I 
110TH CONGRESS 
1ST SESSION H. R. 3057 
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 
JULY 17, 2007 
Mr. POMEROY (for himself, Mr. LARSON of Connecticut, and Mr. ENGLISH of 
Pennsylvania) 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; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Medicare Long-Term Care Patient Safety and Improve-
ment Act of 2007’’. 
VerDate Aug 31 2005 
05:16 Jul 19, 2007
Jkt 059200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H3057.IH
H3057
ccoleman on PROD1PC69 with BILLS
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Definition of long-term care hospital. 
Sec. 3. Implementation of facility and patient criteria. 
Sec. 4. Establishment of rehabilitation units within certain long-term care hos-
pitals. 
Sec. 5. Expanded review of medical necessity. 
Sec. 6. Limited, qualified moratorium of long-term care hospitals. 
Sec. 7. No application of 25 percent patient threshold payment adjustment to 
freestanding and grandfathered LTCHS. 
Sec. 8. Payment for hospitals-within-hospitals. 
Sec. 9. No application of very short-stay outlier policy. 
Sec. 10. No application of one time adjustment to standard amount. 
Sec. 11. Long-term care hospital quality improvement initiative. 
SEC. 2. DEFINITION OF LONG-TERM CARE HOSPITAL. 
(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— 
‘‘(1) is primarily engaged in providing inpatient 
services, by or under the supervision of a physician, 
to Medicare beneficiaries whose medically complex 
conditions require a long hospital stay and programs 
of care provided by a long-term care hospital; 
‘‘(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); 
VerDate Aug 31 2005 
05:16 Jul 19, 2007
Jkt 059200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H3057.IH
H3057
ccoleman on PROD1PC69 with BILLS
‘‘(3) satisfies the requirements of subsection 
(e); 
‘‘(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 has active physician 
involvement with patients during their treat-
ment through an organized medical staff, physi-
cian-directed treatment with physician on-site 
availability on a daily basis to review patient 
progress, and consulting physicians on call and 
capable of being at the patient’s side within a 
moderate period of time, as determined by the 
Secretary; 
‘‘(C) the institution has interdisciplinary 
team treatment for patients, requiring inter-
disciplinary teams of health care professionals, 
including physicians, to prepare and carry out 
VerDate Aug 31 2005 
05:16 Jul 19, 2007
Jkt 059200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H3057.IH
H3057
ccoleman on PROD1PC69 with BILLS
an individualized treatment plan for each pa-
tient; and 
‘‘(5) meets patient criteria relating to patient 
mix and severity appropriate to the medically com-
plex cases that long-term care hospitals are designed 
to treat, as measured under section 1886(m).’’. 
(b) NEW PATIENT CRITERIA FOR LONG-TERM CARE 
HOSPITAL PROSPECTIVE PAYMENT.—Section 1886 of 
such Act (42 U.S.C. 1395ww) is amended by adding at 
the end the following new subsection: 
‘‘(m) PATIENT CRITERIA FOR PROSPECTIVE PAY-
MENT TO LONG-TERM CARE HOSPITALS.— 
‘‘(1) IN GENERAL.—To be eligible for prospec-
tive payment under this section as a long-term care 
hospital, a long-term care hospital must admit not 
less than a majority of patients who have a high 
level of severity and who are assigned to one or more 
of the following major diagnostic categories: 
‘‘(A) Circulatory diagnoses. 
‘‘(B) Digestive, endocrine, and metabolic 
diagnoses. 
‘‘(C) Infection disease diagnoses. 
‘‘(D) Neurological diagnoses. 
‘‘(E) Renal diagnoses. 
‘‘(F) Respiratory diagnoses. 
VerDate Aug 31 2005 
05:16 Jul 19, 2007
Jkt 059200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H3057.IH
H3057
ccoleman on PROD1PC69 with BILLS
‘‘(G) Skin diagnoses. 
‘‘(H) Other major diagnostic categories as 
selected by the Secretary. 
‘‘(2) 
MAJOR
DIAGNOSTIC
CATEGORY
DE-
FINED.—In paragraph (1), the term ‘major diag-
nostic category’ means the medical categories formed 
by dividing all possible principle diagnosis into mu-
tually exclusive diagnosis areas which are referred to 
in 67 Federal Register 49,985 (August 1, 2002).’’. 
(c) ESTABLISHMENT
OF REHABILITATION UNITS 
WITHIN CERTAIN LONG-TERM CARE HOSPITALS.—If the 
Secretary of Health and Human Services does not include 
rehabilitation services within a major diagnostic category 
under section 1886(m)(2) of the Social Security Act, as 
added by subsection (b), the Secretary shall approve for 
purposes of title XVIII of such Act distinct part inpatient 
rehabilitation hospital units in long-term care hospitals 
consistent with the following: 
(1) A hospital that, on or before October 1, 
2004, was classified by the Secretary as a long-term 
care 
hospital, 
as 
described 
in 
section 
1886(d)(1)(B)(iv)(I) 
of 
such 
Act 
(42 
U.S.C. 
1395ww(d)(1)(V)(iv)(I)), and was accredited by the 
Commission on Accreditation of Rehabilitation Fa-
cilities, may establish a hospital rehabilitation unit 
VerDate Aug 31 2005 
05:16 Jul 19, 2007
Jkt 059200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H3057.IH
H3057
ccoleman on PROD1PC69 with BILLS