[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 562 Introduced in House (IH)]
110th CONGRESS
1st Session
H. R. 562
To amend title XVIII of the Social Security Act to ensure and foster
continued patient quality of care by establishing facility and patient
criteria for long-term care hospitals and related improvements under
the Medicare Program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
January 18, 2007
Mr. English of Pennsylvania (for himself and Mr. Pomeroy) introduced
the following bill; which was referred to the Committee on Ways and
Means
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to ensure and foster
continued patient quality of care by establishing facility and patient
criteria for long-term care hospitals and related improvements under
the Medicare Program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare Long-Term Care Hospital
Improvement Act of 2007''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Long-term care hospitals (in this Act referred to as
``LTCHs'') serve a valuable role in the post-acute care
continuum by providing care to medically complex patients
needing long hospital stays.
(2) The Medicare program should ensure that patients
receive post-acute care in the most appropriate setting. The
use of additional certification criteria for LTCHs, including
facility and patient criteria, will promote the appropriate
placement of severely ill patients into LTCHs. Further, patient
admission screening tools and continued stay and discharge
assessment tools can guide appropriate patient placement.
(3) Certain long-term care diagnosis related groups (in
this Act referred to as ``LTC-DRGs'') are associated with
higher severity of illness levels, as measured by the APR-DRG
system, and patients grouped into those LTC-DRGs are predicted
to be appropriate for LTCH services.
(4) Measuring and reporting on quality of care is an
important function of any Medicare provider and a national
quality initiative for LTCHs should be similar to short-term
general acute care hospitals in the Medicare program.
(5) To conform the prospective payment system for LTCHs
with certain aspects of the prospective payment system for
short-term general acute care hospitals and promote payment
stability, the Secretary of Health and Human Services (in this
Act referred to as the ``Secretary'') should--
(A) perform an annual market basket update;
(B) conduct the LTC-DRG reweighting and wage level
adjustments in a budget neutral manner each year;
(C) not perform a proposed one-time budget
neutrality adjustment, and
(D) not extend the 25 percent limitation on
reimbursement of co-located hospital patient admissions
to freestanding LTCHs.
SEC. 3. NEW DEFINITION OF A LONG-TERM CARE HOSPITAL WITH FACILITY AND
PATIENT CRITERIA.
(a) Definition.--Section 1861 of the Social Security Act (42 U.S.C.
1395x) is amended by adding at the end the following new subsection:
``Long-Term Care Hospital
``(ccc) The term `long-term care hospital' means an institution
which--
``(1) is primarily engaged in providing inpatient care, by
or under the supervision of a physician, to medically complex
patients needing long hospital stays;
``(2) has an average inpatient length of stay (as
determined by the Secretary) for Medicare beneficiaries of
greater than 25 days, or as otherwise defined in section
1886(d)(1)(B)(iv);
``(3) satisfies the requirements of subsection (e), except
paragraphs (1) and (9) of such subsection;
``(4) meets the following facility criteria:
``(A) the institution has a patient review process,
documented in the patient medical record, that screens
patients prior to admission, validates within 48 hours
of admission that patients meet admission criteria,
regularly evaluates patients throughout their stay, and
assesses the available discharge options when patients
no longer meet the continued stay criteria;
``(B) the institution applies a standard patient
assessment tool, as determined by the Secretary, that
is a valid clinical tool appropriate for this level of
care, uniformly used by all long-term care hospitals,
to measure the severity of illness and intensity of
service requirements for patients for the purposes of
making admission, continuing stay and discharge medical
necessity determinations taking into account the
medical judgment of the patient's physician, as
provided for under sections 1814(a)(3) and
1835(a)(2)(B);
``(C) the institution has active physician
involvement with patients during their treatment
through an organized medical staff, on-site physician
presence and physician review of patient progress on a
daily basis, and consulting physicians on call and
capable of being at the patient's side within a
moderate period of time, as determined by the
Secretary;
``(D) the institution has interdisciplinary team
treatment for patients, requiring interdisciplinary
teams of health care professionals, including
physicians, to prepare and carry out an individualized
treatment plan for each patient; and
``(E) the institution maintains a minimum staffing
level of licensed health care professionals, as
determined by the Secretary, to ensure that long-term
care hospitals provide an intensive level of care that
is sufficient to meet the needs of medically complex
patients needing long hospital stays; and
``(5) meets patient criteria relating to patient mix and
severity appropriate to the medically complex cases that long-
term care hospitals are uniquely designed to treat, as measured
under section 1886(m).''.
(b) New Patient Criteria for Long-Term Care Hospital Prospective
Payment.--Section 1886 of such Act (42 U.S.C. 1395ww) is amended by
adding at the end the following new subsection:
``(m) Patient Criteria for Prospective Payment to Long-Term Care
Hospitals.--
``(1) In general.--To be eligible for prospective payment
as a long-term care hospital, a long-term care hospital must
discharge the percentage established in paragraph (4) of each
hospital's total patients who are entitled to benefits under
part A and who were admitted with one or more of the medical
conditions specified in paragraph (2).
``(2) Selection of ltc-drgs.--The Secretary shall determine
the long-term care diagnosis related groups (LTC-DRGs) under
section 307(b) of the Medicare, Medicaid, and SCHIP Benefits
Improvement and Protection Act of 2000, that are associated
with a high severity of illness for the following specified
medical conditions:
``(A) Circulatory conditions.
``(B) Digestive, endocrine, and metabolic
conditions.
``(C) Infectious disease.
``(D) Neurological conditions.
``(E) Renal conditions.
``(F) Respiratory conditions.
``(G) Skin conditions.
``(H) Other medically complex conditions as defined
by the Secretary.
``(3) Change to different patient classification system.--
If the Secretary changes the patient classification system for
the long-term care hospital prospective payment system (LTCH
PPS) to a classification system other than the long-term care
diagnosis related group (LTC-DRG) system, the Secretary shall
determine the new patient classification categories that are
associated with a high severity of illness for the medical
conditions specified in paragraph (2) in a manner that
maintains the same proportion of Medicare discharges as the
long-term care diagnosis related groups (LTC-DRGs) in effect at
the time.
``(4) Percentage of medicare patient discharges.--
``(A) In general.--Subject to subparagraph (B), for
each long-term care hospital, the proportion of
discharges from the long-term care diagnosis related
groups (LTC-DRGs) determined under paragraph (2), or
other patient classification categories designated
pursuant to paragraph (3) if applicable, in a cost
reporting year must be a percentage, as determined by
the Secretary, that is not less than 50 percent and not
greater than 75 percent.
``(B) Transition period.--The Secretary shall
provide for a three-year transition period beginning on
October 1, 2007, for hospitals that were certified as
long-term care hospitals before such date. The
applicable proportion of cases in the first year of the
transition period shall be not less than 50 percent.
``(5) Noncompliance.--If a long-term care hospital in a
cost reporting year does not discharge more than the applicable
proportion of cases specified in paragraph (4), then the
hospital must demonstrate in a period of five out of six
consecutive months at the end of the hospital's next cost
reporting year that it meets the applicable proportion of cases
in paragraph (4). If the hospital cannot make such a
demonstration, then the hospital shall be paid for all cases
after the hospital's next cost reporting year as a subsection
(d) hospital under subsection (d).''.
(c) Negotiated Rulemaking to Develop LTCH Facility and Patient
Criteria.--The Secretary shall promulgate regulations to carry out the
amendments made by this section on an expedited basis and using a
negotiated rulemaking process under subchapter III of chapter 5 of
title 5, United States Code.
(d) Effective Date.--The amendments made by this section shall
apply to discharges occurring on or after October 1, 2007.
SEC. 4. LTCH QUALITY IMPROVEMENT INITIATIVE.
(a) Study to Establish Quality Measures.--The Secretary shall
conduct a study (in this section referred to as the ``study'') to
determine appropriate quality measures for Medicare patients receiving
care in LTCHs.
(b) Report.--Not later than October 1, 2007, the Secretary shall
submit to Congress a report on the results of the study.
(c) Selection of Quality Measures.--Subject to subsection (e), the
Secretary shall choose 3 quality measures from the study to be reported
by LTCHs.
(d) Requirement for Submission of Data.--
(1) In general.--LTCHs must collect data on the three
quality measures chosen under subsection (c) and submit all
required quality data to the Secretary.
(2) Failure to submit data.--Any LTCH which does not submit
the required quality data under paragraph (1) to the Secretary
in any fiscal year shall have the applicable LTCH market basket
under section 1886 reduced by not more than 0.4 percent for
such year.
(e) Expansion of Quality Measures.--The Secretary may expand the
number of quality indicators required to be reported by LTCHs under the
study. If the Secretary adds other measures, the measures shall reflect
consensus among the affected parties. The Secretary may replace any
measures in appropriate cases, such as where all hospitals are
effectively in compliance or where measures have been shown not to
represent the best clinical practice.
(f) Availability of Data to Public.--The Secretary shall establish
procedures for making the quality data submitted under this section
available to the public.
SEC. 5. CONFORMING LTCH PPS UPDATES TO THE INPATIENT PPS.
(a) Requiring Annual Updates of Base Rates and Wage Indices and
Annual Updates and Reweighting of LTC-DRGs.--The second sentence of
section 307(b) of the Medicare, Medicaid, and SCHIP Benefits
Improvement and Protection Act of 2000 is amended by inserting before
the period at the end the following: ``, and shall provide (consistent
with updating and reweighting provided for subsection (d) hospitals
under paragraphs (2)(B)(ii), (3)(D)(iii), and (3)(E) of section 1886(d)
of the Social Security Act) for an annual update under such system in
payment rates, in the wage indices (in a budget neutral manner), in the
classification and reweighting (in a budget neutral manner) of the
diagnosis-related groups applied under such system''. Pursuant to the
amendment made by the preceeding sentence, the Secretary shall provide
annual updates to the LTCH base rate, as is specified for the IPPS at
section 1886(d)(2)(B)(ii) of the Social Security Act (42 U.S.C.
1395ww(d)(2)(B)(ii)). The Secretary shall annually update and reweight
the LTC-DRGs under section 307(b) of the Medicare, Medicaid, and SCHIP
Benefits Improvement and Protection Act of 2000 or an alternative
patient classification system in a budget neutral manner, consistent
with such updating and reweighting applied under section
1886(d)(3)(D)(iii) of the Social Security Act (42 U.S.C.
1395ww(d)(3)(D)(iii)). The Secretary shall annually update wage levels
for LTCHs in a budget neutral manner, consistent with such annual
updating applied under section 1886(d)(3)(E) of the Social Security Act
(42 U.S.C. 1395ww(d)(3)(E)).
(b) Elimination of One-Time Budget Neutrality Adjustment.--The
Secretary shall not make a one-time prospective adjustment to the LTCH
PPS rates under section 412.523(d)(3) of title 42, Code of Federal
Regulations, or otherwise conduct any budget neutrality adjustment to
address such rates during the transition period specified in section
412.533 of such title from cost-based payment to the prospective
payment system for LTCHs.
(c) No Application of 25 Percent Patient Threshold Payment
Adjustment to Freestanding LTCHs.--The Secretary shall not extend the
25 percent (or applicable percentage) patient threshold payment
adjustment under section 412.534 of title 42, Code of Federal
Regulations, or any similar provision, to freestanding LTCHs.
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