Bill > HR9125

This bill aims to improve the accuracy and predictability of Medicare payments to long-term care hospitals (LTCHs). It introduces two key provisions: 1. It limits the increase in the fixed loss amount, which is used to determine outlier payments for high-acuity LTCH patients. Specifically, it sets a $50,000 cap on the fixed loss amount for fiscal years 2025 and 2026, and limits any annual increases to 110% of the previous year's amount thereafter. This is intended to ensure adequate payments for the highest complexity LTCH patients. 2. It establishes a payment adjustment to fully account for the higher costs associated with treating the most complex LTCH patients. The bill defines criteria for identifying these high-complexity patients and provides for a 5% or 10% increase in the payment weight for their diagnosis-related groups. The Secretary is required to make temporary and permanent adjustments to the standard prospective payment to account for coding changes related to this new payment adjustment.

Budget and Finance, Health and Social Services

https://www.congress.gov/bill/118th-congress/house-bill/9125/all-info