Miller Introduces Patient Access to Long Term Care Hospitals (LTCH) Care Act
Washington, D.C. – Yesterday, Congresswoman Carol Miller (R-WV) introduced Patient Access to Long Term Care Hospitals (LTCH) Care Act which will help provide financial stability to the LTCH industry through multiple targeted reforms which provide adequate reimbursement to LTCHs for the highest-acuity patients. Joining Congresswoman Miller in introducing the Patient Access to LTCH Care Act are Representatives Adrian Smith (R-NE), Lloyd Smucker (R-PA), Beth Van Duyne (R-TX), and John Joyce (R-PA).
“Long Term Care Hospitals (LTCHs) provide invaluable care to the sickest patients across the United States. During COVID-19, these hospitals stepped up to ensure patients on ventilator support had the care they need, and they continue to provide care to those that need it most. Providing adequate reimbursement for LTCHs will ensure they have the stability they need to continue serving our most vulnerable populations. I’m glad to introduce the Patient Access to LTCH Care Act to support stability in Medicare reimbursement for LTCHs and ensure patient access to these lifesaving facilities. I look forward to this legislation moving through the House of Representatives quickly to provide hospitals the resources they need to deliver the best care for their patients,” said Congresswoman Miller.
“For areas of the country like the Third District with numerous critical access hospitals (CAHs), permitting CAHs to discharge patients directly to a long term care hospital is a critical flexibility to effectively care for patients. This legislation would enact this and other necessary reforms. I thank Rep. Miller for her leadership and my other colleagues for their cooperation in championing this effort to modernize LTCH regulations to support health care providers and enhance care for patients," said Congressman Smith.
"Excessive regulations and rising costs have forced many health care providers to close their doors. Some of the most endangered facilities are Long Term Care Hospitals which provide extended ICU-level care to patients facing complex medical issues. These facilities are crucial for our nation’s most vulnerable, especially in rural and underserved communities where emergency care is not easily accessible. Our bill will help LTCHs keep their doors open by ensuring they receive adequate Medicare reimbursements. I’m glad to join Congresswoman Miller in introducing the Patient Access to Long Term Care Hospitals Care Act to cut down on red tape and improve access to healthcare for those who need it most,” said Congresswoman Van Duyne.
“The National Association of Long Term Hospitals (NALTH) applauds Representatives Carol Miller, Adrian Smith, Lloyd Smucker, Beth Van Duyne and John Joyce for introducing the Patient Access to LTCH Care Act. The important reforms in this comprehensive legislation would ensure Long Term Care Hospitals (LTCHs) are more accurately reimbursed for the costs of caring for our most critically ill seniors. Specifically, key provisions in the bill include reforming the High Cost Outlier Fixed Loss Amount, expanding LTCH standard rate criteria, increasing reimbursement for the most medically complex patients and allowing Critical Access Hospitals to discharge patients directly to an LTCH. NALTH urges Congress to swiftly consider and pass this important legislation to stabilize the LTCH industry so the needs of the sickest and most vulnerable Americans can continue to be met,“ said Dr. Ed Prettyman, President of National Association of Long Term Hospitals.
“The Coalition of Long-Term Acute Care Hospitals is deeply grateful to Rep. Carol Miller, along with Reps. Adrian Smith, Lloyd Smucker, Beth Van Duyne and John Joyce, for introducing the Patient Access to LTCH Care Act. LTCHs fill a vital role in the health care continuum, providing ICU-level care to those very ill patients who need sustained care. Changes to Medicare payment policies, sicker patients, and higher operating costs have caused many LTCHs to shutter their doors in recent years, leaving patients in those communities without access to this level of care. The Patient Access to LTCH Care Act will allow LTCHs to care for the very sickest patients, will improve access to long-term acute care in rural areas, and will ensure that patients across the country have access to the intensive care they require when they need it,” said Ellen Kugler on behalf of the Coalition of Long-Term Acute-Care Hospitals.
Click here for bill text.
Background:
The Patient Access to LTCH Care Act:
- Caps the FY25 and FY26 high-cost outlier fixed cost amount to $50,000 and limits any future year-over-year fixed loss amount increases to 110%;
- Provides a 5% increase in reimbursement for patients with more than 5 major complications or comorbidities (MCCs) and fewer than 6 complications or comorbidities (CCs), or between 3 and 5 MCCs and 5 or more CCs;
- Provides a 10% increase in reimbursement for patients with more than 5 MCCs and more than 5 CCs;
- Extends the LTCH PPS rate to patients with severe wounds, DRG 189 (pulmonary edema and respiratory failure), DRG 871 (septicemia or severe sepsis), or COVID-19;
- Extends the LTCH PPS rate to the top 20% of DRGs with the highest relative rates; and
- Allows for patients to be discharged to an LTCH directly from a Critical Access Hospital (CAH).
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