Health Law News

PROPOSED LEGISLATION TO PROTECT PATIENT ACCESS TO LONG TERM HOSPITAL CARE
Stephen M. Sullivan, JD, MPH

Long-term care hospitals (LTCH) provide hospital-level care for medically complex, long stay patients which may include patients requiring respiratory failure with ventilator dependency, infections, patients with complex wounds, and trauma patients.  LTCHs must meet the same regulatory requirements as general acute hospitals but have a significantly longer average length of stay greater than 25 days.  Recently the Centers for Medicare and Medicaid Services (CMS) published payment regulations that limit patient access to LTCH services.

READ MORE>

___________________________________________________________________________________________________

Five Variations - 25% Limitation HwHs with Satellites
by Stephen M Sullivan, JD, MPH

The Final Rule, which becomes effective July 1st,  amended 42 C.F.R. § 412.534 to add a new requirement making HwHs with satellites subject to five (5) 25% limitations as follows:

a)  One from the hospital co-located with the HwH.

b)  One from the hospital co-located with the satellite.

c)  One for discharges originating from a provider not co-located with the LTCH.

d)  One for discharges originating from a provider not co-located with its satellite.

e)  One for discharges from a non co-located provider from the HwH and its satellites combined.  In other words, discharges from an off campus provider from the LTCH as a whole (i.e. all campuses).

Interestingly Tzvi told me, off the record, that it is CMS’s intention to eliminate § 534 in next year’s notice of proposed rule making.  If that is done it will eliminate the first two of the five 25% limitations described above.  Nevertheless, until the rule is changed the existing regulations are the law until modified by CMS or Congressional intervention.

In other words, unless changed by CMS or Congressional intervention there are five (5) variations of the 25% rule applicable to a HwH with a satellite.  The first two (2), which are based on 42 C.F.R. 412.534, are fully phased in at the 25% limitation level as of an LTCH’s first CRY beginning on or after October 1, 2006.  Accordingly, as of September 1, 2007, all LTCH HwHs and satellites will be at 25% or the percentage that originated from a co-located hospital and discharged from the LTCH during its 2004 CRY, whichever is less.  There are exceptions for discharges from MSA dominant and rural LTCHs

The last three (3) 25% limitations are new and are based on 42 C.F.R. § 412.536 which will be phased in beginning with an LTCH’s CRYs beginning on or after July 1, 2007, e.g. 75% for the first year, 50% for the second, and 25% by no later than June 1, 2010.

In regard to the 25% limit added by 42 C.F.R. § 412.536, it is the lower of the applicable percentage for the transition or the percentage discharged from the LTCH or satellite in its CRY which included July 1, 2005, (i.e. assuming it existed at that time).  The exceptions for MSA dominant and rural LTCHs apply.  In the event CMS does rescind a) and b) above, it is still not much comfort for HwHs and satellites that cannot operate at the 50% threshold.

Please let me know if you have questions or would like to discuss re-organization alternatives to better cope with the transition.

June 11, 2007

This article does not constitute legal advice.  It is intended as an informational service

Sullivan, Stolier & Resor
(A Professional Law Corporation)

New Orleans Office:
909 Poydras Street, Suite 2600
New Orleans, Louisiana 70112-4000
Phone:  504-561-1044
Fax:  504-561-8606

Lafayette Office
1042 Camellia Boulevard, Suite 2
Lafayette, Louisiana  70508
Phone:  337-233-6210
Fax:  337-233-6215

E-mail: attorney@ssrlawfirm.com