H.R. 1924: Securing Access to Care for Seniors in Critical Condition Act of 2025 (119th Congress) Bill Summary

This bill, titled the "Securing Access to Care for Seniors in Critical Condition Act of 2025," aims to change the Medicare payment structure for long-term care hospitals. It specifically seeks to modify the criteria under which certain payment rules apply.

Key Provisions

The bill proposes to amend section 1886(m)(6)(A) of the Social Security Act by introducing a new rule concerning "site-neutral payments" for long-term care hospitals. Site-neutral payments are those that are intended to standardize payments regardless of where the care is provided, ensuring consistency across different types of facilities.

New Criterion for Discharge

The main focus of the bill is the introduction of a "high acuity criterion" for patients discharged from long-term care hospitals. Under this new criterion:

A discharge will qualify for special consideration if it is assigned to a Medicare-Severity-Long-Term-Care-Diagnosis-Related-Group (MS-LTC-DRG) with a relative weight of 0.8 or higher.
This change will take effect for discharges occurring on or after October 1, 2026.

By establishing this "high acuity criterion," the bill aims to ensure that long-term care hospitals receive appropriate compensation for treating more complex and severe cases, thereby protecting access to care for seniors in critical conditions.

Impact on Long-Term Care Hospitals

The proposed changes are significant for long-term care hospitals, as they may affect reimbursement rates and financial sustainability. By increasing the relative weight needed for certain discharges, hospitals might be incentivized to focus on higher acuity patients, which can require more resources and specialized care.

Implementation Timeline

The implementation of this bill would not be immediate; it sets the effective date for discharges to be considered under the new high acuity criterion to begin on October 1, 2026. This gives hospitals and providers time to adapt to the new criteria.

Goals of the Bill

The overarching goal of this legislation appears to be to ensure that Medicare payment policies align with the needs of patients who require more intensive care, thereby securing better access and quality of care for seniors facing serious health challenges.