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

This section exempts designated catastrophic specialty long-term care hospitals (LTCHs)—those specializing in spinal cord injury or acquired brain injury—from Medicare's LTCH prospective payment system (PPS) under SSA section 1886(m)(1) and related payment adjustments under paragraph (6), for cost reporting periods beginning on or after enactment of this section. (As background, the LTCH PPS, implemented in FY2003, pays LTCHs fixed per-discharge amounts based on Medicare Severity LTCH Diagnosis-Related Groups (MS-LTCH-DRGs) to replace prior reasonable-cost reimbursement; paragraph (6) applies certain site-neutral payment rules and other limits to LTCHs. Thus, qualifying hospitals receive payment without regard to the PPS.) The Secretary designates an LTCH as a catastrophic specialty hospital for an initial 3-year period (renewable if criteria continue to be met) if, for each of the prior 3 cost reporting periods, the hospital meets all of the following: (1) at least 80% of discharges (including non-Medicare) were classified under specified MS-LTCH-DRGs for spinal cord injury or acquired brain injury; (2) it offered a continuum of inpatient, outpatient, and long-term health/wellness care for such patients; (3) it had at least 175 qualifying discharges for spinal cord injury and 175 for acquired brain injury in each of those years (including non-Medicare); (4) at least 30% of discharged inpatients were admitted from out-of-state; and (5) it demonstrated neurorehabilitation research commitment via dedicated personnel, peer-reviewed publications, clinical training programs, or approved residencies (as specified). The provision overrides prior moratoriums on certain LTCHs under 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.