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COVID-19: Vulnerable Populations
Q & A: Federal waivers for LTCHs

What federal waivers are available specifically for long-term acute care hospitals (LTCHs)? 

Federal legislative and regulatory action has included several important provisions affecting long-term acute hospitals. As the crisis continues and additional areas emerge, additional waivers may be forthcoming. 

CARES Act: On March 26, President Trump signed the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which includes measures of particular importance to the hospitals, including long-term acute care hospitals     

  • Site-Neutral Payment Policy: The CARES Act waives the LTCH site-neutral payment policy, which uses an inpatient prospective payment system (IPPS) level payment rate for lower-acuity patients.
  • 50% Rule”: The CARES Act waives the LTCH “50% rule,” which requires that greater than 50% of patients be paid a standard LTCH PPS rate for the hospital to maintain an LTCH designation.

CMS Blanket Waivers: On March 13, President Trump declared a national emergency, which allows flexibility in requirements for health care providers.  The Centers for Medicare and Medicaid Services (CMS) announced several 1135 Medicare blanket waivers. Hospitals do not need to request an individual waiver to be relieved from compliance with these laws to the extent described in this list. 

  • 25-day Length-of-Stay Calculation: Allows LTCHs to exclude patient stays where they admit or discharge patients in order to meet the demands of the emergency from the 25-day average length-of-stay requirement, which allows them to be paid as LTCHs.

Additional information is available here.  (3/31)  

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