October 26, 2016

The LTACH MLN: Right but not Quite

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My RACmonitor articles generally tend to the “glass half empty” view of life.

When mistakes are made, you can count on me to reveal them to the world. But today I can finally present a feel-good story.

At a case management meeting in September, I was asked a question by a social worker from a military hospital about long-term acute-care hospitals (LTACHs) not accepting her patients who were otherwise eligible for LTACH care because her hospital was not an Inpatient Prospective Payment System (IPPS) hospital.

So I did some research, and sure enough, there was an MLN Matters, 9105, that indicated that only patients from IPPS hospitals were eligible to go to a LTACH under the LTACH payment structure. But further research revealed that the actual regulation that created the new payment structure for LTACHs did not set this condition. The federal regulation, found at 42 CFR 412.552, specified a “subsection (d) hospital.”

When the 2015 Inpatient Prospective Payment System (IPPS) final rule was published, it specified an “acute-care hospital.” But when MLN Matters 9105 was published, it somehow changed to an IPPS hospital, which does not include critical access hospitals, military hospitals, or veteran’s hospitals, all of which are subsection (d) hospitals. So clearly, that was wrong.

I contacted the appropriate deputy director at CMS, and within 24 hours, on a Sunday, no less, she acknowledged my email and started the correction process. And last week my MLN Matters Special Edition 1627 was released, clarifying that it was in fact a subsection (d) hospital.

Now, I wish that I could say that the story ends there, but two days later CMS released a revision to the old MLN matters, MM 9015, which addresses LTACH payment to add this clarification. But in the revision they forgot to change the phrase “IPPS hospital” to “acute-care hospital,” so the newly revised MLN Matters repeats the same mistake made in the original one. So once again I notified the appropriate people, and hopefully we will see a revision to the revision soon.

Nonetheless, I am very proud of my MLN Matters, at least the special edition release. And hopefully that social worker will no longer have a problem getting her patients accepted to an LTACH.

About the Author

Ronald Hirsch, MD, FACP, CHCQM is vice president of the Regulations and Education Group at Accretive Physician Advisory Services at Accretive Health. Dr. Hirsch’s career in medicine includes many clinical leadership roles at healthcare organizations ranging from acute-care hospitals and home health agencies to long-term care facilities and group medical practices. In addition to serving as a medical director of case management and medical necessity reviewer throughout his career, Dr. Hirsch has delivered numerous peer lectures on case management best practices and is a published author on the topic. He is a member of the Advisory Board of the American College of Physician Advisors, a member of the American Case Management Association, and a Fellow of the American College of Physicians.

Contact the Author

RHirsch@accretivehealth.com

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