Bill Overview
Title: The LTCH Access and Stability Act
Description: This bill waives the Medicare site-neutral payment rate for inpatient services at long-term care hospitals for an additional 12 months after the end of the COVID-19 public health emergency. The Centers for Medicare & Medicaid Services must report on the effects of this waiver on hospital admissions and overall access to services, among other information.
Sponsors: Rep. Sewell, Terri A. [D-AL-7]
Target Audience
Population: People requiring long-term inpatient hospital care who are eligible for Medicare
Estimated Size: 200000
- The bill is focused on long-term care hospitals (LTCHs) and Medicare policies related to payments for inpatient services.
- Medicare beneficiaries who require long-term hospital care are the direct target population affected by this legislation.
- These are individuals who typically have chronic illnesses or require extended recovery periods needing inpatient care.
- Approximately 44 million people are enrolled in Medicare, though not all would require LTCH services.
- The waiver would temporarily increase payment rates, likely affecting the availability and affordability of LTCH services for patients needing such care.
Reasoning
- The policy primarily impacts long-term care hospital settings, so those directly interacting with these institutions, like patients and their families, are most affected.
- Medicare patients requiring specialized long-term care will benefit from extended access to facilities that might otherwise be limited due to financial constraints.
- A significant portion of the population will see no change as they either do not require LTCH services nor are Medicare beneficiaries.
- The perspectives included aim to capture a spectrum from those who derive substantial benefits to those for whom the policy has negligible or no impact.
- The budget constraint implies a careful focus on distinct Medicare beneficiaries truly in need of LTCH services, limiting broader public effects.
Simulated Interviews
Retired teacher (Florida)
Age: 78 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 1.0 years
Commonness: 5/20
Statement of Opinion:
- The waiver sounds beneficial, given my recent stay at a long-term care hospital.
- I often worry about hospital bills; knowing that Medicare might cover more, even temporarily, relieves some stress.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 4 |
| Year 10 | 5 | 4 |
| Year 20 | 4 | 4 |
Retired engineer (Texas)
Age: 85 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 1.0 years
Commonness: 3/20
Statement of Opinion:
- My care needs have been costly; extra Medicare support would help.
- I hope it leads to more care options at LTCHs nearby.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 5 | 4 |
| Year 3 | 5 | 4 |
| Year 5 | 5 | 3 |
| Year 10 | 4 | 3 |
| Year 20 | 3 | 3 |
Retired nurse (California)
Age: 94 | Gender: female
Wellbeing Before Policy: 3
Duration of Impact: 2.0 years
Commonness: 4/20
Statement of Opinion:
- Accessing full Medicare benefits is difficult; this could ease my burden.
- I've been apprehensive about being transferred out of LTCHs due to costs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 3 |
| Year 2 | 4 | 3 |
| Year 3 | 3 | 2 |
| Year 5 | 3 | 2 |
| Year 10 | 2 | 2 |
| Year 20 | 2 | 1 |
Retired lawyer (New York)
Age: 65 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 1.0 years
Commonness: 6/20
Statement of Opinion:
- Although I'm currently healthy, I plan for potential LTCH needs in the future.
- This seems to offer peace of mind for those planning care avenues.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 6 | 5 |
| Year 10 | 5 | 5 |
| Year 20 | 4 | 4 |
Retired postal worker (Illinois)
Age: 75 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 1.5 years
Commonness: 4/20
Statement of Opinion:
- LTCH availability can dramatically affect my life, offering better lifelong care.
- This policy sounds like a temporary solace, hoping for permanent solutions.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 3 |
| Year 3 | 4 | 3 |
| Year 5 | 4 | 3 |
| Year 10 | 3 | 3 |
| Year 20 | 3 | 2 |
Retired librarian (Georgia)
Age: 70 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 10/20
Statement of Opinion:
- I seldom need extended long-term hospital care.
- The policy feels less relevant to me, though it could help others.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 7 |
| Year 20 | 6 | 6 |
Retired firefighter (Ohio)
Age: 83 | Gender: male
Wellbeing Before Policy: 2
Duration of Impact: 2.0 years
Commonness: 2/20
Statement of Opinion:
- The costs here are overwhelming – extra Medicare support would make a huge difference.
- Policies like this make me feel seen and less forgotten.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 2 |
| Year 2 | 3 | 2 |
| Year 3 | 3 | 2 |
| Year 5 | 2 | 2 |
| Year 10 | 2 | 1 |
| Year 20 | 1 | 1 |
Retired artist (Massachusetts)
Age: 68 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 1.0 years
Commonness: 4/20
Statement of Opinion:
- While my conditions are stable, could benefit from better supporting coverage.
- Crafty policies like this can sometimes push better general healthcare reforms.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 5 | 5 |
| Year 5 | 5 | 4 |
| Year 10 | 4 | 4 |
| Year 20 | 4 | 4 |
Retired farmer (Alabama)
Age: 72 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 1.5 years
Commonness: 3/20
Statement of Opinion:
- Being reliant on these hospitals, policy change to help costs feels like a lifeline.
- Spares my savings for other essential needs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 5 | 4 |
| Year 3 | 5 | 4 |
| Year 5 | 4 | 4 |
| Year 10 | 4 | 3 |
| Year 20 | 3 | 3 |
Retired seamstress (Michigan)
Age: 80 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 0.5 years
Commonness: 5/20
Statement of Opinion:
- I occasionally use LTCH services, extra Medicare benefits add comfort.
- Hope it inspires more permanent improvements in patient support.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 5 | 5 |
| Year 10 | 5 | 4 |
| Year 20 | 4 | 4 |
Cost Estimates
Year 1: $1200000000 (Low: $1000000000, High: $1400000000)
Year 2: $0 (Low: $0, High: $0)
Year 3: $0 (Low: $0, High: $0)
Year 5: $0 (Low: $0, High: $0)
Year 10: $0 (Low: $0, High: $0)
Year 100: $0 (Low: $0, High: $0)
Key Considerations
- The waiver is temporary, focusing on immediate impacts post-COVID emergency.
- Effectiveness of the waiver will need evaluation to assess long-term policy adjustments.
- Healthcare access improvement might lead to broad economic benefits not fully captured in immediate estimates.