Despite winning concessions on the allowed levels of self-referrals to their own long-term care units, some long-term care hospitals are pressing forward for even more changes in a new payment rule. The Centers for Medicare & Medicaid Services issued a revised final rule August 2.

CMS still is relying on a patient-quota system that will force the closing of some facilities, hospital advocates say. They favor a proposal floated by the Medicare Payment Advisory Commission in April.

Taking up the facilities’ cause have been some key lawmakers, including House Ways and Means Health Subcommittee Chairwoman Nancy L. Johnson (R-CT).

The number of long-term care hospitals mushroomed to 318 during the decade ending 2003, according to federal statistics.  Medicare spending on them rose to  $1.9 billion in 2001 from $398 million in 1993.