Securing Access to Care for Seniors in Critical Condition Act of 2025

Bill Number

H.R. 1924

Origin Chamber

House

Congress

119th Congress, Session 1

Policy Area

Health

Status

Introduced

Latest Action

2025-03-06: Referred to the House Committee on Ways and Means.

Last Updated

2026-04-14T08:05:35Z

AI-Generated Summary

Purpose

The "Securing Access to Care for Seniors in Critical Condition Act of 2025" (H.R. 1924) aims to ensure that Medicare continues to provide adequate payments to long-term care hospitals (LTCHs) for treating severely ill patients. LTCHs are specialized facilities for patients needing extended hospital stays, often with complex conditions. The bill creates an exception to "site-neutral payments," a policy that standardizes Medicare reimbursement rates across different healthcare settings to reduce costs, allowing LTCHs to receive higher payments for certain high-needs cases.

Key Provisions

• Amends Section 1886(m)(6)(A) of the Social Security Act, which governs Medicare payments to LTCHs.
• Adds a new "high acuity criterion" for exempting LTCH discharges from site-neutral payments:
• The patient discharge must be classified under a Medicare Severity Long-Term Care Diagnosis Related Group (MS-LTC-DRG) with a relative weight of 0.8 or higher for that fiscal year. (MS-LTC-DRGs categorize patient cases based on diagnosis and severity; relative weight measures the expected resource use, with higher values indicating more intensive care needs.)
• The exemption applies only to discharges on or after October 1, 2026.
• Integrates this new criterion alongside existing exceptions, such as those for patients needing prolonged ventilator use.

Significant Changes to Existing Law

• Expands the list of criteria under which site-neutral payments do not apply to LTCHs, building on prior exceptions (e.g., for ventilator-dependent patients).
• Introduces a resource-intensity threshold (relative weight ≥ 0.8) to identify high-acuity cases, which previously lacked this specific measure for LTCH payment protections.
• Delays implementation until fiscal year 2027 (starting October 1, 2026), providing a transition period.

Potential Impacts

• On government agencies: The Centers for Medicare & Medicaid Services (CMS) will need to update payment systems and classification rules to incorporate the new criterion, potentially increasing Medicare spending on LTCH services without altering overall program funding mechanisms.
• On citizens: Seniors and Medicare beneficiaries with severe, resource-intensive conditions (e.g., those requiring long-term critical care) may gain better access to LTCH services, as hospitals could be incentivized to accept such patients without payment reductions. This could improve care quality and availability for vulnerable populations but might indirectly raise Medicare costs, affecting premiums or taxes.
• On international relations: No direct impacts, as the bill focuses on domestic U.S. healthcare policy.

Main Stakeholders Affected

• LTCHs and healthcare providers: Benefit from preserved higher reimbursements for high-acuity patients, potentially stabilizing operations and encouraging specialization in complex care.
• Medicare beneficiaries: Particularly elderly or critically ill individuals who rely on LTCHs for extended treatment.
• Taxpayers and Medicare program: Face potential increased federal spending, as exemptions could lead to higher overall payments to LTCHs.
• Bipartisan congressional sponsors: Representatives from both parties (e.g., Mr. Hern, Mr. Boyle) indicate support from rural and urban districts with LTCH facilities.

Notable Legal, Constitutional, or Political Implications

• Legal: Strengthens LTCH payment protections under Medicare law without challenging the broader site-neutral policy framework established in prior legislation (e.g., the Bipartisan Budget Act of 2018). It requires CMS to define and apply the relative weight threshold administratively, which could invite future rulemaking or legal challenges if implementation disputes arise.
• Constitutional: No apparent issues, as it involves congressional authority over federal spending and social welfare programs under Article I.
• Political: Reflects a compromise to balance cost-saving reforms with access to specialized care, appealing to stakeholders concerned about rural healthcare deserts and senior care. Passage could influence ongoing debates on Medicare sustainability amid rising healthcare costs.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Hern, Kevin [R-OK-1]

Cosponsors (8)

Rep. Boyle, Brendan F. [D-PA-2], Rep. Joyce, John [R-PA-13], Rep. Miller, Carol D. [R-WV-1], Rep. Smucker, Lloyd [R-PA-11], Rep. Tenney, Claudia [R-NY-24], Rep. Davis, Donald G. [D-NC-1], Rep. Carey, Mike [R-OH-15], Rep. Moran, Nathaniel [R-TX-1]

Recent Actions

• 2025-03-06: Referred to the House Committee on Ways and Means.
• 2025-03-06: Introduced in House
• 2025-03-06: Introduced in House

Bill Versions

• Securing Access to Care for Seniors in Critical Condition Act of 2025 — issued 2025-03-06 — PDF (2 pages)