,i  #aah? ,,congress  #b;d ,session  ,h4
 ,r4 #iabe  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,july #bd1 #bjbd ,mrs4
 ,mill] ( ,we/ ,virg9ia 7= h]self1 ,ms4 
,van ,duyne1 ,mr4 ,smuck]1 ,mr4 ,smi? ( 
,nebraska1 & ,mr4 ,joyce ( ,p5nsylvania7
 introduc$ ! foll[+ bill2 :i* 0 ref]r$  
to ! ,committee on ,ways & ,means  ,a   
,,bill  ,to am5d title ,,xviii ( !      
,social ,security ,act to improve !     
accuracy & pr$ictability ( ,m$ic>e      
paym5ts to long-t]m c>e hospitals4  #a4 
,%ort title ,?is ,act may be cit$ z !   
,pati5t ,access to ,,lt* ,c>e ,act4  #b4
 ,ensur+ adequacy ( paym5ts =           
high-acuity long-t]m c>e hospital       
pati5ts  7a7 ,9 g5]al ,section          
#ahhf7m77#g7 ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #acieww7m77#g77 is       
am5d$--  7#a7 9 subp>agraph 7,b7-- 7,a7 
by /rik+ ,not)/&+ subp>agraph 7,a7 &    
ins]t+ ! foll[+3  7i7 ,9 g5]al ,not)/&+ 
subp>agraph 7,a7  2 &  7,b7 by add+ at !
 end ! foll[+ new clause3  7ii7         
,limitation on increase ( fix$ loss     

am\nt ,not)/&+ clause 7i7-- 7,i7 9 !    
case t application ( su* clause w\ld    
result 9 a fix$ loss am\nt e/abli%$ =   
fiscal ye> #bjbe or #bjbf t is great]   
?an #ej1jjj1 ! ,secret>y %all set su*   
fix$ loss am\nt = su* fiscal ye> at     
#ej1jjj2 &  7,,ii7 9 ! case t           
application ( su* clause w\ld result 9 a
 fix$ loss am\nt e/abli%$ = fiscal ye>  
#bjbg or a subsequ5t fiscal ye> t is    
great] ?an #aaj p]c5t ( ! fix$ loss     
am\nt e/abli%$ = ! prec$+ fiscal ye>1 ! 
,secret>y %all set su* fix$ loss am\nt =
 su* fiscal ye> at #aaj p]c5t ( ! fix$  
loss am\nt e/abli%$ = ! prec$+ fiscal   
ye>4  2 &  7#b7 9 subp>agraph 7,c71 by  
/rik+ r$uction & ins]t+ *ange4  7b7     
,paym5t adju/m5t = complex long-,t]m c>e
 hospital pati5ts ,section #ahhf7m7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acieww7m77 is am5d$ by add+ at ! end ! 
foll[+ new p>agraph3  7#h7 ,paym5t      
adju/m5t = pati5ts ) complications or   
comorbidities or major complications or 
comorbidities  7,a7 ,9 g5]al ,= dis*>ges

 occurr+ on or aft] ,octob] #a1 #bjbe1  
or su* e>li] date z ! ,secret>y may     
specify1 ! ,secret>y %all increase      
paym5t rates "u ! sy/em describ$ 9      
p>agraph 7#a7 9 accordance ) subp>agraph
 7,b7 to fully acc\nt = ! high] co/s    
associat$ ) treat+ ! highe/ complexity  
individuals4  7,b7 ,increase ,9         
calculat+ paym5t rates "u ! sy/em       
describ$ 9 p>agraph 7#a7 = a dis*>ge (  
an individual occurr+ on or aft] ,octob]
 #a1 #bjbe 7or su* e>li] date z !       
,secret>y may specify71 ! ,secret>y     
%all-- 7i7 9 ! case su* individual _h m 
?an #e major complications or           
comorbidities & few] ?an #f             
complications or comorbidities t 7 n    
major or _h betwe5 #c & #e major        
complications & comorbidities & #e or m 
complications & comorbidities t 7 n     
major 7z demon/rat$ by claims data on ! 
claim =m submitt$ by ! long-t]m c>e     
hospital71 increase ! paym5t weight = ! 
applicable diagnosis-relat$ gr\p by #e  
p]c5t2 &  7ii7 9 ! case su* individual  

_h m ?an #e major complications or      
comorbidities & m ?an #e complications  
or comorbidities t 7 n major 7z s       
demon/rat$71 increase ! paym5t weight = 
! applicable diagnosis-relat$ gr\p by   
#aj p]c5t4  7,c7 ,assumptions &         
adju/m5ts  7i7 ,9 g5]al ,! ,secret>y    
%all annually det]m9e ! impact (        
,,icd-#aj cod+ *anges on aggregate sp5d+
 z a result ( ! application ( ! paym5t  
increases "u subp>agraph 7,a7 ) respect 
to fiscal ye>s #bjbf ?r\gh #bjcj4  7ii7 
,p]man5t adju/m5ts ,! ,secret>y %all1 at
 a "t & 9 a mann] det]m9$ appropriate by
 ! ,secret>y1 ?r\gh notice & comm5t     
rulemak+1 provide = "o or m p]man5t     
increases or decreases to ! /&>d        
prospective paym5t am\nt 7or am\nts7 =  
fiscal ye>s ref]5c$ 9 clause 7i71 on a  
prospective basis1 to (fset = increases 
or decreases 9 aggregate exp5ditures    
associat$ ) cod+ *anges attributable to 
! application ( ! paym5t increases "u   
subp>agraph 7,a74  7iii7 ,tempor>y      
adju/m5ts = retrospective behavior ,!   

,secret>y %all1 at a "t & 9 a mann]     
det]m9$ appropriate by ! ,secret>y1     
?r\gh notice & comm5t rulemak+1 provide 
= "o or m tempor>y increases or         
decreases to ! /&>d prospective paym5t  
am\nt 7or am\nts7 = fiscal ye>s ref]5c$ 
9 clause 7i74 ,su* a tempor>y increase  
or decrease %all apply only ) respect to
 ! fiscal ye> = :i* su* tempor>y        
increase or decrease is made1 & !       
,secret>y %all n take into acc\nt su* a 
tempor>y increase or decrease 9 comput+ 
su* am\nt "u ?is subsection = a         
subsequ5t fiscal ye>4  7,d7             
,nonapplication ( budget neutrality ,!  
additional paym5ts result+ f !          
application ( ?is p>agraph %all n be    
implem5t$ 9 a budget neutral mann]4  4  
#c4 ,safegu>d+ s]vices = long-t]m c>e   
hospital pati5ts ) c]ta9 complex        
conditions ,section #ahhf7m77#f7 ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acieww7m77#f77 is am5d$--  7#a7 9      
subp>agraph 7,a7-- 7,a7 9 clause 7i71 by
 /rik+ & 7,g7 & ins]t+ 7,g71 & 7,h72    

7,b7 9 clause 7iii77,i71 by ins]t+ or1 )
 respect to dis*>ges f a long-t]m c>e   
hospital occurr+ on or aft] ,octob] #a1 
#bjbc1 by a dis*>ge f a /ay 9 a critical
 access hospital1 aft] f a subsection   
7d7 hospital2 &  7,c7 9 clause 7iv77,i71
 by ins]t+ = dis*>ges f a long-t]m c>e  
hospital occurr+ be=e ,octob] #a1 #bjbc1
 be=e ! /ay 9 ! long-t]m c>e hospital4  
7#b7 by add+ at ! end ! foll[+ new      
subp>agraph3  7,h7 ,additional exception
 = pati5ts ) c]ta9 complex conditions   
7i7 ,9 g5]al ,= a dis*>ge 9 a co/       
report+ p]iod beg9n+ on or aft] ,octob] 
#a1 #bjbc1 subp>agraph 7,a77i7 %all n   
apply 7& paym5t %all be made to a       
long-t]m c>e hospital )\t reg>d to ?is  
p>agraph7 if su* dis*>ge--  7,i7 meets  
ei!r ( ! crit]ia describ$ 9 clause 7ii72
 &  7,,ii7 does n h a pr9cipal diagnosis
 relat+ to a psy*iatric diagnosis or to 
rehabilitation4  7ii7 ,crit]ia describ$ 
,= purposes ( clause 7i71 ! crit]ia     
describ$ 9 ?is clause are1 ) respect to 
a dis*>ge ( an individual f a long-t]m  

c>e hospital1 ! foll[+3 7,i7 ,! /ay 9 ! 
long-t]m c>e hospital end+ ) su* dis*>ge
 0 imm$iately prec$$ by a dis*>ge f a   
/ay 9 a subsection 7d7 hospital or a    
critical access hospital &--  7aa7 su*  
individual 0 treat$ at ! long-t]m c>e   
hospital = a sev]e w\nd 7z def9$ 9      
clause 7iii772  7bb7 su* dis*>ge f su*  
long-t]m c>e hospital is assign$ to     
,m$ic>e-,sev]ity-,long-,t]m-,c>e-,diagno
sis-,relat$-,gr\p 7,,ms-,,ltc-,,drg7    
#ahi relat+ to pulmon>y edema &         
respiratory failure 7or any successor   
,,ms-,,ltc-,,drg72  7cc7 su* dis*>ge f  
su* long-t]m c>e hospital is assign$ to 
,,ms-,,ltc-,,drg #hga relat+ to         
septicemia or sev]e sepsis )\t me*anical
 v5tilation great] ?an #if h\rs ) major 
complications or comorbidities 7or any  
successor ,,ms-,,ltc-,,drg72 or  7dd7   
su* individual 0 treat$ at ! long-t]m   
c>e hospital = ,,covid-#ai4  7,,ii7 ,!  
dis*>ge f su* long-t]m c>e hospital is  
assign$ to a ,,ms-,,ltc-,,drg ) a       
relative weight t is equal to or great] 

?an ! specifi$ am\nt 7z def9$ 9 clause  
7iii77 = ! fiscal ye> 9 :i* su* dis*>ge 
occurr$4  7iii7 ,def9itions ,9 ?is      
subp>agraph3  7,i7 ,sev]e w\nd ,! t]m   
sev]e w\nd means a /age #c w\nd1 /age #d
 w\nd1 un/ageable w\nd1 non-heal+       
surgical w\nd1 infect$ w\nd1 fi/ula1    
o/eomyelitis1 or a w\nd ) morbid        
obesity1 z id5tifi$ by applicable codes 
on ! claim f ! long-t]m c>e hospital4   
7,,ii7 ,specifi$ am\nt ,! t]m specifi$  
am\nt means1 ) respect to fiscal ye>1 an
 am\nt equal to ! #hj? p]c5tile ( !     
relative weights = ,,ms-,,ltc-,d,r,gs t 
7 assign$ to prim>y diagnoses = all     
dis*>ges occurr+ 9 ! prec$+ fiscal ye>4 
7,,iii7 ,w\nd ,! t]m w\nd means z an    
injury involv+ division ( tissue or     
rupture or ! integum5t or muc\s membrane
 ) exposure to ! ext]nal environm5t4  4