Acute Care: Long Term Care Hospital (LTCH)
Guidelines for admission
Long term care hospitals (LTCHs) are certified as hospitals and are intended to treat medically complex patients. The regulatory distinction between long term care hospitals and acute inpatient hospitals is the length of stay. Medicare requires that the average Medicare length of stay be more than 25 days.
Pathway to LTC-DRG payment
Long Term Care DRG (LTC-DRG) payment is based on the individual patient’s discharge diagnosis (primary and secondary), age, sex and other procedures performed during the hospitalization.
- Discharge diagnosis converted to ICD-C CM code
- ICD-9 CM code cross walked to LTC -DRG, that corresponds to a single payment
- LTC-DRG payment covers all care required for treatment of patient during hospitalization
- Hospitals can not balance bill patient when LTC-DRG payment is lower than the actual cost to provide care.
LTCH PPS Model1
Coverage of medical supplies and equipment
The LTC-DRG payment is all inclusive and includes ostomy products, wound dressings, fecal collectors, Negative Pressure Wound Therapy devices, and all drugs, including enzymatic debriding agents.
References
- MedPac. Payment Basics, Long Term Care Hospitals Payment System, October 2010.Available at http://www.medpac.gov/documents/MedPAC_Payment_Basics_10_LTCH.pdf, Accessed February 10, 2011