Medicare FY 2019 Payment Rule Finalized for Long-term-care Hospitals

Posted on August 07, 2018

On Aug. 2, the Centers for Medicare & Medicaid Services released the final rule to update the Medicare fee-for-service, long-term-care hospital (LTCH) prospective payment system (PPS) for fiscal year (FY) 2019. Highlights of the final rule include:

  • Permanent elimination of the 25 percent threshold policy in FY 2019. Currently, this policy reduces payment amounts to LTCHs that admit more than a certain threshold of Medicare patients from an on-site or neighboring inpatient acute care hospital during a single cost reporting period. The MHA, along with the American Hospital Association and others, have long advocated for the elimination of this threshold. 
  • A net 0.4 percent increase in the standard federal rate for facilities that successfully participate in the LTCH quality reporting program (QRP) and are meaningful users of electronic health records in FY 2019. This includes a 0.9 percent cut to maintain budget neutrality after eliminating the 25 percent rule.
  • Continuation of the statutorily mandated two-tiered payment system, which includes a standard LTCH PPS component for higher acuity cases and a site-neutral payment component for lower acuity cases.
  • A high-cost outlier threshold of $27,124 for standard rate cases, down from the current $27,381. For site-neutral cases, the high-cost outlier threshold will continue to mirror that of the inpatient PPS, which is $25,769, down from the current $26,601. These changes will result in slightly more cases qualifying for an outlier payment. 
  • Removal of three measures from the LTCH QRP.  Effective Oct. 1, 2018, LTCHs will no longer have to report data for the National Healthcare Safety Network (NHSN) facilitywide inpatient hospital-onset methicillin-resistant Staphylococcus aureus bacteremia outcome measure, the NHSN ventilator-associated event outcome measure or the seasonal vaccination measures.

The MHA soon will distribute updated facility-specific impact analyses to members with LTCH operations. Members with questions should contact Vickie Kunz at the MHA.

Tags: Medicare, LTCH, PPS, final rule

Posted in: Member News

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