1.This Act may be cited as the &short-title1;
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2.Congress finds the following:
(1) Long-term care hospitals are one of four types of post-acute care settings that are reimbursed under the Medicare program.
(2)There has been substantial growth in the number of these hospitals over the past decade. Since 1993, the number of long-term care hospitals has increased over 275 percent from 109 to 300 facilities.
(3)Corresponding to the increase in number of these facilities is a rapid increase in Medicare spending on long-term care hospitals. Medicare spending has jumped over 500 percent from $398 million in 1993 to an anticipated 2.3 billion in 2005.
(4)Long-term care hospitals are the most expensive on average of all the post acute alternatives, currently costing approximately $35,700 per patient episode. Current earnings and margins for these hospitals are significantly higher than for comparable Medicare reimbursed clinical service programs.
(5)There is evidence that patients are being admitted into long-term care hospitals when services can be provided in other less expensive post-acute care settings.
(6)These trends raise questions about—
(A)the clinical need to support the rapid growth in long-term care hospitals;
(B)the appropriateness of the current Medicare payment system for long-term care hospital services; and
(C)the extent to which clinical admissions criteria for long-term care hospital patients can be modified so as to minimize the acceptance of patients into these settings that can be appropriately treated in alternative, less costly post-acute settings.
(7)A temporary moratorium on recognizing additional long-term care hospital beds is appropriate until these questions are answered, in order to ensure that beneficiaries are receiving the treatment they require and that Medicare funds are being prudently spent.
3.Moratorium on medicare payment for inpatient hospital services in additional long-term care hospital beds
(a)Notwithstanding any other provision of law, except as provided in subsection (b), no payment shall be made under section 1886 of the Social Security Act (42 U.S.C. 1395ww) for inpatient hospital services provided in a long-term care hospital unless such services were provided for services furnished for a patient in a bed which was either in operation or in development (as determined by the Secretary) as of the date of the introduction of the &short-title1;.
(b)Termination of moratorium
(1)The Secretary may terminate the moratorium under subsection (a) if the Secretary determines that adequate information is obtained and any appropriate interventions are implemented to ensure that beneficiaries within long-term care hospitals are receiving the treatment they require and that Medicare funds allocated to these hospitals are being prudently spent.
(2) The Secretary shall only make such determination based on the Secretary judgment that there is adequate evidence—
(A)of a clinical need for a growth in the number of beds in long-term care hospitals;
(B)that an appropriate reimbursement system and rate is in place for Medicare payment for inpatient hospital services in such hospitals; and
(C)of a clinical admission policy for such hospitals that minimizes the acceptance of patients into these settings that can be appropriately treated in alternative, less costly post acute settings.
(c)If the Secretary intends to terminate the moratorium under subsection (b), the Secretary shall submit to Congress a report at least 1 month before the date of such termination. Such report shall include the rationale for the termination and shall specify the evidence described in subsection (b)(2) that supports the termination of the moratorium.
(d)For purposes of this section:
(1)The term long-term care hospital
means a hospital described in section 1886(d)(1)(B)(iv) of the Social Security Act (42 U.S.C. 1395ww(d)(1)(B)(iv)).
(2)The term Secretary
means the Secretary of Health and Human Services.