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The Centers for Medicare and Medicaid Services (CMS) announced a proposed rate increase of 0.71 percent for the rate year beginning July 1, 2007, for Long-Term Care Hospitals (LTCHs). The increase raises the average Medicare payment per discharge to $38,356, an amount that varies according to the beneficiary's assigned diagnosis-related group (DRG). The LTCH-DRGs are the same DRGs used in the acute hospital prospective payment system. There are approximately 390 LTCHs for which the Medicare prospective payment system has been in place since October 2003.
The LTCHs are unique in that the average Medicare length of stay must be greater than 25 days for patients who are clinically complex and may suffer from multiple acute or chronic conditions. Services typically include comprehensive rehabilitation, respiratory therapy, head trauma treatment, and pain management. CMS cites "upcoding" in 2004 and 2005 as the reason for the proposed small payment increase. In other words, changes in coding practices and documentation created an increase in Medicare payments rather than an actual more costly case mix. The low proposed update is higher than the zero percent update recommended by the Medicare Payment Advisory Commission (MedPAC) earlier this year.
Public comments on the proposal will be accepted through March 26, 2007. ASHA members seeking additional facts or possessing information that may influence the proposed payment increase should contact Mark Kander, ASHA's Director of Health Care Regulatory Analysis, via e-mail at mkander@asha.org or by phone at 800-498-2071, ext. 4139.
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