Under the LTCH PPS, patients are classified into distinct diagnostic groups based on clinical characteristics and expected resource needs. The patient classification system groupings under the LTCH PPS are called long-term care diagnosis-related groups (LTC-DRGs). The LTC-DRGs are the same DRGs used under the hospital inpatient prospective payment system (IPPS), but they have been weighted to reflect the resources required to treat the type of medically complex patients characteristic of LTCHs. Relative weights for the LTC-DRGs reflect resource utilization for each diagnosis and account for the variation in cost per discharge. Under the LTCH PPS, the LTC-DRG relative weights are updated annually for each Federal fiscal year (October 1st through September 30th) using the most recently available LTCH claims data. Beginning in FY 2008, we adopted the refined severity-adjusted DRGs that were also adopted under the IPPS, that is, the Medicare-Severity-LTC-DRGs (MS-LTC-DRGs), which continue to be weighted to account for the difference in resource use by LTCH patients. (See the "downloads" section below for all of the LTC-DRG files since the implementation of the LTCH PPS.)

Page Last Modified:
11/10/2022 10:57 AM