The Centers for Medicare & Medicaid Services (CMS) has issued the
final rule for the long-term care hospital (LTCH) prospective
payment system (PPS) for federal fiscal year (FFY) 2020. The
provisions of the final rule will be effective Oct. 1, 2020.
Below are highlights of the final rule.
As provided in the FFY 2016 final rule, LTCHs are reimbursed
under a dual-rate system; patients who meet specified criteria
are reimbursed by the LTCH PPS standard federal payment amount
and remaining patients are reimbursed at the lower site-neutral
payment rate. Implementation of the dual-rate payment system
included a transition period during which facilities received a
blended rate. For cost reporting periods beginning in FFY
2020, the transition period will end and LTCHs will be paid
exclusively on the site-neutral payment rate for patients
who do not meet LTCH PPS criteria.
Overall, CMS projects that LTCH PPS payments will increase by
approximately 1%, or $43 million. For cases reimbursed at the
site-neutral rate, CMS projects a decrease of approximately
CMS finalizes several proposals relating to the LTCH Quality
Reporting Program (QRP), including the addition of several
standardized patient assessment data elements (SPADEs), several
of which address social determinants of health. CMS also
finalizes two new measures addressing transfer of health
information and changes the existing “Discharge to Community”
measure to exclude baseline nursing home residents.