Catastrophic Specialty Hospital Act of 2025
The Catastrophic Specialty Hospital Act of 2025 would create a new category of long-term care hospitals (LTCHs) that qualify as “catastrophic specialty hospitals” focused on spinal cord injury (SCI) and acquired brain injury (ABI). If an LTCH receives designation, Medicare would pay it outside the standard LTCH cost-reporting and payment system (the LTCH Prospective Payment System) for cost reporting periods after enactment. designation lasts for a 3-year period, with a renewal process that requires the hospital to continue meeting specific criteria. To obtain and maintain designation, hospitals must meet a set of stringent, multi-year thresholds related to patient mix, services offered, out-of-state admissions, and a demonstrated commitment to neurorehabilitation research and training. The Secretary would oversee designation and redesignation, with a 60-day window for additional information if a hospital no longer meets criteria.
Key Points
- 1Establishes a new designation for LTCHs as “catastrophic specialty hospitals,” targeting spinal cord injury and acquired brain injury care, and provides a payment carve-out from the LTCH Prospective Payment System for designated hospitals.
- 2Designation criteria require: (A) at least 80% SCI/ABI-related discharges (or would be under MS-LTCH-DRG) over a 3-year lookback; (B) provision of a continuum of care including inpatient, outpatient, and long-term wellness for SCI/ABI; (C) in each year within the 3-year period, at least 175 SCI or 175 ABI discharges; (D) at least 30% of inpatients admitted from outside the state; (E) demonstrated commitment to neurorehabilitation research through personnel, publications, training programs, or residency/affiliation in neurology/PM&R.
- 3Designation lasts for a 3-year period and can be redesignated if the hospital continues to meet criteria; if not, the hospital is given 60 days to submit additional information before the designation expires.
- 4The Secretary is authorized to determine and redesignate hospitals, with a process that allows for demonstration of ongoing compliance or expiration of designation.