I 
109TH CONGRESS 
2D SESSION 
H. R. 6236 
To amend title XVIII of the Social Security Act to ensure and foster contin-
ued patient quality of care by establishing facility and patient criteria 
for long-term care hospitals and related improvements under the Medi-
care Program. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 28, 2006 
Mr. ENGLISH of Pennsylvania (for himself and Mr. POMEROY) introduced the 
following bill; which was referred to the Committee on Ways and Means 
A BILL 
To amend title XVIII of the Social Security Act to ensure 
and foster continued patient quality of care by estab-
lishing facility and patient criteria for long-term care 
hospitals and related improvements under the Medicare 
Program. 
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 2006’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
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(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 se-
verely ill patients into LTCHs. Further, patient ad-
mission screening tools and continued stay and dis-
charge assessment tools can guide appropriate pa-
tient placement. 
(3) Certain long-term care diagnosis related 
groups (LTC–DRGs) are associated with higher se-
verity of illness levels, as measured by the APR– 
DRG system, and that patients grouped into those 
LTC–DRGs are predicted to be appropriate for 
LTCH services. 
(4) Measuring and reporting on quality of care 
is an important function of any Medicare provider 
and that a national quality initiative for LTCHs 
should be similar to short-term general acute care 
hospitals in the Medicare program. 
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(5) To conform the prospective payment system 
for LTCHs with certain aspects of the prospective 
payment system for short-term general acute care 
hospitals and promote payment stability, the Sec-
retary of Health and Human Services (in this Act 
referred to as the ‘‘Secretary’’) should— 
(A) perform an annual market basket up-
date; 
(B) conduct the LTC–DRG reweighting 
and wage level adjustments in a budget neutral 
manner each year; 
(C) not perform a proposed one-time budg-
et neutrality adjustment, and 
(D) not extend the 25 percent limitation 
on reimbursement of co-located hospital patient 
admissions to freestanding LTCHs. 
SEC. 3. NEW DEFINITION OF A LONG-TERM CARE HOSPITAL 
WITH FACILITY AND PATIENT CRITERIA. 
(a) DEFINITION.—Section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x) is amended by adding at the 
end the following new subsection: 
‘‘Long-Term Care Hospital 
‘‘(ccc) The term ‘long-term care hospital’ means an 
institution which— 
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‘‘(1) is primarily engaged in providing inpatient 
care, by or under the supervision of a physician, to 
medically complex patients needing long hospital 
stays; 
‘‘(2) has an average inpatient length of stay (as 
determined by the Secretary) for Medicare bene-
ficiaries of greater than 25 days, or as otherwise de-
fined in section 1886(d)(1)(B)(iv); 
‘‘(3) satisfies the requirements of paragraphs 
(2) through (9) of subsection (e), except the first 
sentence of paragraph (9); 
‘‘(4) meets the following facility criteria: 
‘‘(A) the institution has a patient review 
process, documented in the patient medical 
record, that screens patients prior to admission, 
validates within 48 hours of admission that pa-
tients meet admission criteria, regularly evalu-
ates patients throughout their stay, and as-
sesses the available discharge options when pa-
tients no longer meet the continued stay cri-
teria; 
‘‘(B) the institution applies a standard pa-
tient assessment tool, as determined by the Sec-
retary, that is a valid clinical tool appropriate 
for this level of care, uniformly used by all long- 
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term care hospitals, to measure the severity of 
illness and intensity of service requirements for 
patients for the purposes of making admission, 
continuing stay and discharge medical necessity 
determinations taking into account the medical 
judgment of the patient’s physician, as provided 
for 
under 
sections 
1814(a)(3) 
and 
1835(a)(2)(B); 
‘‘(C) the institution has active physician 
involvement with patients during their treat-
ment through an organized medical staff, on- 
site physician presence and physician review of 
patient progress on a daily basis, and con-
sulting physicians on call and capable of being 
at the patient’s side within a moderate period 
of time, as determined by the Secretary; 
‘‘(D) the institution has interdisciplinary 
team treatment for patients, requiring inter-
disciplinary teams of health care professionals, 
including physicians, to prepare and carry out 
an individualized treatment plan for each pa-
tient; and 
‘‘(E) the institution maintains a minimum 
staffing level of licensed health care profes-
sionals, as determined by the Secretary, to en-
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