In 2016, the Centers for Medicare & Medicaid Services (CMS) began phasing in new patient-level criteria, as established by Congress in the Pathway for SGR Reform Act of 2013. In 2015, 54% of all LTCH Medicare fee-for-service (FFS) patients met the new criteria. Although the full effects of the new criteria on access to LTCH care may not be known for some time, significant changes in reimbursement for cases not meeting the criteria (i.e., “site-neutral cases”) will force changes in the LTCH sector with potential implications for Medicare beneficiary access to the programs offered by these specialty hospitals. In this report, we examined the current availability of LTCH care, how the availability of LTCH care has changed between 2009 and 2016, and how LTCH closures have affected utilization. The study found: LTCHs treat beneficiaries from every state and one-third of LTCH patients travel to a different hospital referral region to receive LTCH care; 80% of Medicare beneficiaries reside in a hospital referral region with at least one LTCH and 90% live within 80 miles of an LTCH; since 2012, the LTCH market has been contracting and the current number of LTCHs and LTCH beds is now comparable to what it was in 2009.
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