I 
111TH CONGRESS 
1ST SESSION H. R. 2124 
To extend subsections (c) and (d) of section 114 of the Medicare, Medicaid, 
and SCHIP Extension Act of 2007 (Public Law 110–173) to provide 
for regulatory stability during the development of facility and patient 
criteria for long-term care hospitals under the Medicare Program, and 
for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 27, 2009 
Mr. POMEROY (for himself, Mr. LARSON of Connecticut, Mr. DOGGETT, and 
Mr. YARMUTH) introduced the following bill; which was referred to the 
Committee on Ways and Means 
A BILL 
To extend subsections (c) and (d) of section 114 of the 
Medicare, Medicaid, and SCHIP Extension Act of 2007 
(Public Law 110–173) to provide for regulatory stability 
during the development of facility and patient criteria 
for long-term care hospitals under the Medicare Pro-
gram, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Medicare Long-Term 
Care Hospital Improvement Act of 2009’’. 
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SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Long-term care hospitals (in this section re-
ferred to as ‘‘LTCHs’’) serve a valuable role in the 
post-acute care continuum by providing care to 
medically complex patients needing long hospital 
stays. 
(2) The Medicare program should ensure that 
patients receive post-acute care in the most appro-
priate setting. The use of additional certification cri-
teria for LTCHs, including facility and patient cri-
teria, will promote the appropriate placement of 
medically complex patients into LTCHs. 
(3) Subsections (c) and (d) of section 114 of 
the Medicare, Medicaid, and SCHIP Extension Act 
of 2007 (Public Law 110–173) provide necessary 
regulatory stability and temporary limits on the 
growth of new hospitals during the development of 
facility and patient criteria for LTCHs. An exten-
sion of section 114 is warranted to allow for addi-
tional time to develop facility and patient criteria for 
LTCHs. 
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SEC. 3. EXTENSION OF CERTAIN PROVISIONS UNDER SEC-
TION 114 OF THE MEDICARE, MEDICAID, AND 
SCHIP EXTENSION ACT OF 2007. 
Subsections (c) and (d) of section 114 of the Medi-
care, Medicaid, and SCHIP Extension Act of 2007 (Public 
Law 110–173), as amended by section 4302 of division 
B of the American Recovery and Reinvestment Act of 
2009 (Public Law 111–5), are amended by striking ‘‘3- 
year period’’ and inserting ‘‘5-year period’’ each place it 
appears. 
SEC. 4. LONG-TERM CARE HOSPITAL BUDGET NEUTRALITY 
OFFSET. 
Section 1886(m) of the Social Security Act (42 
U.S.C. 1395ww(m)) is amended by adding at the end the 
following new paragraph: 
‘‘(3) BUDGET NEUTRALITY OFFSET FOR RATE 
YEARS 2011 THROUGH 2015.—In implementing the 
system described in paragraph (1) for discharges oc-
curring during each of the rate years ending in 2011 
through 2015 for a hospital, the base rate shall be 
adjusted annually by the market basket update 
amount allowed by the Secretary less an amount de-
termined by the Secretary, in advance of each rate 
year, to implement a budget neutrality offset of the 
cost of implementation of section 3 of the Medicare 
Long-Term Care Hospital Improvement Act of 2009 
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for such year, not to exceed a maximum percentage 
reduction of 1.5 percent per rate year. Each such 
budget neutrality offset shall apply only with respect 
to the single rate year involved. The Secretary shall 
not reflect, or take into account, any such budget 
neutrality offset in computing and establishing the 
applicable market basket update percentage increase 
to the base rate for a subsequent rate year.’’. 
Æ 
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