/ en Sat, 26 Apr 2025 03:55:37 -0500 Tue, 15 Apr 25 13:22:45 -0500 /lettercomment/2025-04-15-aha-supports-house-securing-access-care-seniors-critical-condition-act <p>April 15, 2025</p><p>The Honorable Kevin Hern<br>U.S. House of Representatives<br>171 Cannon House Office Building<br>Washington, DC 20515</p><p>The Honorable Brendan Boyle<br>U.S. House of Representatives<br>1502 Longworth House Office Building<br>Washington, DC 20515</p><p>Dear Representatives Hern and Boyle:</p><p>On behalf of our nearly 5,000 member hospitals and health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and our 2,425 post-acute care members, the ���������� Association (AHA) is pleased to support the Securing Access to Care for Seniors in Critical Condition Act (H.R. 1924).</p><p>Long-term care hospitals (LTCHs) play a unique role for Medicare and other beneficiaries by caring for the most severely ill and medically complex patients, who often require extended hospitalization and highly specialized care. LTCHs are critical partners for acute-care hospitals, alleviating capacity for overburdened intensive care units and other parts of the care continuum that would otherwise be further strained without access to LTCHs for these patients.</p><p>Since implementing the dual-rate payment system in 2016, the volume of LTCH standard-rate cases has fallen by approximately 70% from its peak under the prior system, and the number of LTCH providers has decreased by 20%. At the same time, the average acuity of LTCH patients has risen by 20% or more in that same period, and these patients are increasingly consolidated into a limited number of Diagnosis-Related Groups (DRGs).<sup>1</sup> The smaller yet sicker patient population and dwindling reimbursement have created many challenges for LTCHs, as evidenced by the closure of so many of these facilities. The remaining patient pool is notably more acute and costly to treat, resulting in cases increasingly qualifying for high-cost outlier (HCO) payments to compensate for the lack of precision in the DRGs, as so many cases are consolidated into a limited number of DRGs. However, the fixed-loss amount for HCO cases has risen by more than 300% since 2016, forcing LTCHs to take on significant financial losses when caring for these particularly ill patients.</p><p>For these reasons, the AHA supports legislation that would provide more adequate reimbursement to LTCH providers caring for some of Medicare’s sickest beneficiaries. Thank you for your leadership on these important issues to ensure patients have continued access to this vital care.</p><p>Sincerely,</p><p>/s/</p><p>Lisa Kidder Hrobsky<br>Senior Vice President<br>Advocacy and Political Affairs<br>__________</p><p><small class="sm"><sup>1</sup></small><a href=/white-papers/2023-12-29-white-paper-medicares-ltch-outlier-policy-needs-reforms-protect-extremely-ill-beneficiaries" target="_blank"><span><small class="sm"><sup> </sup>/white-papers/2023-12-29-white-paper-medicares-ltch-outlier-policy-needs-reforms-protect-extremely-ill-beneficiaries</small></span></a></p> Tue, 15 Apr 2025 13:22:45 -0500 Long-term Care <div class="container"><div class="row"><div class="col-md-8"><p>The Centers for Medicare & Medicaid Services (CMS) April 11 issued a <a href="https://www.federalregister.gov/public-inspection/2025-06271/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the">proposed rule</a> for the inpatient and long-term care hospital (LTCH) prospective payment systems (PPS) for fiscal year (FY) 2026. This Regulatory Advisory reviews highlights of the LTCH provisions in the rule, while the inpatient PPS provisions are covered in a separate advisory.</p><div class="panel module-typeC"><div class="panel-heading"><p><strong>KEY HIGHLIGHTS</strong></p><p>The rule proposes to:</p><ul><li>Increase net LTCH payments by 2.5%, or $61 million, in FY 2026, relative to FY 2025, including both standard rate payments and site-neutral payments.<ul><li>CMS proposes to increase standard LTCH PPS payments by 2.2%, or $52 million in FY 2026 relative to FY 2025.</li><li>CMS proposes to increase site-neutral LTCH PPS payments by 8.5%, or $9 million, in FY 2026 relative to FY 2025.</li></ul></li><li>Increase the standard rate fixed-loss amount for high-cost outlier (HCO) cases from $77,048 in FY 2025 to $91,247 for FY 2026.</li><li>Remove four patient assessment data elements from the LTCH quality reporting program (QRP) and modify the COVID-19 vaccine among patients and residents measure.</li></ul></div></div><h2>AHA Take</h2><p>As the AHA said in its <a href="/press-releases/2025-04-14-aha-statement-fy-2026-proposed-ipps-ltch-payment-rule">statement</a> to the media, we are concerned that the proposed payment updates for LTCHs would lead to continued strain on these providers as they care for some of Medicare’s sickest patients. Under the high-cost outlier proposal, LTCHs would be expected to absorb thousands of additional dollars in losses before Medicare would help cover some of the additional cost of caring for extremely ill beneficiaries. Coupled with the minimal proposed market basket update, it would become increasingly difficult for LTCHs to care for these patients and alleviate pressure on their acute-care hospital partners. The AHA looks forward to working with CMS to ensure continued access for these patients.</p><p>Highlights from the rule follow.</p><h2>LTCH PPS PAYMENT CHANGES</h2><p><strong>Overall Proposed FY 2026 Payment Update.</strong> When considering all proposed LTCH provisions in the rule, CMS estimates that aggregate payments for LTCH services would increase by 2.5%, or $61 million, in FY 2026 compared to FY 2025. This includes updates to both the standard rate and site-neutral rates. For purposes of its estimates, CMS assumes that standard-rate cases would account for 90% of LTCH cases, with site-neutral cases accounting for the remaining 10%. CMS says this is the split of cases that it found among LTCH discharges in FY 2024.</p><p><strong>Update for Standard LTCH PPS Rate Cases.</strong> CMS proposes to increase standard rate payments by 2.2%, or $52 million, in FY 2026 relative to FY 2025. This update includes a 3.4% market-basket update that would be offset by a statutorily mandated cut of 0.8 percentage points for productivity. In addition, as discussed further below, CMS proposes to decrease HCO payments as a percentage of total LTCH PPS standard federal payment rate payments by 0.3%.<a href="#_ftn1" title><sup>[1]</sup></a> As a result, the proposed FY 2026 standard rate is $50,728.77, an increase from the current $49,383.26.</p><p><strong>Standard Rate HCO Threshold.</strong> CMS proposes to increase the FY 2026 fixed-loss amount for standard-rate HCO cases to $91,247, an approximate 18% increase over the FY 2025 fixed-loss amount of $77,048. CMS states this increase is necessary to maintain the statutory 7.975% HCO pool. The agency acknowledges the significant proposed increase and requests comments on the proposal.</p><p><strong>Update for Site-neutral Rate Cases.</strong> CMS proposes to increase payments for site-neutral cases by 8.5% (or $9 million) in FY 2026 as compared to FY 2025. Site-neutral cases are paid the lower of the inpatient PPS-comparable per-diem amount, including any outlier payments, or 100% of the estimated cost of the case. Therefore, this update largely reflects CMS’ proposed updates under the inpatient PPS. CMS further estimates that site-neutral payments would make up approximately 4.5% of estimated aggregate FY 2026 LTCH PPS payments. For FY 2026, the proposed HCO threshold for site-neutral cases would continue to mirror that of the proposed inpatient PPS threshold of $44,305.</p><h2>LTCH QUALITY REPORTING PROGRAM</h2><p>Beginning with the FY 2028 LTCH QRP, CMS proposes to remove four standardized patient assessment data elements focused on social determinants of health. This includes one item focused on living situation, two items focused on food insecurity and one item focused on utilities. Additionally, CMS proposes to modify the COVID-19 vaccine among patients and residents measure by excluding patients who expire during the LTCH QRP.</p><p>CMS also asks for input on future LTCH QRP measure concepts, changing deadlines for reporting patient assessment data and advancing digital quality measures in the LTCH QRP.</p><h2>REQUEST FOR INFORMATION: UNLEASHING PROSPERITY THROUGH DEREGULATION OF THE MEDICARE PROGRAM (EXECUTIVE ORDER 14192)</h2><p>On Jan. 31, 2025, President Trump issued Executive Order (EO) 14192, "Unleashing Prosperity Through Deregulation," which states the administration’s policy to significantly reduce the private expenditures required to comply with federal regulations. CMS would like public input on approaches and opportunities to streamline regulations and reduce administrative burdens on providers, suppliers, beneficiaries and other interested parties participating in the Medicare program. The agency has made available an RFI at <a href="https://www.cms.gov/medicare-regulatory-relief-rfi" target="_blank" title="Original URL: https://www.cms.gov/medicare-regulatory-relief-rfi. Click or tap if you trust this link.">https://www.cms.gov/medicare-regulatory-relief-rfi</a> and requests stakeholders to submit all comments in response to this RFI through the provided web link.</p><h2>NEXT STEPS</h2><p>CMS will accept comments on the LTCH proposed rule through June 10.</p><p>Please contact Jonathan Gold, AHA’s senior associate director of policy, at <a href="mailto:jgold@aha.org">jgold@aha.org</a>, with any questions related to payment, and Akin Demehin, AHA’s vice president of quality and safety policy, at <a href="mailto:ademehin@aha.org">ademehin@aha.org</a>, regarding any quality-related questions.</p><div><hr><div id="ftn1"><p><small class="sm"><sup>1</sup>Due to rounding, the 2.6% net market basket update is described as a 2.2% overall update after accounting for the 0.3% reduction in outlier payments. </small></p></div></div></div><div class="col-md-4"><a href="/system/files/media/file/2025/04/cms-releases-fy-2026-long-term-care-hospital-pps-proposed-rule-advisory-4-14-2025.pdf"><img src="/sites/default/files/inline-images/cover-cms-releases-fy-2026-long-term-care-hospital-pps-proposed-rule-advisory-4-14-2025-f_1.png" data-entity-uuid data-entity-type="file" width="1275" height="1662"></a></div></div></div> Mon, 14 Apr 2025 17:30:46 -0500 Long-term Care /press-releases/2025-04-14-aha-statement-fy-2026-proposed-ipps-ltch-payment-rule <p class="text-align-center"><strong>Ashley Thompson</strong><br><strong>Senior Vice President, Public Policy Analysis and Development</strong><br><strong>���������� Association</strong></p><p class="text-align-center"><strong>April 11, 2025</strong></p><p>America’s hospitals and health systems spend too many resources each year on regulatory requirements, forcing many of our clinicians to focus more time completing paperwork than treating patients. The AHA appreciates the Administration’s request for information on approaches and opportunities to streamline regulations and reduce burdens in the Medicare program. We particularly welcome the agency’s emphasis on ways to streamline and focus quality measurement efforts, including by proposing to eliminate the outdated reporting related to staff vaccination rates. We look forward to sharing our ideas and working closely with CMS to further cut down on excessive administrative red tape.</p><p>However, we are disappointed to see that the agency proposed an inadequate inpatient hospital payment update of 2.4%, including of particular concern an extremely high proposed productivity cut of 0.8%. We are very concerned that this update will hurt our ability to care for our communities. Indeed, many hospitals across the country, especially those in rural and underserved communities, already operate under unsustainable financial situations, including negative margins. We urge CMS to reconsider its policy in the final rule to enable all hospitals to provide high-quality, around-the-clock, essential care for their patients and communities.</p><p>Additionally, we appreciate that CMS continues to gather stakeholder feedback and make modifications to the Transforming Episode Accountability Model (TEAM). The AHA has long supported the adoption of value-based and alternative payment models to deliver high-quality care at lower costs; however, we are concerned that TEAM, even with the proposed changes, may force some hospitals to assume more risk than they can manage, threatening their ability to maintain access to quality care. Thus, we continue to urge the agency to make TEAM voluntary.</p><p>Finally, the AHA is concerned that the proposed payment updates for long-term care hospitals (LTCHs) would lead to continued strain on these providers as they care for some of Medicare’s sickest patients. In recent years, the outlier threshold has skyrocketed, forcing LTCHs to absorb tens of thousands of additional dollars in losses before Medicare will help cover some costs of extremely ill beneficiaries. CMS’ proposal this year to increase this threshold even more — by an additional $14,199 — coupled with its minimal proposed market basket update, would make it increasingly difficult for LTCHs to care for these patients and alleviate pressure on their acute-care hospital partners. The AHA looks forward to working with CMS to ensure continued access for these patients.</p><p class="text-align-center">###</p> Mon, 14 Apr 2025 08:41:37 -0500 Long-term Care /guidesreports/2025-02-14-aha-commissioned-report-challenges-inappropriate-conclusions-regarding-long-term-care-hospitals <div class="container"><div class="row"><div class="col-md-8"><p>The ���������� Association (AHA) released a new analysis conducted by the prominent health care economics and policy consulting firm Dobson DaVanzo & Associates, LLC (Dobson). The analysis critiques the findings of an academic paper that misconstrues the facts and draws faulty conclusions regarding the role of long-term care hospitals (LTCHs).<sup>1</sup> Specifically, in its comprehensive critique of the paper by Einav and colleagues (Einav paper), Dobson’s economists and analysts rebut the findings and implications of the paper by analyzing the data, assumptions, econometric approach and methodologies. Ultimately, Dobson found that the conclusions reached by the study are not warranted and represent an overreach of the facts.</p><p>LTCHs play an important and unique role for Medicare and other beneficiaries by caring for the most severely ill patients who require extended hospitalization. As discussed in the Dobson analysis, LTCHs offer an intensive level of care that is not normally provided in other post-acute care settings. LTCH patients are typically very medically complex, with multiple organ failures, and stay in the LTCH on average at least 25 days. Many LTCH patients depend on ventilators due to respiratory failure or similar ailments, which require highly specialized care. In addition, LTCHs are critical partners for acute-care hospitals, alleviating capacity for overburdened intensive care units and other parts of the care continuum that would otherwise be further strained without access to LTCHs for these patients.</p><p>Dobson’s report identified numerous shortcomings in the Einav paper. Some of the most problematic include:</p><ul><li>Use of data that is more than 10 years old, despite dramatic payment reforms and other changes in the field since that time.</li><li>Weak assumptions about substitutability of LTCH care with non-hospital care provided in skilled-nursing facilities.</li><li>Narrowly defined outcomes that do not include the totality of health spending or care outcomes for Medicare beneficiaries.</li><li>Econometric shortcomings involving sensitivity analysis, misspecification errors, variable bias and others.</li><li>Research that contradicts the paper’s findings and which supports the value and unique role that LTCHs fulfill in caring for beneficiaries.</li><li>Bias and other weakness with the external and internal validity of the paper.</li><li>Failure to consider alternative factors that contribute to the observed variations in spending.</li></ul><p>Dobson’s critique of these defects in the Einav paper underscores the importance of not using it to support policymaking or other decisions regarding the Medicare program. Instead, policymakers should consider the input of the doctors and other experts who support the LTCHs role in the care continuum for severely ill patients.</p><p>For questions or more information about this report, please contact Jonathan Gold, AHA’s senior associate director of post acute payment policy, at <a href="mailto:jgold@aha.org">jgold@aha.org</a>. </p><p>__________<br><small><sup>1</sup> Liran Einav, Amy Finkelstein & Neale Mahoney, July 2023. "Long-Term Care Hospitals: A Case Study in Waste," The Review of Economics and Statistics, MIT Press, vol. 105(4), pages 745-765.</small></p><div><p class="text-align-center">###</p><p><strong><u>About the ���������� Association (AHA)</u></strong></p><p>The ���������� Association (AHA) is a not-for-profit association of health care provider organizations and individuals committed to improving their communities' health. The AHA advocates on behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups. Founded in 1898, the AHA provides insight and education for health care leaders and is a source of information on health care issues and trends. For more information, visit the AHA website at <a href="https://nam11.safelinks.protection.outlook.com/?url=http%3A%2F%2Flink.mediaoutreach.meltwater.com%2Fls%2Fclick%3Fupn%3DOYJSCMTyBhNCCTfI0zdwszOYn3sJE-2FXqs5pFQbQToVu1czeS7DyxR-2FigHWVFiRY4Oo6oAgJXLD947TA-2BGEZyx1U-2BxMxhwGCmeu3hpBv62ixi4Gaoj3ungeoEa3-2FYAHGK3BHm7IClPMOpqGGuehZcHKd2iz31UD7RKmKyCEcMXRTnoh8yBlJu8acmYAALrp6EOP-2Ft3cnmMdvK5nqZdJSXLePqsym9B6l3-2FhTMq7-2Bb8JosjEZoUHARSNRXcRhjtYuUW8b3Ruh3OnqTtP1rycsXtU4hb5fYexe1wss235Q3FCy9uHmriYCFIBuZf8PnpO5pyRJ-2FfmPIBok22615K4oIqgUtbmSmoQxAPJDlI7OGQnCH5suHHwqHxLuBPxjhw3x0S-2BOlVbfr1tyv5q4WDmwhJfnRB1I2CVYvbzsfDnVWzRIoFI5EC2XZl5-2BaBihF3e-2FZvUWbpesKDlmo2VQLhaEk7M6hRO-2FHBlIG-2BTjT7VkJw709CcEkALVTPDz8y0UzEZs0GoIuPdJHeZARIbFOa9gR6fjMkrPAI6LO9FTom-2BexnSp9GQ4l5mmgXaZ7CsIwtMrheRImxdy5MBp05eji1HpT-2FNeN3hN6rYbIdat8ariKfBzqMjtOAgMDnZCRiHvatebOaiSETOoI2jYpwKKhpJNfNHrF0zx672dz7CsT5YmZ5HXzolBt0R012j2tkbYqtPNOY8oBz1wGPjBnTq9EPST8F-2BW8-2FYikePbYBMDgUMo0nlUeQBC8AZre7rJcTTITJnjl-2BNiFadG9NwKiA-2FxQgjk7VqHqHGjMpXr5hphWufxQss37NhkSCN3PHCfPGELMAyVsuWEKFwhoII57va6Oc-2FP5fsy4s0pxWYIqbY7TFBxC4wv2vIQPbuK-2Ffgk92daVI0JbCyEOx-2BFh5dH28vCEzpcdfxN7krdKp1FgVQ77i4Sezf0l7WnGrdsLMGXrQAqt9yGU-2BRKCi2ifh3BBnB5JbeuGETPkYqxtKSPZi-2BtIy8eF9puF4krxKbkq8cKiKnElAahdVAnleE-2FzQ7bHPiUMu3JZ72gbqCPI5qXrELa9W2-2Fu-2FiJArYirVKXaV8uTZytnN7QZGhEDdUUzOBh5hjtGiUnGFG-2FbedfAFF738UgbctI6-2F6LwvaxUTT-2F3f5-2BYAtNOA3gFIkr0YZI-2Bkp0pooE3R22sTgBSNmdXiivkpApx6Ei-2BDX8-3D3DAA_kFmn947cPXeH4Nw5FKo9qWRARJUhwQXnY03SXbOJmd4fh-2FMf2fOpasllheBrYb-2F8tnjtjNDujBrG4uugreK5OWkDI227pG8YPlYGd-2Boz0WRezRdoSQJc-2FP-2FpAltWiLE9pScP81GIyVR1BztpaUmvq4E4zMoLikDKB7qk7SlL1-2FSGTuq0Bu0R3sCFv0AlEvmdDd75oyZbY7RlObuKy8esCENzQALhVZozv7LMFYFbh6FoAftC2xff7B2RF1o4DyYa8Yk0qnye3e4M7f-2FLTDmb41Sre88XiBBVGOfI8xGJkG97-2FD0XhYt4wg6fI0ygMcU4RnkuCvJp-2FGmWHgxvA8ix-2B09NZaMuyjMcnGo-2FFsPDtVZB0niWZpguf-2FSbdPRwWfez&data=05%7C01%7Ccmilligan%40aha.org%7Ce2604527eb3f4875ea0a08da552477fc%7Cb9119340beb74e5e84b23cc18f7b36a6%7C0%7C0%7C637915912395382238%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=jDbJ5gw8UdYtaVoma4Dn5DzDDHMI494FNLdQQh">www.aha.org</a>. </p><div id="ftn1"> </div></div></div><div class="col-md-4"><a href="/system/files/media/file/2025/02/aha-commissioned-report-challenges-inappropriate-conclusions-regarding-long-term-care-hospitals.pdf"><img src="/sites/default/files/inline-images/cover-aha-commissioned-report-challenges-inappropriate-conclusions-regarding-long-term-care-hospitals.png" data-entity-uuid="4a657bb1-635e-42a4-be73-743de1a4db5d" data-entity-type="file" alt="Cover Image of AHA Commissioned Report" width="682" height="882"></a></div></div></div> Fri, 14 Feb 2025 14:15:03 -0600 Long-term Care /news/headline/2024-10-24-aha-files-brief-challenging-cms-minimum-staffing-rule-nursing-homes <p>The AHA Oct. 24 filed a friend-of-the-court <a href="/amicus-brief/2024-10-24-amicus-brief-ahatha-nurse-staffing-rule-amicus-brief-ahca-v-becerra-litigation">brief</a> in the U.S. District Court for the Northern District of Texas, in a case challenging the Centers for Medicare & Medicaid Services' minimum staffing mandate for nursing homes. CMS' new rule requires all nursing homes to have an RN onsite and available to provide direct resident care 24/7. Other requirements of the rule include minimum hours per day: 0.55 hours for RNs, 2.45 hours for nursing assistants and 3.48 hours for total nurse staffing. AHA opposes the mandate, arguing that it "is not just an overly simplistic and costly solution to the nursing shortage; it is no solution at all."  <br>  <br>"CMS’s modest characterization of the mandate as supplying a 'minimum baseline' applicable to every facility is belied by the data: 79% of long-term-care facilities will need to increase staff above current levels to meet the new thresholds, which exceed the existing requirements in 'nearly all States,'" AHA wrote. "Its unfunded, across-the-board mandate not only is incapable of mitigating the nursing shortage but also is counterproductive. Nursing homes may be forced to reach compliance by increasing demands on their existing staff (fueling additional burnout), or hiring more staff from a limited labor pool (reducing the availability of qualified staff for all healthcare providers)." <br><br>The AHA last year <a href="/lettercomment/2023-10-26-aha-comments-long-term-care-facility-minimum-staffing-proposed-rule">urged</a> CMS not to finalize the mandate but instead develop more patient- and workforce-centered approaches focused on ensuring a continual process of safe staffing in nursing facilities.</p> Thu, 24 Oct 2024 15:19:00 -0500 Long-term Care /press-releases/2024-08-01-aha-statement-fy-2025-final-ipps-ltch-payment-rule <p class="text-align-center"><strong>Molly Smith</strong><br><strong>Group Vice President for Public Policy</strong><br><strong>���������� Association</strong></p><p class="text-align-center"><strong>August 1, 2024</strong></p><p>CMS’ payment updates for hospitals will exacerbate the already unsustainable negative or break-even margins many hospitals are already operating under as they care for their patients. The AHA is deeply concerned about the impact these inadequate payments will have on patient access to care, especially in rural and underserved communities.</p><p>We are troubled that the final long-term care hospital outlier threshold is nearly 30% higher than it is currently. Since FY 2021, this figure has increased by more than 180%, which forces these hospitals to absorb hundreds of thousands of dollars in additional losses when caring for the sickest patients. This increase will create serious access issues for patients and put additional burden back on acute-care hospitals and other providers that do not specialize in caring for this unique patient population.</p><p>In addition, while the AHA has long supported widespread adoption of meaningful value-based and alternative payment models to deliver high quality care at lower costs, the rule’s mandatory bundled payment model for five different surgical episodes will not advance these objectives. Not only is the model extremely similar to other bundled payment approaches that have failed to meet the statutory criteria for expansion as they have not reduced program costs or generated net savings, it puts at particular risk many hospitals that are not of an adequate size or in a position to support the investments necessary to succeed. <br> </p><p class="text-align-center">###</p> Thu, 01 Aug 2024 17:49:21 -0500 Long-term Care /news/headline/2024-08-01-cms-issues-ltch-final-rule-fy-2025 <p>The Centers for Medicare & Medicaid Services Aug. 1 <a href="https://www.federalregister.gov/public-inspection/2024-17021/medicare-medicaid-and-childrens-health-insurance-programs-hospital-inpatient-prospective-payment">finalized policy changes</a> to the long-term care hospital standard rate payment system that will increase payments by 2.0%, or $45 million, in fiscal year 2025 relative to FY 2024. This includes a 3.0% market basket update, a cut of 0.5 percentage points for productivity, and a cut related to outlier payments, among other policies. Specifically, due to an increase in the outlier threshold, CMS will reduce outlier payments as a percentage of total LTCH PPS standard federal payment rate payments by 0.8%. CMS also finalized a rebasing of the LTCH market basket using a 2022 base year.  </p><p> <br>In a statement shared with the <a href="/press-releases/2024-08-01-aha-statement-fy-2025-final-ipps-ltch-payment-rule">media</a>, Molly Smith, AHA group vice president for public policy, said, “We are troubled that the final long-term care hospital outlier threshold is nearly 30% higher than it is currently. Since FY 2021, this figure has increased by more than 180%, which forces these hospitals to absorb hundreds of thousands of dollars in additional losses when caring for the sickest patients. This increase will create serious access issues for patients and put additional burden back on acute-care hospitals and other providers that do not specialize in caring for this unique patient population.”</p><p>While CMS did not adopt or remove any quality measures from the LTCH Quality Reporting Program, the agency finalized its proposal to adopt and modify certain patient assessment items related to health-related social needs; LTCHs will be required to collect and report specific data elements related to living situation, food and utilities beginning with the FY 2028 LTCH QRP. CMS also extends the window in which patient assessments must be done from three to four days after admission.</p><p>Provisions of the final rule generally take effect Oct. 1. </p> Thu, 01 Aug 2024 17:00:48 -0500 Long-term Care /protectLTCH <div class="container"><div class="row"><div class="col-md-8"><p>The federal agency that oversees the Medicare program (CMS) recently announced a proposed change in the long-term care hospital (LTCH) high-cost outlier payment policy. As a result, LTCHs are being asked to incur greater and greater losses as they care for severely ill patients. LTCHs play an important role for Medicare patients by caring for those who need extended stays in a hospital. If more LTCHs close, general hospitals will have to keep these patients in their ICUs. The nation already faces a shortage of ICU beds. The AHA calls on policymakers to take action to ensure LTCHs can continue caring for the sickest patients and serving their communities</p><div class="panel module-typeC"><div class="panel-heading"><h3 class="panel-title"><span>Resources</span></h3></div><div class="panel-body"><p><a href="/special-bulletin/2024-08-02-cms-releases-fy-2025-long-term-care-hospital-pps-final-rule" target="_blank" title="Ppecial Bulletin: CMS Releases FY 2025 Long-term Care Hospital PPS Final Rule">Special Bulletin: CMS Releases FY 2025 Long-term Care Hospital PPS Final Rule</a></p><p><a href="/white-papers/2023-12-29-white-paper-medicares-ltch-outlier-policy-needs-reforms-protect-extremely-ill-beneficiaries" target="_blank" title="White Paper: Medicare's TLCH Oulier Policy Needs Reforms to Protect Extremely Ill Beneficiaries">White Paper: Medicare’s LTCH Outlier Policy Needs Reforms to Protect Extremely Ill Beneficiaries</a></p><p><a href="/lettercomment/2024-06-07-aha-comment-cmss-fiscal-year-2025-ltch-prospective-payment-system-proposed-rule" target="_blank" title="AHA Comment on the CMS' Fiscal Year 2025 LTCH PPS Rule">AHA Comment on the CMS' Fiscal Year 2025 LTCH Prospective Payment System Proposed Rule</a></p><p> </p></div></div></div><div class="col-md-4"><p><img src="/sites/default/files/inline-images/Long-Term-Care-Hospitals-Print-ad.png" data-entity-uuid="fea4e0d9-bf94-4860-962a-ebd6ef9f9ff5" data-entity-type="file" alt="New CMS policy could jeopardize services for severely ill patients. Tell Congress to ensure long-term care hospitals can continue caring for our nation’s sickest. We Must Protect Patients. For more information, visit AHA.org/ProtectLTCH." width="900" height="621"></p></div></div></div> Thu, 04 Jul 2024 23:06:30 -0500 Long-term Care /news/headline/2024-06-25-aha-urges-senate-house-members-halt-enforcement-nurse-staffing-mandate <p>The AHA June 24 sent letters to <a href="/lettercomment/2024-06-24-aha-letter-senator-lankford-expressing-support-congressional-review-act-cra-resolutions">Senate</a> and <a href="/lettercomment/2024-06-25-aha-letter-reps-fischbach-and-pence-expressing-support-congressional-review-act-cra-resolutions">House</a> members supporting legislation that would prevent enforcement of the Centers for Medicare & Medicaid Services’ final rule on minimum staffing requirements for long-term care facilities. In the letters, AHA expressed concerns that the requirements would stymie innovation in care delivery and potentially lead nursing homes to reduce capacity or close, including those performing well on quality and safety metrics. <br><br>"Even more troubling, this final rule could lead to delays in urgent medical care as patients coming into hospital emergency departments (EDs) may experience longer waits as EDs and inpatient beds are occupied by patients awaiting nursing home placements." AHA wrote. "Lastly, we believe this final rule could exacerbate the already serious shortages of nurses and skilled health care workers across the care continuum. The agency estimates that 79% of LTC facilities would have to increase staffing to meet the proposed standards, including the new standard requiring 24/7 RN staffing."</p> Tue, 25 Jun 2024 16:01:05 -0500 Long-term Care /lettercomment/2024-06-25-aha-letter-reps-fischbach-and-pence-expressing-support-congressional-review-act-cra-resolutions <p>June 24, 2024</p><table><tbody><tr><td>The Honorable Michelle Fischbach<br>U.S. House of Representatives<br>1004 Longworth House Office Building<br>Washington, DC 20515</td><td>The Honorable Greg Pence<br>U.S. House of Representatives<br>404 Cannon House Office Building<br>Washington, DC 20515</td></tr></tbody></table><p>Dear Representatives Fischbach and Pence:</p><p>On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the ���������� Association (AHA) writes in support of H.J.Res. 139, a joint resolution for congressional disapproval of a rule relating to<strong> "Medicare and Medicaid Programs; Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting."</strong></p><p>The AHA and its members are committed to safe staffing to ensure high-quality, equitable and patient-centered care in all health care settings, including long-term care (LTC) facilities. Yet, the process of safely staffing any health care facility is about much more than achieving an arbitrary number set by regulation. It requires clinical judgment and flexibility to account for patient needs, facility characteristics, and the expertise and experience of the care team. The Centers for Medicare & Medicaid Services’ (CMS) one-size-fits-all minimum staffing rule for LTC facilities creates more problems than it solves and could jeopardize access to all types of care across the continuum, especially in rural and underserved communities that may not have the workforce levels to support these requirements.</p><p>Safe staffing is complex and dynamic. It must account for the acuity of the patients’ needs, the experience and clinical expertise of the nurses and health care professionals on the care team, and the technical capabilities of the facility. Mandated nurse staffing standards remove from the practice of nursing real-time clinical judgment and flexibility. Numerical staffing thresholds do not consider advanced capabilities in technology or the interprofessional team care model that supports data-driven decision-making and collaborative practice. Emerging care models incorporate nurses at various levels of licensure, respiratory therapists, occupational therapists, speech-language pathologists, physical therapists and case managers. A simple mandate of a base number of registered nurse (RN) and nurse aide hours per resident day emphasizes staff roles of yesterday, rather than what current and emerging practices may show is most effective and safe for the patient, and best aligned with the capabilities of the care team. AHA is concerned that these rigid standards will stymie innovation in care delivery.</p><p>The AHA also is concerned that this final rule could lead nursing homes to reduce capacity or close outright, including those that are otherwise performing well on quality and safety metrics. The loss of these nursing home beds could adversely impact patients who have completed their hospital treatment and need continuing care in nursing facilities. The AHA <a href="/system/files/media/file/2022/12/Issue-Brief-Patients-and-Providers-Faced-with-Increasing-Delays-in-Timely-Discharges.pdf" target="_blank">has already documented</a> rising lengths of stay for hospital patients in need of skilled post-acute care, with patients waiting days, weeks or even months for post-acute care placements. As those patients continue to occupy hospital beds, other patients awaiting elective surgeries or other scheduled procedures may find their care disrupted because there is no bed for them in the hospital. Even more troubling, this final rule could lead to delays in urgent medical care as patients coming into hospital emergency departments (EDs) may experience longer waits as EDs and inpatient beds are occupied by patients awaiting nursing home placements. The AHA <a href="/lettercomment/2023-10-26-aha-comments-long-term-care-facility-minimum-staffing-proposed-rule" target="_blank">urged</a> CMS not to finalize the rule and to instead focus on developing more patient and workforce-centered approaches to safely staff nursing facilities.</p><p>Lastly, we believe this final rule could exacerbate the already serious shortages of nurses and skilled health care workers across the care continuum. The agency estimates that 79% of LTC facilities would have to increase staffing to meet the proposed standards, including the new standard requiring 24/7 RN staffing. Considering the massive structural shortages described by recent studies, it is unclear from where this supply of nurses will come, and it is inconceivable that LTC facilities will be able to meet these standards without detrimental effects to workforce availability throughout the care continuum. Strengthening the health care workforce requires investment and innovation, not inflexible mandates. <strong>Therefore, AHA supports H.J.Res 139 for Congress to disapprove this rule and prohibit the Secretary of Health and Human Services from implementing or enforcing this rule.</strong></p><p>Sincerely,<br>/s/<br>Stacey Hughes<br>Executive Vice President</p><p> </p> Mon, 24 Jun 2024 17:16:00 -0500 Long-term Care