare Trust Fund may face higher costs because some LTCH stays will be paid at higher site-specific rates rather than lower site-neutral rates.
Some patients discharged to LTCHs who do not meet the 0.8 relative weight threshold will remain subject to lower site-neutral payments, potentially creating unequal facility reimbursement and differential access for similar clinical cases.
Hospitals may have incentives to alter DRG assignments or coding to meet the 0.8 threshold, increasing administrative burden, audits, and compliance costs for provider systems.
Based on analysis of 2 sections of legislative text.
Excludes LTCH discharges with MS‑LTC‑DRG relative weight ≥ 0.8 (on/after Oct 1, 2026) from site‑neutral Medicare payment treatment.
Introduced March 6, 2025 by Kevin Hern · Last progress March 6, 2025
Amends Medicare payment rules so that certain long-term care hospital (LTCH) discharges deemed “high acuity” are not subject to site‑neutral payment reductions. Specifically, for LTCH discharges on or after October 1, 2026, those assigned to an MS‑LTC‑DRG with a relative weight of at least 0.8 will be excluded from site‑neutral payment treatment. The change preserves higher LTCH payments for those high‑acuity cases and changes how Medicare pays for a subset of post‑acute hospital care.