I 
110TH CONGRESS 
1ST SESSION 
H. R. 562 
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 
JANUARY 18, 2007 
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 2007’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
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(1) Long-term care hospitals (in this Act 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 (in this Act referred to as ‘‘LTC–DRGs’’) 
are associated with higher severity of illness levels, 
as measured by the APR–DRG system, and 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 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 subsection 
(e), except paragraphs (1) and (9) of such sub-
section; 
‘‘(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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sure that long-term care hospitals provide an 
intensive level of care that is sufficient to meet 
the needs of medically complex patients needing 
long hospital stays; and 
‘‘(5) meets patient criteria relating to patient 
mix and severity appropriate to the medically com-
plex cases that long-term care hospitals are uniquely 
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 as a long-term care hospital, a long- 
term care hospital must discharge the percentage es-
tablished in paragraph (4) of each hospital’s total 
patients who are entitled to benefits under part A 
and who were admitted with one or more of the 
medical conditions specified in paragraph (2). 
‘‘(2) SELECTION OF LTC–DRGS.—The Secretary 
shall determine the long-term care diagnosis related 
groups (LTC–DRGs) under section 307(b) of the 
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Medicare, Medicaid, and SCHIP Benefits Improve-
ment and Protection Act of 2000, that are associ-
ated with a high severity of illness for the following 
specified medical conditions: 
‘‘(A) Circulatory conditions. 
‘‘(B) Digestive, endocrine, and metabolic 
conditions. 
‘‘(C) Infectious disease. 
‘‘(D) Neurological conditions. 
‘‘(E) Renal conditions. 
‘‘(F) Respiratory conditions. 
‘‘(G) Skin conditions. 
‘‘(H) Other medically complex conditions 
as defined by the Secretary. 
‘‘(3) CHANGE TO DIFFERENT PATIENT CLASSI-
FICATION
SYSTEM.—If the Secretary changes the 
patient classification system for the long-term care 
hospital prospective payment system (LTCH PPS) 
to a classification system other than the long-term 
care diagnosis related group (LTC–DRG) system, 
the Secretary shall determine the new patient classi-
fication categories that are associated with a high 
severity of illness for the medical conditions specified 
in paragraph (2) in a manner that maintains the 
same proportion of Medicare discharges as the long- 
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