reimbursement@wiki

 

On October 1, 2002, CMS implemented, through the Federal Register (August 30, 2002; http://www.access.gpo.gov/su_docs/fedreg/a020830c.html), a PPS for Long Term Care Hospitals (LTCHs) under the Medicare program in accordance with provisions of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act (BBRA) of 1999, as amended by the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act (BIPA) of 2000.

The LTCH prospective payment system uses Federal prospective payment rates across 499 distinct LTC-DRGs. We have established a standard Federal payment rate based on the best available LTCH cost data. LTC-DRG relative weights are applied to the standard Federal rate to account for the relative differences in resource use across the LTC-DRGs.  (67 Fed Reg 55983)

 

CMS Info -- Long-Term Care PPS

• Overview.  The MS-LTC-DRGs are the same DRGs used under the IPPS, but they have been weighted to reflect the resources required to treat the type of medically complex patients characteristic of LTCHs. Relative weights for the MS-LTC-DRGs reflect resource utilization for each diagnosis and account for the variation in cost per discharge.
• (attached)  Medicare National Average Payment Amounts for MS-LTC-DRGs (2008)
• MS-LTC-DRG files
• • FY 2008  (Standard Federal rate = $38,356.45)

 

Analyses

• Adequacy of payments for long-term care hospital services (MedPAC, December 2007)
• The Impact of the Long-Term Acute Care Hospital (LTCH) Final Rule for 2008 (Health Dimensions Group, 2007)

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