Securing Access to Care for Seniors in Critical Condition Act of 2025
This bill, the Securing Access to Care for Seniors in Critical Condition Act of 2025, would modify Medicare payment rules for long-term care hospitals (LTCHs) by adding a new “high acuity” criterion to determine when site-neutral payments do not apply. Specifically, it amends the 1886(m)(6)(A) provision to include a new criterion (clause (v)) for discharges from LTCHs. A discharge would qualify as high acuity if (1) it is assigned to a Medicare-Severity-Long-Term-Care-DRG (MS-LTC-DRG) with a relative weight of 0.8 or higher for that fiscal year, and (2) the discharge occurs on or after October 1, 2026. This new criterion, along with the existing ventilator criterion, would determine when LTCH discharges are not subject to site-neutral payments, effectively preserving LTCH-specific payment treatment for these high-acuity cases.
Key Points
- 1Adds a new “high acuity criterion” to determine non-application of site-neutral payments for LTCH discharges.
- 2The high acuity criterion requires: (I) an MS-LTC-DRG weight of at least 0.8 for the relevant fiscal year, and (II) a discharge date on or after October 1, 2026.
- 3The new criterion is added to the existing set of criteria (which already includes a ventilator criterion) governing when site-neutral payments do not apply.
- 4Implementing language focuses on LTCH discharges and aligns with the MS-LTC-DRG framework used to measure acuity and resource use.
- 5The bill is a formal amendment to the Social Security Act and would be administered through the Department/Center administering Medicare payment rules, with no explicit funding provision included in the text provided.