The site neutral payment will be phased in during FY 2016 and 2017. Circumstances qualifying for an LTCH discharge (Payment under LTCH PPS) ... IRF, or SNF and then readmitted to the LTCH within a fixed period of days. In FY 2020, LTCH PPS payments for discharges paid using the standard LTCH payment rate are expected to increase by 2.3 percent. threshold adjustment (you are eligible for the full per-discharge payment under the LTCH PPS): If a patient transferred from an acute care hospital that already qualifies for outlier payments, the admission will not count as part of the LTCH’s allowable percentage from that hospital; If the LTCH exceeds its threshold during a cost reporting year, Since FFY 2016, CMS has been providing each LTCH their discharge payment percentage for cost reporting periods during or after FFY 2016. A. LTCH Discharge Payment Percentage 50% rule: At least 50% of all discharges must be reimbursed at LTACH rates to preserve facility’s eligibility for LTACH reimbursements (i.e., 50% critical care or vent patients). The payment rates and policies described in the IPPS/LTCH final rule (CMS-1716-F) affect Medicare’s operating and capital payments for short-term acute care hospital inpatient services and services provided in long- term care hospitals paid under their respective prospective Reimbursement Rates – LTCH. ̶Discharges that do not meet the critical conditions will be paid ½ the site neutral payment and ½ LTCH PPS rate. During or after FFY 2021, the IPPS equivalent payme nt rate will be mandated for The federal payment rate is expected to increase by 2.7% after accounting for the 2.5% FY20 annual update, increased outlier payments and “other factors,” according to a fact sheet. for payment under the LTCH PPS, all discharges will paid an IPPS comparable amount, subject to a “process for reinstatement.” ... CMS’s proposed implementation of the 50 percent discharge payment percentage requirement would take too many years to resolve an LTCH provider’s . The LTCH discharge payment percent is the percent of all Medicare FFS discharges that are paid the standard LTCH payment rate, and not the site neutral payment rate. For several years there has been a transitional blended rate used. 4 . Implementation of the Long Term Care Hospital (LTCH) Discharge Payment Percentage (DPP) Payment Adjustment Change Request (CR) 11616 prepares the Medicare claims processing systems to calculate the LTCH Prospective Payment System (PPS) payment when an LTCH is subject to the Discharge Payment Percentage (DPP) payment adjustment. A standard federal payment net rate increase of 2.5 percentage points (2.9% standard update minus 0.4% multifactor productivity adjustment) The standard federal payment rate be set at $43,849.28 ; A total labor-related share for FY 2021 of 68% (the sum of 63.6% for the operating cost and 4.4% for the labor-related share of capital) This mandate would be effective for discharges occurring in cost reporting periods during or after FFY 2021. 3 Long-term care hospitals payment system paymentbasics (SNF), stays for a specified period, then goes back to the same LTCH. The new version includes the payment policy for an LTCH that is subject to the Discharge Payment Percentage (DPP) payment adjustment described in CR 11616. Change Request (CR) 11616 prepares the Medicare claims processing systems to calculate the LTCH Prospective Payment System (PPS) payment when an LTCH is subject to the Discharge Payment Percentage (DPP) payment adjustment. The initial payment level (base rate) for a typical discharge in fiscal year 2014 is $40,607. Any LTCH discharge readmitted within three days is also considered an interrupted stay. The law includes a reinstatement process for LTCHs that fail to meet the required discharge threshold percentage in a particular year. In FY 2020, CMS will implement the LTCH Discharge Payment Percentage applicable discharge threshold (less than 50% of patients for whom the standard LTCH PPS payment is made). In addition, the CR includes new payment policy for the Novel Coronavirus Disease, COVID-19. A hospital receives a single payment for the stay based on the payment classification – MS-DRGs under the IPPS and MS-LTC-DRGs under the LTCH PPS – assigned at discharge. If you need assistance with your Wolters Kluwer products or would like to get more information on a complimentary Guest Pass to any of our online products, please contact your representative. CMS is also waiving some site-neutral payment provisions for LTCHs. Revised: October 2013 This document does not reflect proposed legislation CMS uses the following criteria in order to identify cases eligible for a standard LTCH PPS payment: The LTCH discharge does not have a principal diagnosis relating to a psychiatric ... -0.5 percentage points Wage Index Budget Neutrality Adjustment 1.0064747 Budget Neutrality Adjustment (as a result of Elimination of 25- They are subject to a 2% reduction in the next year's percentage increase in the market basket. 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