119-s2628

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 2628 Introduced in Senate

    (IS) ]

<DOC>

119th CONGRESS
 1st Session
 S. 2628

 To amend title XVIII of the Social Security Act to establish new 
 payment rules for certain catastrophic specialty hospitals under the 
 Medicare program.

_______________________________________________________________________

 IN THE SENATE OF THE UNITED STATES

 July 31, 2025

Mr. Warnock (for himself and Mr. Wicker) introduced the following bill; 
 which was read twice and referred to the Committee on Finance

_______________________________________________________________________

 A BILL

 To amend title XVIII of the Social Security Act to establish new 
 payment rules for certain catastrophic specialty hospitals under the 
 Medicare program.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Catastrophic Specialty Hospital Act 
of 2025''.

SEC. 2. ESTABLISHING NEW PAYMENT RULES FOR CERTAIN CATASTROPHIC 
 SPECIALTY HOSPITALS UNDER THE MEDICARE PROGRAM.

 

Section 1886
            (m) of the Social Security Act (42 U.S.C. 1395ww
            (m) ) is 
amended--

    (1) in paragraph

    (6)
        (A)
            (i) , by inserting ``and paragraph

    (8) '' after ``and
        (G) ''; and

    (2) by adding at the end the following new paragraph:
 ``

    (8) Treatment of certain catastrophic specialty 
 hospitals.--
 ``
        (A) In general.--Notwithstanding 

section 123 of 
 the Medicare, Medicaid, and SCHIP Balanced Budget 
 Refinement Act of 1999 and 

section 307

    (b) of the 
 Medicare, Medicaid, and SCHIP Benefits Improvement and 
 Protection Act of 2000, for cost reporting periods 
 beginning on or after the date of the enactment of this 
 subparagraph, the system described in paragraph

    (1) shall not apply and payment shall be made to a long-
 term care hospital without regard to such system and 
 without regard to paragraph

    (6) if such long-term care 
 hospital is designated as a catastrophic specialty 
 hospital under subparagraph
        (B) with respect to such 
 period.
 ``
        (B) Designation.--The Secretary shall designate a 
 long-term care hospital as a catastrophic specialty 
 hospital with respect to a cost reporting period if 
 such long-term care hospital meets the following 
 criteria:
 ``
            (i) Of the discharges from the hospital 
 during each cost reporting period occurring 
 during the 3-year period ending on the day 
 before the first day of the cost reporting 
 period for which such hospital seeks such 
 designation, including discharges of 
 individuals not entitled to benefits under part 
 A, at least 80 percent were classified under an 
 MS-LTCH-DRG relating to spinal cord injury or 
 acquired brain injury (as specified by the 
 Secretary) or would have been so classified had 
 such individual been entitled to such benefits.
 ``
            (ii) The hospital offered a continuum of 
 care during such 3-year period that included 
 inpatient care, outpatient care, and a focus on 
 long-term health and wellness for individuals 
 with spinal cord injuries or acquired brain 
 injuries.
 ``
            (iii) The hospital had, for the 1-year 
 period beginning on the first day of such 3-
 year period and for each subsequent 1-year 
 period occurring during such 3-year period--
 ``
            (I) at least 175 discharges of 
 individuals (including individuals not 
 entitled to benefits under part A) 
 classified under an MS-LTCH-DRG 
 relating to spinal cord injury (as 
 specified by the Secretary) or that 
 would have been so classified had such 
 individual been so entitled to such 
 benefits; and
 ``
            (II) at least 175 discharges of 
 individuals (including individuals not 
 entitled to benefits under part A) 
 classified under an MS-LTCH-DRG 
 relating to acquired brain injury (as 
 specified by the Secretary) or that 
 would have been so classified had such 
 individual been so entitled to such 
 benefits.
 ``
            (iv) At least 30 percent of inpatients 
 discharged from the hospital during each cost 
 reporting period occurring during such 3-year 
 period (including both individuals entitled to, 
 or enrolled for, benefits under this title and 
 individuals not so entitled or enrolled) were 
 admitted from outside of the State in which 
 such hospital is located, as determined by the 
 States of residency of such inpatients and 
 based on such data submitted by the hospital to 
 the Secretary as the Secretary may require.
 ``
            (v) The hospital has exhibited, during 
 such 3-year period, commitment to 
 neurorehabilitation research in specialty 
 areas, as evidenced by one or more (as 
 determined appropriate by the Secretary) of the 
 following:
 ``
            (I) Employment of full-time 
 dedicated neurorehabilitation research 
 personnel who are primarily focused on 
 spinal cord injury or acquired brain 
 injury neurorehabilitation.
 ``
            (II) Contributions to the field 
 of neurorehabilitation via publications 
 of such personnel in peer reviewed 
 journals in the areas of the 
 neurorehabilitation of spinal cord 
 injuries, acquired brain injuries, and 
 other paralyzing neuromuscular 
 conditions.
 ``
            (III) The maintenance of a 
 clinical training program providing 
 fellowships, residencies, or Master of 
 Public Health programs with a focus on 
 acquired brain injury or spinal cord 
 injury.
 ``
            (IV) Maintenance of an approved 
 medical residency training program (or 
 affiliation with such a program) in 
 neurology or physical medicine and 
 rehabilitation.
 ``
            (C) Length of designation.--
 ``
            (i) In general.--A designation made by 
 the Secretary under subparagraph
        (B) (or a 
 redesignation made by the Secretary under 
 clause
            (ii) ) with respect to a hospital and a 
 cost reporting period (referred to in this 
 clause as the `initial cost reporting period') 
 shall be effective for such initial cost 
 reporting period and each succeeding cost 
 reporting period occurring during the 3-year 
 period beginning on the first day of such 
 initial cost reporting period.
 ``
            (ii) Redesignation.--The Secretary shall, 
 for the first cost reporting in which a 
 designation (or redesignation) of a hospital as 
 a catastrophic specialty hospital is due to 
 expire under clause
            (i) , determine whether such 
 hospital continues to meet the criteria 
 specified in subparagraph
        (B) for such cost 
 reporting period. If the Secretary determines 
 that such hospital does continue to meet such 
 criteria for such cost reporting period, the 
 Secretary shall redesignate such hospital as a 
 catastrophic specialty hospital. If the 
 Secretary determines that such hospital does 
 not continue to meet such criteria for such 
 cost reporting period, the Secretary shall--
 ``
            (I) provide such hospital 60 days 
 to submit additional information 
 demonstrating such hospital's 
 compliance with such criteria; and
 ``
            (II) if such hospital fails to 
 make such demonstration, allow such 
 designation to expire as of the first 
 day of such cost reporting period.''.
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