H.R.1924 - Securing Access to Care for Seniors in Critical Condition Act of 2025 (119th Congress)
Summary
H.R.1924, the "Securing Access to Care for Seniors in Critical Condition Act of 2025," amends Title XVIII of the Social Security Act, modifying Medicare payments to long-term care hospitals (LTCHs). The bill introduces a "high acuity criterion" for determining whether site-neutral payment policies apply to LTCHs. This criterion exempts LTCH discharges with a high acuity level (MS-LTC-DRG relative weight >= 0.8) from site-neutral payment reductions, starting October 1, 2026.
Expected Effects
The primary effect of this bill is to potentially increase Medicare payments to LTCHs for treating high-acuity patients. This could incentivize LTCHs to accept and treat more critically ill seniors. The change aims to ensure that LTCHs are adequately compensated for the specialized care they provide to the most vulnerable patients.
Potential Benefits
- Ensures adequate reimbursement for long-term care hospitals treating critically ill seniors.
- May improve access to specialized care for seniors with complex medical needs.
- Could incentivize LTCHs to invest in resources and staff necessary for high-acuity patients.
- Potentially reduces the financial strain on LTCHs, helping them remain viable providers.
- May lead to better patient outcomes due to focused and specialized care.
Most Benefited Areas:
Potential Disadvantages
- Could increase Medicare spending if LTCHs increase the number of high-acuity discharges.
- May create an incentive for LTCHs to upcode diagnoses to meet the high-acuity criterion.
- Could lead to uneven access to care if LTCHs in certain regions are better equipped to handle high-acuity patients.
- May not address the underlying issues of care coordination and transitions between different healthcare settings.
- The 0.8 relative weight threshold may be arbitrary and could exclude some patients who require intensive care.
Most Disadvantaged Areas:
Constitutional Alignment
The bill appears to align with the general welfare clause of the Constitution (Preamble), as it aims to improve healthcare access for seniors. Congress has the power to legislate on matters related to Medicare under its enumerated powers. The bill does not appear to infringe upon any specific constitutional rights or limitations.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).