LTC hospital operators say most wouldn't meet CMS proposed limits

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Facility operators are saying that the Centers for Medicare and Medicaid Services overstepped its authority when it announced a proposal last week that says long-term care hospitals located within another would not be able to accept more than 25% of its patients from its bigger host. Facilities that do not stay within the 25% limit could face lower payments, or lose LTC hospital status under the proposed regulation.

Facility managers instead advocate adopting recommendations from the Medicare Payment Advisory Commission. In late April, MedPAC recommended Congress and CMS define long-term care hospitals by facility and patient criteria and require Quality Improvement Organizations to review patient admissions to these facilities.

The advisory body to Congress made its recommendations after studying figures showing that long-term care hospitals are providing care to patients who could be treated in less costly settings, such as acute care hospitals or skilled nursing facilities.

The general counsel of the National Association of Long-Term Care Hospitals said the majority of long-term care hospitals would not be able to meet CMS' proposed 25% limit. He also questioned whether the federal agency had the authority to possibly switch to the inpatient prospective payment system from the LTCH one.

The CMS proposal was released May 11 and was slated to appear in today's Federal Register. A final rule is expected in late summer.

Medicare spending on long-term care hospitals was $398 million in 1993 and $1.9 billion in 2001. CMS estimates spending will further soar to $2.8 billion this year, thus the push to hold the facilities in check or limit their number.