The Centers for Medicare & Medicaid Services (CMS) recently released a final rule to update the Medicare fee-for-service (FFS) long term care hospital (LTCH) prospective payment system for fiscal year (FY) 2024.
Specifics of the rule include the following:
- Provides a net 3.6% increase from $46,433 to $48,116 for LTCHs that meet the CMS quality program reporting (QPR) requirements. LTCHs that fail to meet these requirements are subject to a two percentage point reduction to the annual update.
- Increases the high-cost outlier (HCO) threshold for standard LTCH cases by 55% from the current $38,518 to $59,873 (instead of the proposed $94,378) to achieve the target of paying roughly 8% of aggregate LTCH payments as HCO payments. This increase will result in a decrease in the number of cases qualifying for an outlier payment.
- Pays all site-neutral cases at the site neutral rate following the May 11, 2023, expiration of the public health emergency, which ended the requirement that all LTCH cases be paid based on the standard LTCH rate regardless of whether they met LTCH criteria.
- Updates the cost outlier threshold for site-neutral cases to the inpatient PPS finalized threshold of $42,750, up 10% from the current $38,859 threshold.
- Updates the LTCH quality reporting program (QRP) by adopting two new measures, modifying the COVID-19 Vaccination Coverage among Healthcare Personnel measure and removing two measures.
- Increases the data completion threshold beginning with the FY 2026 LTCH QRP. The CMS will require LTCHs to report 100% of the required quality measure data and standardized assessment data collected using the LTCH CARE Data Set tool on at least 85%, up from the current 80%, of assessments submitted to the CMS. LTCHs that fail to meet this requirement will be subject to a two percentage point reduction to their applicable annual update.
The MHA continues to review the final rule and will provide hospitals with an estimated impact analysis in the near future.
Members with questions should contact Vickie Kunz at the MHA.