Medicare Payment Policy

Long-term care hospital
services
Chapter summary
Long-term care hospitals (LTCHs) furnish care to beneficiaries who need
hospital-level care for relatively extended periods. To qualify as an LTCH for
Medicare payment, a facility must meet Medicare’s conditions of participation
for acute care hospitals, and its Medicare patients must have an average length
of stay greater than 25 days. In 2011, Medicare spent $5.4 billion on care
furnished in 424 LTCHs nationwide. About 123,000 beneficiaries had almost
140,000 LTCH stays. On average, Medicare accounts for about two-thirds of
LTCHs’ discharges.
Assessment of payment adequacy
Beneficiaries’ access to care—We have no direct measures of beneficiaries’
access to LTCH services. Instead, we consider the capacity and supply of
LTCH providers and changes over time in the volume of services they furnish.
• Capacity and supply of providers—In spite of the moratorium imposed
by the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA)
and subsequent amendments, the number of LTCHs filing Medicare cost
reports increased 9.3 percent between 2008 and 2011.
• Volume of services—Controlling for growth in the number of fee-forservice
beneficiaries, we found that the number of LTCH cases rose 2.8
percent between 2010 and 2011, suggesting that access to care increased
during this period.
C H A p t e R 11
In this chapter
• Are Medicare payments
adequate in 2013?
• How should Medicare
payments change in 2014?
Report to the Congress: Medicare Payment Policy | March 2013
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