H.R. 5644: Catastrophic Specialty Hospital Act of 2025

The Catastrophic Specialty Hospital Act of 2025 aims to change the way Medicare pays for certain long-term care hospitals known as catastrophic specialty hospitals. Specifically, this bill outlines new payment rules under the Social Security Act for hospitals that meet specific criteria related to the treatment of individuals with spinal cord injuries or acquired brain injuries.

Key Provisions of the Bill

• New Payment Structure: The bill proposes a different payment method for designated catastrophic specialty hospitals, allowing them to be reimbursed outside of the standard system that typically applies to long-term care hospitals.
• Designation Criteria: A hospital can be designated as a catastrophic specialty hospital if it meets several requirements over a three-year period, including:
  • At least 80% of discharges must relate to spinal cord injury or acquired brain injury.
  • Provision of comprehensive care that includes inpatient and outpatient services focused on long-term health and wellness for relevant patients.
  • A minimum of 175 discharges for both spinal cord injury and acquired brain injury classifications annually during the three-year assessment period.
  • At least 30% of inpatients must be from outside the state in which the hospital is located.
  • Commitment to neurorehabilitation research, which may be demonstrated through various means such as hiring specialized staff or publishing in peer-reviewed journals.
• Length of Designation: Once a hospital is designated as a catastrophic specialty hospital, this status is valid for three years, with evaluations required thereafter to determine ongoing compliance with the designation criteria.

Implementation Timeline

The new payment rules would apply to cost reporting periods that begin after the enactment of the bill. This means that hospitals need to prepare to meet the criteria and demonstrate their qualifications as soon as the law is in effect and the relevant rules are clarified.

Regulatory Oversight

The responsibility for designating hospitals as catastrophic specialty hospitals falls to the Secretary of Health and Human Services. The Secretary will also oversee the redesignation process, ensuring hospitals continue to meet the required criteria for maintaining their status.

Impact on Patients

One of the goals of the bill is to improve patient care for individuals with catastrophic conditions by ensuring specialized hospitals provide adequate services and maintain a high level of care focused on rehabilitation and recovery.

Relevant Companies

• AMGN: Amgen may be impacted if it has partnerships with specified hospitals for research and development, especially regarding neurorehabilitation therapies.
• ABBV: AbbVie could see effects depending on its involvement in therapies or treatments targeted at spinal cord and acquired brain injuries.