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HHS/CMS RIN: 0938-AP33 Publication ID: Spring 2009 
Title: Changes to Long-Term Care Prospective Payment System Based on Specific Provisions in the Medicare, Medicaid, and SCHIP Extension Act of 2007 (CMS-1493-F) 
Abstract: This rule implements provisions of the Medicare, Medicaid, and SCHIP Extension Act of 2007 relating to long-term care hospitals. In addition to amending section 1861 of the Act with a new definition of LTCHs, this rule includes provisions that are effective on the date of enactment (December 29, 2007). Specifically, the statute imposes a 3-year delay in implementation of certain payment policies that set percentage thresholds for LTCH patients admitted from certain referring hospitals and raises the percentage threshold for those LTCHs unaffected by the 3-year delay. The legislation imposes the same 3-year delay on the implementation of a particular payment adjustment for short-stay patients and also for the possible application of a one-time adjustment to the standard Federal rate. The statute also required a change in the Federal rate for RY 2008, (effective April 1, 2008). Additionally, the statute created a 3-year moratorium on the establishment of new LTCHs and LTCH satellites and on bed expansion in existing LTCHs, subject to significant exceptions. 
Agency: Department of Health and Human Services(HHS)  Priority: Other Significant 
RIN Status: Previously published in the Unified Agenda Agenda Stage of Rulemaking: Completed Actions 
Major: No  Unfunded Mandates: No 
CFR Citation: 42 CFR 412.500    42 CFR 412.523    42 CFR 412.529    42 CFR 412.534    42 CFR 412.536   
Legal Authority: Provisions of sec 114 of PL 110-173 (MMSE Act of 2007)    sec 1886(d) of the Social Security Act as amended by sec 114 of PL 110-173 (MMSE Act of 2007)   
Legal Deadline:
Action Source Description Date
Other  Statutory  Some provisions implemented upon enactment (12/29/2007)  12/00/2007 
Timetable:
Action Date FR Cite
Interim Final Rule  05/06/2008  73 FR 24871   
Interim Final Rule  05/22/2008  73 FR 29699   
Withdrawn  01/29/2009    
Regulatory Flexibility Analysis Required: Yes  Government Levels Affected: State 
Small Entities Affected: Businesses  Federalism: No 
Included in the Regulatory Plan: No 
RIN Data Printed in the FR: Yes 
Related RINs: Related to 0938-AO94, Merged with 0938-AP39 
Agency Contact:
Tzvi Hefter
Director, Division of Acute Care and Ambulatory Policy Group
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Mailstop C4-08-06, 7500 Security Boulevard,
Baltimore, MD 21244
Phone:410 786-4487
Email: tzvi.hefter@cms.hhs.gov