42 U.S.C. § 1395tt : US Code - Section 1395TT: Hospital providers of extended care services

Search 42 U.S.C. § 1395tt : US Code - Section 1395TT: Hospital providers of extended care services

(a) Hospital facility agreements; reasonable costs of services
(1) Any hospital which has an agreement under section 1395cc of
this title may (subject to subsection (b) of this section) enter
into an agreement with the Secretary under which its inpatient
hospital facilities may be used for the furnishing of services of
the type which, if furnished by a skilled nursing facility, would
constitute extended care services.
(2)(A) Notwithstanding any other provision of this subchapter,
payment to any hospital (other than a critical access hospital) for
services furnished under an agreement entered into under this
section shall be based upon the reasonable cost of the services as
determined under subparagraph (B).
(B)(i) The reasonable cost of the services consists of the
reasonable cost of routine services (determined under clause (ii))
and the reasonable cost of ancillary services (determined under
clause (iii)).
(ii) The reasonable cost of routine services furnished during any
calendar year by a hospital under an agreement under this section
is equal to the product of -
(I) the number of patient-days during the year for which the
services were furnished, and
(II) the average reasonable cost per patient-day, such average
reasonable cost per patient-day being the average rate per
patient-day paid for routine services during the most recent year
for which cost reporting data are available with respect to such
services (increased in a compounded manner by the applicable
increase for payments for routine service costs of skilled
nursing facilities under subsections (a) through (d) of section
1395yy of this title for subsequent cost reporting periods and up
to and including such calendar year) under this subchapter to
freestanding skilled nursing facilities in the region (as defined
in section 1395ww(d)(2)(D) of this title) in which the facility
is located.
(iii) The reasonable cost of ancillary services shall be
determined in the same manner as the reasonable cost of ancillary
services provided for inpatient hospital services.
(3) Notwithstanding any other provision of this subchapter, a
critical access hospital shall be paid for covered skilled nursing
facility services furnished under an agreement entered into under
this section on the basis of equal to 101 percent of the reasonable
costs of such services (as determined under section 1395x(v) of
this title).
(b) Eligible facilities
The Secretary may not enter into an agreement under this section
with any hospital unless, except as provided under subsection (g)
of this section, the hospital is located in a rural area and has
less than 100 beds.
(c) Terms and conditions of facility agreements
An agreement with a hospital under this section shall, except as
otherwise provided under regulations of the Secretary, be of the
same duration and subject to termination on the same conditions as
are agreements with skilled nursing facilities under section 1395cc
of this title and shall, where not inconsistent with any provision
of this section, impose the same duties, responsibilities,
conditions, and limitations, as those imposed under such agreements
entered into under section 1395cc of this title; except that no
such agreement with any hospital shall be in effect for any period
during which the hospital does not have in effect an agreement
under section 1395cc of this title. A hospital with respect to
which an agreement under this section has been terminated shall not
be eligible to enter into a new agreement until a two-year period
has elapsed from the termination date.
(d) Post-hospital extended care services
Any agreement with a hospital under this section shall provide
that payment for services will be made only for services for which
payment would be made as post-hospital extended care services if
those services had been furnished by a skilled nursing facility
under an agreement entered into under section 1395cc of this title;
and any individual who is furnished services, for which payment may
be made under an agreement under this section, shall, for purposes
of this subchapter (other than this section), be deemed to have
received post-hospital extended care services in like manner and to
the same extent as if the services furnished to him had been post-
hospital extended care services furnished by a skilled nursing
facility under an agreement under section 1395cc of this title.
(e) Reimbursement for routine hospital services
During a period for which a hospital has in effect an agreement
under this section, in order to allocate routine costs between
hospital and long-term care services for purposes of determining
payment for inpatient hospital services, the total reimbursement
due for routine services from all classes of long-term care
patients (including this subchapter, subchapter XIX of this
chapter, and private pay patients) shall be subtracted from the
hospital's total routine costs before calculations are made to
determine this subchapter reimbursement for routine hospital
services.
(f) Conditions applicable to skilled nursing facilities
A hospital which enters into an agreement with the Secretary
under this section shall be required to meet those conditions
applicable to skilled nursing facilities relating to discharge
planning and the social services function (and staffing
requirements to satisfy it) which are promulgated by the Secretary
under section 1395i-3 of this title. Services furnished by such a
hospital which would otherwise constitute post-hospital extended
care services if furnished by a skilled nursing facility shall be
subject to the same requirements applicable to such services when
furnished by a skilled nursing facility except for those
requirements the Secretary determines are inappropriate in the case
of these services being furnished by a hospital under this section.
(g) Agreements on demonstration basis
The Secretary may enter into an agreement under this section on a
demonstration basis with any hospital which does not meet the
requirement of subsection (b)(1) of this section, if the hospital
otherwise meets the requirements of this section.