Catastrophic Specialty Hospital Act of 2025

Bill Summary: Catastrophic Specialty Hospital Act of 2025 (H.R. 5644)

Overview

The Catastrophic Specialty Hospital Act of 2025 is a legislative proposal to amend the Social Security Act to change how certain specialized long-term care hospitals are reimbursed under the Medicare program. The bill seeks to exempt highly specialized hospitals—specifically those focusing on catastrophic injuries like spinal cord and acquired brain injuries—from certain standard Medicare payment limitations and systems.

Main Purpose and Intent

The primary goal of the bill is to ensure that hospitals providing intensive, specialized neurorehabilitation for catastrophic injuries remain financially viable. By creating a new "Catastrophic Specialty Hospital" designation, the bill removes these facilities from specific payment rules (referencing the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999) that may not account for the high cost and complexity of catastrophic injury care.

Key Provisions

To qualify for this new designation and the resulting payment exemptions, a long-term care hospital must meet strict criteria over a three-year period:

1. Patient Population & Volume

• Specialization: At least 80% of discharges must be for patients with spinal cord injuries or acquired brain injuries (as classified by MS–LTCH–DRG).
• Volume: The hospital must have at least 175 discharges per year for spinal cord injuries AND at least 175 discharges per year for acquired brain injuries.
• Geographic Reach: At least 30% of inpatients must be admitted from outside the state where the hospital is located, demonstrating its role as a regional or national center of excellence.

2. Scope of Care & Research

• Continuum of Care: The hospital must provide a comprehensive range of services, including inpatient care, outpatient care, and a focus on long-term health and wellness.
• Research Commitment: The hospital must demonstrate a commitment to neurorehabilitation research through at least one of the following:
  • Employing full-time dedicated research personnel.
  • Publishing in peer-reviewed journals regarding neurorehabilitation.
  • Maintaining clinical training programs (Fellowships, Residencies, or MPH programs).
  • Maintaining an approved medical residency training program in neurology or physical medicine and rehabilitation.

Procedural and Timeline Aspects

• Designation Period: Once designated, the status is effective for the initial cost reporting period and the subsequent three-year period.
• Redesignation: At the end of the three-year term, the Secretary of Health and Human Services must determine if the hospital still meets the criteria.
• Grace Period: If a hospital is found to no longer meet the criteria, it is granted 60 days to submit additional information to prove compliance before the designation expires.

Who is Affected?

• Specialized Hospitals: Long-term care hospitals focusing on brain and spinal injuries may see a change in how they are reimbursed, potentially increasing their financial stability.
• Patients: Individuals with catastrophic neurological injuries may benefit from the continued availability of high-volume, specialized rehabilitation centers.
• The Medicare Program: The federal government would modify its payment calculations for a specific subset of healthcare providers.