The 25 percent rule The 25 percent rule is intended to help ensure that LTCHs do not function as units of acute care hospitals and that decisions about admission, treatment, and discharge in both acute care hospitals and LTCHs are made for clinical rather than financial reasons. Overall, under the changes included in the Final Rule, CMS projects that LTCH PPS payments will increase by approximately 0.9 percent, or $39 million, in FY 2019. “Further, given the scale of LTCH cuts under site-neutral payment, implementing the 25-Percent Rule payment penalties would unjustifiably exacerbate the instability and strain on the field, which would threaten access for the high-acuity, long-stay patients that require LTCH-level care,” he continued. An LTCH is paid full LTCH rates for patients admitted from any ACH until the percentage of Medicare admissions from any one ACH exceeds the applicable threshold of the LTCH’s Medicare cases. The goal of this rule is to insure that admissions to LTCHs are made for clinical rather than financial reasons. (A separate 5-percent threshold applies to cases transferred to co-located SNFs, IRFs, and psychiatric facilities.) In an effort to control LTCH costs following the introduction of PPS, Medicare enacted the 25 percent rule. The rule sets a limit on The 4 Percent Rule is often confused with the Multiply by 25 Rule, for obvious reasons—the 4 Percent Rule, as its name implies, assumes a 4 percent return. ... coding adjustment and equals the 2.6 percent market basket net of MFP less 2.25 percentage points. Congress Short On Time To Delay LTCH 25 Percent Rule Pay Cut. The 25 percent rule The 25 percent rule reduces payments for The legislation reinstates the 50 percent threshold that was in effect prior to July 1, 2016, and delays the rule for nine months (October 1, 2016 through June 30, 2017). However, the 4 Percent Rule, more importantly, guides how much money you can withdraw annually once you're retired, without cutting into your investment principal. As a result, it presents an access barrier for patients who are clinically appropriate for the LTCH … Elimination of the “25-Percent Threshold Policy” Adjustment: CMS is eliminating the 25% threshold policy because it believes aggregate LTCH PPS payments are sufficient. The 25-percent rule uses payment adjustments to create disincentives for LTCHs to admit a large share of their patients from a single ACH. This is a flawed and arbitrary manner in which to create a policy. • The 25 percent rule is arbitrary. The LTCH 25 Percent Rule and the IRF 60 Percent Rule. Under the 25 Percent Rule, an LTCH is allowed to admit up to 25% of its patients from a single general acute care hospital; for patients admitted past the 25% threshold, an LTCH faces a significant Medicare reimbursement reduction. 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