Medicare Law and its Relationship to Long-Term Care Hospitals
The Medicare law defines a long-term care hospital (LTCH) as a facility that specializes in treating patients with complex medical conditions requiring extended hospitalization, usually exceeding 25 days. According to the Centers for Medicare and Medicaid Services (CMS), an LTCH is “a hospital that has an average length of stay greater than 25 days and treats patients who require prolonged mechanical ventilation, have multiple serious medical conditions, or are recovering from major surgery.”
In the United States, CMS is responsible for administering the Medicare program, which provides health insurance for citizens aged 65 or older, younger individuals with disabilities, and people with end-stage renal disease. Among its many responsibilities, CMS is also responsible for ensuring that all Medicare providers, including LTCHs, meet certain quality and safety standards.
What Services are offered at Long-Term Care Hospitals?
LTCHs provide medically necessary, specialized care for patients with a wide range of complex medical conditions. They offer intensive and often comprehensive rehabilitative therapies, as well as other treatments, such as ventilator weaning, tracheostomy care, wound care, and many others. Patients who are admitted to LTCHs typically have comorbidities that require specialized and coordinated care that can be difficult to manage in a shorter-stay acute-care hospital.
LTCHs also offer palliative care. This type of medical care is provided to relieve patients from the symptoms and stress of serious illnesses, regardless of whether cure is possible. The goal of palliative care is to improve the quality of life for both the patient and their family.
How Do Long-Term Care Hospitals Differ from Other Hospitals?
The main difference between an LTCH and other hospitals is the length of stay. LTCH patients generally require a longer hospitalization period compared to patients in traditional acute-care hospitals. LTCHs also have a higher level of specialized staff and equipment to provide the necessary care to their patients.
An acute-care hospital, in contrast, provides short-term medical care and treatment to patients with serious illnesses or injuries. Acute-care hospitals usually provide shorter hospital stays, with most being discharged within a few days or weeks.
What is the Role of Medicare in Covering Long-Term Care Hospitalizations?
Under the Medicare program, LTCHs are covered under Part A. Part A coverage includes inpatient hospital services and other related services such as skilled nursing care, hospice care, and home health care. However, LTCH patients must meet certain eligibility requirements to receive coverage.
To be eligible for Medicare coverage in an LTCH, patients must meet the CMS criteria that define the medical necessity for such hospitalization. The complexity and severity of a patient’s medical conditions are often the determining factor in whether a patient is considered suitable for LTCH care.
In conclusion, the Medicare law, through CMS, defines a long-term care hospital as a facility that specializes in treating complex medical conditions and offers specialized and comprehensive care to patients who need longer hospital stays. Patients who require LTCH care must meet certain eligibility requirements and have complex medical conditions that require specialized care and treatment. LTCHs play a crucial role in providing extended hospitalization and specialized care, ensuring that patients receive the necessary care to manage complex medical conditions and achieve the best possible outcomes.