Long-Term Acute Care Hospitals

Long-Term Acute Care Hospitals (LTCH) specialize in treating critically ill patients, including those dependent on ventilators for life support, patients with complex wounds, and patients with multiple organ system failure who require extended treatment in hospital settings.  LTCHs are an indispensable provider in the post-acute spectrum of care.

In December 2013, Congress enacted legislation long advocated by the FAH, establishing patient criteria governing payment for patients admitted to an LTCH.  Effective with cost report periods after October 1, 2015, patients are considered LTAC “appropriate” and covered under the LTCH prospective payment system if they meet either one of two criteria: 

  • Patients with 3 or more days in an acute care hospital Intensive Care Unit (ICU)
  • Patients receiving “prolonged mechanical ventilation” (greater than 96 hours) in the LTAC.   

Other patients may still be admitted to LTACs receiving a rate that is either at cost of care, or at a per diem rate comparable to payments made to acute care hospitals under the IPPS payment system.

Going forward, it is essential that CMS implement LTCH patient criteria legislation in a manner that meets the spirit and intent of Congress when it enacted the enabling legislation.