Long-Term Care Hospital (LTCH)

Key facts

Medicare definition

Section 1886(d)(1)(B)(iv) of the Social Security Act; 42 CFR 412.23(e)

Length of stay test

Average Medicare inpatient length of stay greater than 25 days

Medicare payment

LTCH Prospective Payment System, since October 2002

Case classification

MS-LTC-DRGs

CCN range

Last four digits 2000 to 2299

What is a long-term care hospital?

LTCHs, often called long-term acute care hospitals, admit patients who survive a critical illness but remain too sick for a skilled nursing or inpatient rehabilitation facility. Typical patients need weaning from mechanical ventilation, complex wound care, prolonged intravenous antibiotics or management of several failing organ systems.

An LTCH must meet the same Conditions of Participation as any hospital. Some are freestanding; others are hospitals within hospitals, located in space leased from a host acute care hospital and subject to Medicare separateness rules.

Despite the name, an LTCH is not a long-term care facility in the nursing home sense. It is a hospital, and stays usually last weeks, not months or years.

How LTCH payment works

Medicare pays LTCHs per discharge under the LTCH Prospective Payment System. Since fiscal year 2016, under the Bipartisan Budget Act of 2013, payment has had two tiers:

• The full LTCH standard rate applies when the patient had an immediately preceding acute care hospital stay with at least three days in an intensive care unit, or receives at least 96 hours of mechanical ventilation in the LTCH.
• Other discharges, and those with a principal psychiatric or rehabilitation diagnosis, receive a lower site-neutral rate, generally the lesser of an amount comparable to acute care hospital payment or the estimated cost of the case.

Why LTCHs matter

LTCHs serve a small, high-acuity population that is expensive and easy to misclassify:

• Site-neutral payment shrank the pool of fully paid LTCH cases and many LTCHs have closed since, so current facility lists matter more than historical ones.
• Respiratory care, ventilator, wound care and anti-infective suppliers target LTCHs because of their concentrated high-acuity populations.
• Post-acute network and accountable care teams must distinguish LTCHs from skilled nursing and rehabilitation facilities when analyzing discharge patterns and spending.
• Including LTCHs in acute care hospital benchmarks distorts length of stay and cost per case.