The Centers for Medicare & Medicaid Services late today issued its long-term care hospital prospective payment system proposed rule for fiscal year 2018. Under the proposed rule, traditional LTCH PPS rates would increase by a net of 0.4%, while payment rates for site-neutral cases would decrease by a net of 22%. After accounting for all the rule’s provisions, LTCH payments are estimated to decrease by 3.75% ($173 million) compared to FY 2017 payment levels. In addition, during FY 2018, CMS proposes a regulatory moratorium on the 25% Rule so that it can evaluate whether the policy is still needed; this proposal would increase payments by $65 million. “Today’s rule outlines some promising proposals intended to reduce regulatory barriers for hospitals, health systems and the patients they serve,” said AHA Executive Vice President Tom Nickels. “Specifically, we are extremely pleased with the proposed regulatory moratorium on the implementation of the 25% Rule for long-term care hospitals that will allow CMS time to determine if the policy is still necessary.” In addition, CMS proposes to pay all short-stay outlier cases a graduated per diem that blends the IPPS and LTCH amounts to remove the financial incentive to delay discharge. The rule also proposes a number of changes to the FY 2020 LTCH Quality Reporting Program. Specifically, the agency would add measures assessing pressure ulcer changes, compliance with a spontaneous breathing trial, and ventilator liberation rates. CMS also proposes to remove an existing pressure ulcer measure, and a measure assessing all-cause readmissions within 30-days of LTCH discharge. In addition, CMS would require LTCHs to collect certain standardized patient assessment data beginning with LTCH admissions on or after April 1, 2018 to meet the requirements of the Improving Medicare Post-Acute Care Transformation Act of 2014. The proposed rule will be published in the April 28 Federal Register and comments will be accepted through June 13. AHA members will receive a Special Bulletin with further details. 

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