CMS Pub. 100-04, ch. 3, § 150.9.1.2

Beginning on July 1, 2004, there are two interruption of stay policies in effect under the

LTCH PPS.

A 3-day or less interruption of stay is a stay at an LTCH during which the beneficiary is

discharged from the LTCH to an acute care hospital, IRF, SNF, or home and readmitted to

the same LTCH within 3-days of the discharge. The 3-day or less period begins with the

date of discharge from the LTCH and ends not later than midnight of the third day.

Medicare payment for any test, procedure, or care provided on an outpatient basis or for

any inpatient treatment during the “interruption" would be the responsibility of the LTCH

“under arrangements” with one limited exception: for RY 2005 and RY 2006, if treatment

at an inpatient acute care hospital would be grouped to a surgical DRG, a separate

Medicare payment would be made under the IPPS for that care. Effective for dates of

service on or after July 1, 2006 (RY 2007), this limited exception for surgical DRGs is no

longer applicable. No further separate payment to an acute care hospital will be made.

Any tests or procedures, that were administered to the patient during that period of time of

interruption will be considered to be part of that single episode of LTCH care and bundled

into the payment to the LTCH. The LTCH will be required to pay any other providers

without additional Medicare program payment liability.

If no additional Medicare services are delivered during the3-day or less interruption (e.g.,

the patient is home and doesn’t receive any outpatient or inpatient services at an acute care

hospital or IRF or care at a SNF) prior to readmission to the LTCH, the number of days

away from the LTCH will not be included in the total length of stay for that beneficiary

stay. If care is delivered on any day during the interruption, however, that the LTCH pays

for “under arrangements,” all the days of the interruption are included in the total length of

stay for that beneficiary stay. Therefore, if a patient receives services on only one of the

days of the interruption but is away from the LTCH for 3 days, all 3 days will be deemed a

part of the total episode of care and counted towards the length of stay for that patient

stay. If an interruption of stay exceeds 3-days, the original interrupted stay policy, below,

governs payment.

• The original interrupted stay policy is now defined as “a greater than 3-day

interruption of stay” and is a stay in which a LTCH patient that is admitted upon

discharge to an inpatient acute care hospital, an inpatient rehabilitation facility

(IRF), a skilled nursing facility (SNF), or swing bed and returns to the same LTCH

within a specified period of time. The day count begins on the day of discharge

from the LTCH, which is also the admission day to the other provider, and ends on

the day of readmission to the LTCH.

o For an acute care hospital: between 4 and 9 consecutive days;

o For an IRF: between 4 and 27 consecutive days;

o For a SNF: between 4 and 45 consecutive days; and

o For a Swing Bed: between 4 and 45 consecutive days or less.

Note that although the greater than 3-day interruption of stay policy only governs when a

patient is away from the LTCH for between 4 days and the applicable provider threshold,

the day count for determining whether the threshold is met begins when the patient is

discharged. So if a patient is discharged on 9/2/04, the 3-day or less interrupted stay

policy will govern payment if the patient is readmitted to the LTCH on 9/2, 9/3, or 9/4. If

the patient is readmitted to the LTCH on 9/5, payment will be paid to, for example, the

acute care hospital which provided treatment, but the day count for determining whether

or not the stay is one interrupted stay or a whether the return to the LTCH is a separate

admission starts on 9/2. For example, if the LTCH discharges a patient to an acute care

hospital on 9/2/04, if they are readmitted to the LTCH by 9/10/04, this is an interrupted

stay. If they are readmitted on 9/11/04, it counts as a separate admission. An interrupted

stay case is treated as one discharge for the purposes of payment; only one LTCH PPS

payment is made. (The bill generated by the original stay in the LTCH should be

cancelled by the provider or they may do a debit/credit adjustment.)

Multiple interrupted stays should be entered as one claim but each interrupted stay should

be evaluated individually for the rule regarding the appropriate number of days at the

intervening facility.

If the length of stay at the "receiving" site of care exceeds the above- specified period of

time, the return to the LTCH is a new admission. This means that the original discharge to

that site is treated as a discharge for payment purposes.

For the percentage of payments that are to be made under the TEFRA system during the 5-year transition, the A/B MAC (A) treats each segment of the interrupted stay as a separate

discharge. (A/B MACs (A) are to follow the same procedure as provided under the IRF

PPS in determining the amount of the payment under the blend that TEFRA would have

paid.)