[Congressional Record Volume 155, Number 65 (Thursday, April 30, 2009)]
[Senate]
[Pages S4965-S4966]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CONRAD (for himself, Mr. Hatch, Mr. Crapo, Mr. Roberts, 
        Mr. Wicker, Mr. Vitter, Mr. Voinovich, Mr. Chambliss, Mr. 
        Isakson, Mr. Cochran, Mr. Bunning, Mr. Kerry, Ms. Stabenow, Mr. 
        Harkin, Mr. Wyden, Mr. Specter, and Mr. Alexander):
  S. 935. A bill to extend subsections (c) and (d) of section 114 of 
the Medicare, Medicaid, and SCHIP Extension Act of 2007 (Public Law 
110-173) to provide for regulatory stability during the development of 
facility and patient criteria for long-term care hospitals under the 
Medicare program, and for other purposes; to the Committee on Finance.
  Mr. CONRAD. Mr. President, today I am introducing legislation that 
would extend reasonable measures to protect access to long-term care 
hospitals, while ensuring that these institutions are admitting the 
appropriate type of patients. I am pleased to be introducing the bill 
along with my colleague, Senator Hatch, and I urge my colleagues to 
consider cosponsoring this cost-saving proposal.
  Long Term Acute Care hospitals, or LTAC hospitals, serve a vital role 
in the Medicare program by providing care to beneficiaries with 
clinically complex conditions that need hospital care for extended 
periods of time. I am happy to have two of these hospitals in North 
Dakota, one in Fargo and one in Mandan. They are a vital part of the 
North Dakota continuum of care.
  While these hospitals provide important health services to very frail 
individuals, the Centers for Medicare and Medicaid Services, CMS, 
became concerned with the rapid growth in these facilities, and as a 
result began to arbitrarily cut LTAC hospital payments across-the-
board. The Medicare, Medicaid and SCHIP Extension Act of 2007, MMSEA, 
enacted important changes that included the development of much-needed 
patient and facility certification criteria to assure that the right 
patient is seen in the right post-acute care setting. This law issued a 
moratorium on new facilities and expansions of older facilities and 
provided regulatory relief to protect patient access to LTAC hospitals 
while patient criteria are being developed. The legislation I am 
introducing today would extend these provisions by two years to provide 
stability to these hospitals and the patients they serve as CMS 
considers payment bundles and other changes in post-acute care.
  As Chairman of the Budget Committee, I have a unique appreciation for 
the enormous fiscal challenges that face our country and respect CMS's 
efforts to reduce growth in Medicare. We should address the growth in 
LTAC hospitals, but we also want to ensure that there is a place for 
patients who truly need long-term hospital stays.
  It was not easy for the LTAC hospitals in North Dakota and across the 
country to support legislation that restricts their payments, but I 
compliment them for working with me to put forward a constructive 
public policy proposal. Long-term care hospitals serve a vital role in 
our health care system, and we must protect access to these facilities 
for those who truly need it. But we can also take responsible steps to 
ensure that our federal tax dollars are well spent and directed to the 
most appropriate level of care. I believe my legislation achieves this 
balance and urge my colleagues to support this measure.
  Mr. HATCH. Mr. President, I am pleased to join my friend, Senator 
Kent Conrad, and others in introducing the Medicare Long-Term Care 
Hospital Improvement Act of 2009. This legislation would help ensure 
that Medicare beneficiaries continue to have access to long-term, 
acute-care,

[[Page S4966]]

LTAC, hospitals. These hospitals provide inpatient care to Medicare 
beneficiaries who spend at least 25 days in the hospital. Typically, 
the average patient stay in an acute care hospital is only six days. We 
have several LTAC hospitals and facilities in Salt Lake, Provo, and 
Bountiful, UT.
  Our bill would extend for two more years the LTAC hospital moratorium 
included in the Medicare, Medicaid, and SCHIP Extension Act of 2007, 
MMSEA, P.L. 110-173. While MMSEA's LTAC hospital provisions helped the 
LTAC hospitals, they also addressed important issues raised by the 
Centers for Medicare and Medicaid Services, CMS, regarding these 
hospitals. Under MMSEA, new LTAC hospitals would not be allowed to open 
until the three year moratorium ends in 2010--the intent was to give 
CMS time to develop new federal standards on LTAC patient criteria. The 
bill that we are introducing today would extend the MMSEA moratorium 
for another 2 years.
  To my friends in the hospital community and to those responsible for 
issuing federal regulations impacting the hospital community, I urge 
you to work together to address some of the valid concerns that have 
been raised with regard to LTAC hospitals. But I want these concerns 
addressed fairly so that beneficiaries will continue to have access to 
quality care and choice of long-term care coverage.
  I also believe that while most LTAC hospitals provide good care in 
many parts of the country, the industry must do a better job convincing 
Congress and Federal agencies that the type of care you provide is 
valuable and necessary. Only truly sick patients should go to LTAC 
hospitals. Less medically-complex patients should be seen at less 
intensive facilities.
  It is my hope that Federal officials making important decisions 
regarding LTACs get the job done. Five years ago, LTAC hospitals were 
told that they needed new standards and yet, we have made limited 
progress in this area. You need to finish this important job once and 
for all! It needs to be done in partnership with the LTAC community. 
Hopefully, the introduction of this bill will get the ball rolling in 
this area.
  Finally, President Obama's budget guidelines for fiscal year 2010 has 
a bundling proposal that would include the payment of post-acute care 
with the hospital payment system. The Senate Finance Committee is 
considering a similar proposal. Therefore, I do not want to leave the 
impression with anyone that the introduction of this legislation is 
meant to delay such a proposal from moving forward. However, I do 
believe that should bundling be seriously considered by Congress, all 
stakeholders should be included in those discussions, including the 
LTACH hospitals.
  I look forward to working with my Senate colleagues on this important 
bill.
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