HFMA VIEWS

Barbara Straub Williams, Esq.
Principal, Powers Pyles Sutter & Verville, PC, Washington, D.C.

The January 2008 hfm article “Regulating Long-Term Care Hospitals: Is There a Roadmap from Ad Hoc Limitations to Clarity in Certification and Coverage?” dealt with Medicare regulations that have attempted to control the expansion of LTCHs by restricting certification, patient access, and payment. After this article was sent to press, Congress passed the Medicare, Medicaid and SCHIP Extension Act of 2007 that significantly modified the payment provisions discussed in the article, and President Bush signed it into law on Dec. 29, 2007.

Highlights of Section 114 of the legislation are:

• A detailed definition of LTCH that requires patient screening to determine the appropriateness of admissions
• A three-year moratorium on the application of the 25 percent rule to free-standing and grandfathered LTCHs
• A three-year moratorium on payment adjustments for rural LTCHs and HWHs co-located with an “urban single” or “Metropolitan Statistical Area-dominant” hospital if no more than 75 percent of the LTCH’s Medicare discharges are from the co-located hospital
• A three-year moratorium on payment adjustments for co-located LTCHs and satellites if no more than 50 percent of the LTCH’s Medicare discharges are from the host hospital
• A three-year moratorium on the regulatory amendment changing the short-stay outlier payment provision for LTCHs
• A three-year moratorium on the establishment of new LTCHs, satellite LTCHs and new beds in existing LTCHs
• A freeze in the LTCH base rate at the 2007 level for April 1, 2008 through June 30, 2008