Securing Access to Care for Seniors in Critical Condition Act of 2025
Sponsored By: Representative Hern (OK)
Introduced
Summary
Expands which long-term care hospital discharges are excluded from Medicare's site-neutral payment rule. This bill would add a new "high acuity" criterion tied to the Medicare-Severity-Long-Term-Care-Diagnosis-Related-Group (MS-LTC-DRG) relative weight and apply it to discharges on or after October 1, 2026.
Show full summary
- Long-term care hospitals (LTCHs): More discharges that meet the "high acuity" test could qualify for nonapplication of site-neutral payments, which may change how those stays are paid.
- Patients with severe needs: Discharges assigned to MS-LTC-DRGs with a relative weight of 0.8 or higher would meet the new criterion if they occur on or after October 1, 2026.
- Medicare payments and policy: The change adds a weight-based pathway alongside the existing ventilator criterion and alters which LTCH discharges escape site-neutral rates.
Personalized for You
How does this bill affect your finances?
Personalize government policy and PRIA will tell you what this bill means for your household, plus every other piece of legislation we track. PRIA reads each provision against your financial profile to show you exactly what matters to your wallet.
Bill Overview
Analyzed Economic Effects
1 provisions identified: 1 benefits, 0 costs, 0 mixed.
Keep higher Medicare rates for serious long-term care hospital stays
This bill would add a new high-acuity test for long-term care hospital discharges. If a discharge happens on or after October 1, 2026, and its MS-LTC-DRG weight for that year is 0.8 or higher, Medicare’s site-neutral payment cut would not apply. The existing ventilator rule would still qualify as well. This could preserve higher Medicare payments for very sick cases and may help keep access to specialized long-term care hospitals.
Sponsors & CoSponsors
Sponsor
Hern (OK)
OK • R
Cosponsors
Rep. Boyle, Brendan F. [D-PA-2]
PA • D
Sponsored 3/6/2025
Joyce (PA)
PA • R
Sponsored 3/6/2025
Rep. Miller, Carol D. [R-WV-1]
WV • R
Sponsored 3/6/2025
Rep. Smucker, Lloyd [R-PA-11]
PA • R
Sponsored 3/6/2025
Rep. Tenney, Claudia [R-NY-24]
NY • R
Sponsored 3/6/2025
Davis (NC)
NC • D
Sponsored 4/9/2025
Rep. Carey, Mike [R-OH-15]
OH • R
Sponsored 6/4/2025
Rep. Moran, Nathaniel [R-TX-1]
TX • R
Sponsored 4/13/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov