[Congressional Record Volume 157, Number 120 (Tuesday, August 2, 2011)]
[Senate]
[Page S5261]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. ROBERTS (for himself, Mr. Nelson of Florida, Mr. Crapo, 
        Mr. Wyden, Mr. Toomey, and Mr. Heller):
  S. 1486. A bill to amend title XVIII of the Social Security Act to 
clarify and expand on criteria applicable to patient admission to and 
care furnished in long-term care hospitals participating in the 
Medicare program, and for other purposes; to the Committee on Finance.
  Mr. ROBERTS. Mr. President, I rise today to introduce the Long-Term 
Care Hospital Improvement Act of 2011, with the support of my colleague 
Mr. Nelson of Florida. This legislation develops new federal standards 
and certification criteria for Long Term Acute Care Hospitals, LTCHs.
  We are also joined by Senators Crapo, Wyden, Toomey and Heller, in 
introducing this bill. We hope to get the support of many more of our 
colleagues.
  This legislation has the support of the major hospital associations, 
including the American Hospital Association, AHA, the Federation of 
American Hospitals, FAH, and the Acute Long Term Hospital Association, 
ALTHA.
  As many of you know, Long-Term Acute Care Hospitals, referred to as 
LTCHs, specialize in treating medically complex patients who need 
longer than usual hospital stays, on average 25 days. By comparison, 
the average stay for a patient in a general acute hospital is only 5-6 
days.
  LTCHs, like rehabilitation hospitals and nursing homes, often care 
for patients who are discharged from a general hospital. Because of 
that, LTCHs are sometimes referred to as post-acute care providers. 
However, LTCHs are fully licensed and certified as acute care 
hospitals. There are approximately 425 LTCHs in the nation, compared to 
approximately 12,000 nursing homes and 1,400 rehabilitation hospitals. 
LTCH patients are very ill, with many suffering from complex 
respiratory issues, including those who are ventilator dependent, or 
other complex medical issues. LTCHs account for about of Medicare 
spending.
  The bill that I am introducing today implements a comprehensive set 
of federal criteria that will supplement existing Medicare 
classification criteria for LTCHs. These criteria are designed to 
ensure that LTCHs are treating high acuity patients who need extended 
hospital stays. Analysis by the Moran Company estimates that these 
criteria could generate approximately $374 million over 5 years and 
$2.7 billion over 10 years. The bill is expected to result in a net 
savings of $500 million over 10 years. I plan to work with CBO to 
confirm that estimate.
  This legislation will generate savings for the Medicare program; 
promote patients being cared for in the most appropriate setting; and, 
protect access to LTCH care for medically acute beneficiaries who need 
extended stays due to their complex condition.
  This is not a new concept and the American Hospital Association has 
been working on this issue for years. In August 2010, the AHA initiated 
a workgroup representing a cross section of the nation' LTCHs and 
larger general hospital systems including Geisinger Medical System, 
Pennsylvania, and Partners HealthCare System, Inc., Boston. The goals 
of the AHA workgroup were to develop policy recommendations for uniform 
LTCH patient and facility criteria; distinguish LTCH hospitals from 
general acute hospitals and all post-acute settings; assess fiscal 
impact, with goal of showing overall Medicare savings; develop 
consensus among AHA's LTCH members; and achieve relief from the LTCH 
``25 percent Rule.''
  We believe that we have accomplished these goals with my legislation. 
Additionally, for a body that just voted on a debt ceiling increase, 
this bill has the potential to achieve significant savings.
  I hope that my colleagues will agree with me and that this 
legislation is something that they can support. I urge my colleagues to 
join me in cosponsoring the Long-Term Care Hospital Improvement Act of 
2011.
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