1.This Act may be cited as
the Medicare Long-Term Care Hospital
Improvement Act of 2007
.
2.Congress finds the following:
(1)Long-term care
hospitals (in this Act referred to as LTCHs
) serve a valuable
role in the post-acute care continuum by providing care to medically complex
patients needing long hospital stays.
(2)The Medicare
program should ensure that patients receive post-acute care in the most
appropriate setting. The use of additional certification criteria for LTCHs,
including facility and patient criteria, will promote the appropriate placement
of severely ill patients into LTCHs. Further, patient admission, continued
stay, and discharge screening tools can guide appropriate patient
placement.
(3)Measuring and
reporting on quality of care is an important function of any Medicare provider
and a national quality initiative for LTCHs should be similar to short-term
general acute care hospitals in the Medicare program.
(4)To conform the
prospective payment system for LTCHs with certain aspects of the prospective
payment system for short-term general acute care hospitals and promote payment
stability, the Secretary of Health and Human Services (in this Act referred to
as the Secretary
) should—
(A)perform an annual
market basket update;
(B)conduct the long
term care diagnosis related groups (in this Act referred to as
LTCDRGs
) reweighting and wage level adjustments in a budget
neutral manner each year;
(C)not perform a
proposed one-time budget neutrality adjustment; and
(D)not extend the
25-percent limitation on reimbursement of co-located hospital patient
admissions to freestanding LTCHs.
(5)LTCHs co-located
with another hospital in underserved areas, including rural areas and areas
with an urban single or MSA dominant hospital, should be afforded greater
relief from the 50 percent limitation on reimbursement of co-located hospital
patient admissions.
3.New definition
of a long-term care hospital with facility and patient criteria
(a)Section
1861 of the Social Security Act (42 U.S.C. 1395x) is amended by adding at the
end the following new subsection:
(ccc)The term long-term care
hospital means an institution which—”
(1)is primarily
engaged in providing, by or under the supervision of physicians, to medically
complex inpatients needing long hospital stays—
(A)diagnostic
services and therapeutic services for medical diagnosis, treatment, and care of
injured, disabled, or sick persons; or
(B)rehabilitation
services for the rehabilitation of injured, disabled, or sick persons;
(2)has an average
inpatient length of stay (as determined by the Secretary) for beneficiaries
under this title of greater than 25 days, or as otherwise defined in section
1886(d)(1)(B)(iv);
(3)satisfies the
requirements of paragraphs (2) through (9) of subsection (e);
(4)meets the
following additional facility criteria:
(A)the institution
has a patient review process, documented in the patient medical record, that
screens patients prior to admission, validates within 48 hours of admission
that patients meet admission criteria, regularly evaluates patients throughout
their stay, and assesses the available discharge options when patients no
longer meet the continued stay criteria;
(B)the institution
applies a standard patient screening tool, as determined by the Secretary, that
is a valid clinical tool appropriate for this level of care, uniformly used by
all long-term care hospitals, to measure the severity of illness and intensity
of service requirements for patients for the purposes of making admission,
continuing stay, and discharge medical necessity determinations taking into
account the medical judgment of the patient’s physician, as provided for under
sections 1814(a)(3) and 1835(a)(2)(B);
(C)the institution
has active physician involvement with patients during their treatment through
an organized medical staff, physician review of patient progress on a daily
basis, and consulting physicians on call and capable of being at the patient’s
side within a moderate period of time, as determined by the Secretary;
(D)the institution
has interdisciplinary team treatment for patients, requiring interdisciplinary
teams of health care professionals, including physicians, to prepare and carry
out an individualized treatment plan for each patient; and
(E)the institution
maintains adequate staffing levels of licensed health care professionals, as
determined by the Secretary, to ensure that long-term care hospitals provide
the intensive level of care that is sufficient to meet the needs of medically
complex patients needing long hospital stays; and
(5)meets patient
criteria relating to patient mix and severity appropriate to the medically
complex cases that long-term care hospitals are uniquely designed to treat, as
measured under section
1886(m).
.
(b)New patient
criteria for long-term care hospital prospective paymentSection
1886 of such Act (42 U.S.C. 1395ww) is amended by adding at the end the
following new subsection:
(m)Patient
criteria for prospective payment to long-term care hospitals
(1)To be eligible for prospective payment as a long-term
care hospital, a majority of the total number of patients entitled to benefits
under part A who are discharged from a long-term care hospital must be
medically complex patients admitted with a high severity of illness, as that
term is defined by the Secretary for payment purposes, with 1 or more
enumerated medical conditions specified in paragraph (2).
(2)Medically
complex medical conditionsThe Secretary shall determine a list
of medical conditions associated with a high severity of illness of patients
who are appropriate for treatment in long-term care hospitals, as indicated by
the presence of clinical comorbidities in accordance with a methodology
specified by the Secretary. Such list shall include the following medical
conditions:
(A)Circulatory
conditions.
(B)Digestive,
endocrine, and metabolic conditions.
(C)Infectious
disease.
(D)Neurological
conditions.
(E)Renal
conditions.
(F)Respiratory
conditions.
(G)Skin
conditions.
(H)Other medically
complex conditions as defined by the
Secretary.
.
(c)Negotiated
rulemaking to develop LTCH facility and patient criteriaThe
Secretary shall promulgate regulations to carry out the amendments made by this
section on an expedited basis and using a negotiated rulemaking process under
subchapter III of chapter 5 of title 5, United States Code.
(d)The amendments made by this section shall apply to
discharges occurring on or after October 1, 2007.
4.LTCH quality
improvement initiative
(a)Study To
establish quality measuresThe Secretary shall conduct a study
(in this section referred to as the study
) to determine
appropriate quality measures for Medicare beneficiaries receiving care in
LTCHs.
(b)Not
later than October 1, 2007, the Secretary shall submit to Congress a report on
the results of the study.
(c)Selection of
quality measuresSubject to subsection (e), the Secretary shall
choose 3 quality measures from the study to be reported by LTCHs.
(d)Requirement for
submission of data
(1)LTCHs shall—
(A)collect data on
the 3 quality measures chosen under subsection (c); and
(B)submit all
required quality data to the Secretary.
(2)Any LTCH which does not submit the required quality
data to the Secretary in any fiscal year shall have the applicable LTCH market
basket under section 1886 reduced by not more than 0.4 percent for such
year.
(e)Expansion of
quality measuresThe Secretary may expand the number of quality
indicators required to be reported by LTCHs under the study. If the Secretary
adds other measures, the measures shall reflect consensus among the affected
parties. The Secretary may replace any measures in appropriate cases, such as
where all hospitals are effectively in compliance or where measures have been
shown not to represent the best clinical practice.
(f)Availability of
data to publicThe Secretary shall establish procedures for
making the quality data submitted under this section available to the
public.
5.Conforming LTCH
PPS updates to the inpatient PPS
(a)Requiring
annual updates of base rates and wage indices and annual updates and
reweighting of LTCDRGs
(1)The second sentence of section 307(b)(1) of the Medicare,
Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (114 Stat.
2763A–496), as enacted into law by section 1(a)(6) of Public Law 106–554, is
amended by inserting before the period at the end the following: , and
shall provide (consistent with updating and reweighting provided for subsection
(d) hospitals under paragraphs (2)(B)(ii), (3)(D)(iii), and (3)(E) of section
1886 of the Social Security Act) for an annual update under such system in
payment rates, in the wage indices (in a budget neutral manner), and in the
classification and reweighting (in a budget neutral manner) of the
diagnosis-related groups applied under such system
.
(2)Pursuant
to the amendment made by paragraph (1), the Secretary shall provide annual
updates to the LTCH base rate, as is specified for the inpatient hospital
prospective payment system under section 1886(d)(2)(B)(ii) of the Social
Security Act (42 U.S.C. 1395ww(d)(2)(B)(ii)). The Secretary shall annually
update and reweight the LTCDRGs under section 307(b) of the Medicare, Medicaid,
and SCHIP Benefits Improvement and Protection Act of 2000 or an alternative
patient classification system in a budget neutral manner, consistent with such
updating and reweighting applied under section 1886(d)(3)(D)(iii) of the Social
Security Act (42 U.S.C. 1395ww(d)(3)(D)(iii)). The Secretary shall annually
update wage levels for LTCHs in a budget neutral manner, consistent with such
annual updating applied under section 1886(d)(3)(E) of the Social Security Act
(42 U.S.C. 1395ww(d)(3)(E)).
(b)Elimination of
one-time budget neutrality adjustmentThe Secretary shall not
make a one-time prospective adjustment to the LTCH prospective payment system
rates under section 412.523(d)(3) of title 42, Code of Federal Regulations, or
otherwise conduct any budget neutrality adjustment to address such rates,
during the transition period specified in section 412.533 of such title from
cost-based payment to the prospective payment system for LTCHs.
(c)No application
of 25 percent patient threshold payment adjustment to freestanding
LTCHsThe Secretary shall not extend the 25 percent (or
applicable percentage) patient threshold payment adjustment under section
412.534 of title 42, Code of Federal Regulations, or any similar provision, to
freestanding LTCHs.
6.Relief for
certain long-term care hospitals and satellite facilities that are co-located
with other hospitals
(a)Urban single
and MSA dominant hospitalsThe Secretary shall permit up to 75
percent of the discharged Medicare impatient population of an applicable
hospital to be admitted from a co-located urban single or co-located MSA
dominant hospital (as defined in section 412.534(e)(4) of title 42, Code of
Federal Regulations) without adjustment to the hospital’s LTCH prospective
payment system payment in the manner described in section 412.534(e) of such
title.
(b)The Secretary shall permit up to 75 percent of the
discharged Medicare impatient population of an applicable hospital which is
located in a rural area (as defined in section 412.64(b)(1)(ii)(C) of title 42,
Code of Federal Regulations) to be admitted from a co-located hospital without
adjustment to the hospital’s LTCH prospective payment system payment in the
manner described in section 412.534(d) of such title.
(c)Applicable
long-term care hospital definedIn this section, the term
applicable long-term care hospital
means—
(1)a long-term care
hospital that meets the criteria in section 412.22(e) of title 42, Code of
Federal Regulations; and
(2)a satellite
facility of a long-term care hospital that meet the criteria in section
412.22(h) of such title.