Legislation would lift 25% rule

New patient-safety legislation for long-term acute-care hospitals would eliminate the so-called 25% rule (PDF) on patient-admission referrals from host hospitals to LTACs.

The CMS rule, which was established in 2004 and expanded in 2007, limited patient-admission referrals from a host hospital to 25%. After that threshold, the CMS would reimburse for those patients under the standard prospective pricing, which is a lower payment. In 2007, the 25% rule also was applied to free-standing hospitals. The rule has drawn strong objections from LTACs, which credit it with severe economic harm to the industry.

At least some hospital advocates praised the new bill, which was quietly introduced Tuesday by Sen. Pat Roberts (R-Kan.).

“Eliminating the 25% rule will ensure that patients are not prohibited arbitrarily from receiving needed care” in long-term-care hospitals, Richard Umbdenstock, president and CEO of the American Hospital Association (PDF), said in a news release. “This bill will replace blunt payment policies with comprehensive clinical criteria to ensure that LTCHs uniformly serve high-acuity patients. This will allow LTCHs to focus on their mission of caring for very sick patients who need intensive care for a long period of time.”

In addition, the legislation would create specific requirements for patient preadmission, admission, continued stay and discharge. The measure also would specify long-term-care hospitals' “core services” and patient-care requirements, such as physician availability, according to the legislation.

The measure would require that a minimum percentage of annual discharges fit at least one of the following categories: patients for at least 25 days; a short-term acute-care hospital outlier immediately prior to admission to the LTAC; an inpatient who received ventilator services in the LTAC; or a patient who has at least three major complications and co-morbidities. Failure to meet that standard would result in a probationary period, followed by rate cuts.