Long-Term Care Hospital PPS

The Medicare, Medicaid, and SCHIP [State Children's Health Insurance Program] Balanced Budget Refinement Act of 1999 (BBRA) (Pub. L. 106-113) and the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) (Pub. L. 106-554) provide for payment for both the operating and capital-related costs of hospital inpatient stays in long-term care hospitals (LTCHs) under Medicare Part A based on prospectively set rates. The Medicare prospective payment system (PPS) for LTCHs applies to hospitals described in section 1886(d)(1)(B)(iv) of the Social Security Act (the Act), effective for cost reporting periods beginning on or after October 1, 2002. Section 1886(d)(1)(B)(iv)(I) of the Act defines a LTCH as "a hospital which has an average inpatient length of stay (as determined by the Secretary of Health and Human Services (the Secretary)) of greater than 25 days.” Section 114(e) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) added section 1886(m) of the Act, and codified the provisions of the BBA and BIPA in paragraph (1) of that subsection.

Section 1886(d)(1)(B)(iv)(II) of the Act had provided an alternative definition of LTCHs. However, with the changes required by section 15008 of the 21st Century Cures Act (Pub. L 114-255), hospitals meeting this alternative definition were, effective January 1, 2015, redesignated as a separate category of inpatient PPS-excluded hospitals at section 1886(d)(1)(b)(vi) of the Act, referred to as “Extended Neoplastic Disease Care Hospitals.” As such, hospitals now classified as Extended Neoplastic Disease Care Hospitals (including provider 33-2006) are no longer LTCHs and are no longer paid under the LTCH PPS at section 1886(m) of the Act.