Long-Term Care Hospital (LTCH) Quality Reporting Program (QRP) Reconsideration and Exception & Extension
The Reconsideration webpage provides information and updates related to the reconsideration process for the LTCH QRP. On this page, you will find guidelines and processes for submitting reconsiderations requests and requests for exceptions and exemptions.
LTCH QRP: Natural Disaster Protocol
For disasters impacting the Post-Acute Care (PAC) Quality Reporting programs, a disaster-specific memo will be posted to the Downloads section below with additional information, including impacted counties and quality reporting quarters.
March 27, 2020
Exceptions for LTCH QRP Due to COVID-19 Pandemic
The Centers for Medicare & Medicaid Services (CMS) is granting exceptions for Medicare Quality Reporting Programs (QRPs) for Long-Term Care Hospitals (LTCHs) across the United States and its territories in response to the 2019 Novel Coronavirus (COVID-19) pandemic. More information and additional guidance can be found in the COVID-19 Quality Reporting Programs Guidance Memo (PDF) and the LTCH QRP COVID-19 PHE Tip Sheet (PDF).
Reconsideration Request Overview
In the Fiscal Year (FY) 2015 Inpatient Prospective Payment System/LTCH Prospective Payment System Final Rule (79 FR 50317 through 50318), the Centers for Medicare & Medicaid Services (CMS) finalized the FY 2016 and subsequent year’s LTCH QRP Reconsideration and Exception and Extension requirements. Any LTCH determined to be out of compliance with the LTCH QRP requirements may be subject to a two percentage (2%) point reduction in their Annual Update (i.e., APU).
What is Reconsideration?
Reconsideration is a request for a review of the initial CMS compliance determination for a given LTCH for a given fiscal year.
When Would an LTCH Submit a Reconsideration Request?
LTCHs may file for reconsideration if they believe the finding of non-compliance is an error, or they have evidence of the impact of extraordinary circumstances that prevented timely submission of data.
Reconsideration Request Process
An LTCH must first receive a CMS letter of non-compliance to apply for reconsideration. An LTCH disagreeing with the compliance determination and the impending payment reduction decision may submit a request for reconsideration to CMS within thirty (30) days from the date at the top of the non-compliance notification letter distributed electronically using the Internet Quality Improvement and Evaluation System (iQIES). CMS will not accept any requests submitted after the thirty (30) day deadline. In addition, all Medicare-certified LTCH compliance letters will be distributed electronically into the Non-Compliance Notification folders within iQIES for each LTCH to access.
Creating a Reconsideration Request
Please note: The only method for submitting reconsideration requests is via email. Requests submitted by any other means will not be reviewed for reconsideration.
LTCHs are required to submit their request to CMS via email with the subject line: “LTCH ACA 3004 Reconsideration Request” and include the LTCH CMS Certification Number (CCN) (e.g., LTCH ACA 3004 Reconsideration Request, XXXXXX). The request must be sent to the following email address: LTCHQRPReconsiderations@cms.hhs.gov.
The email request must include the following information:
- LTCH CCN
- LTCH Business Name
- LTCH Business Address
- CEO or CEO-designated representative contact information including name, email address, telephone number, and physical mailing address
- CMS identified reason(s) for non-compliance from the non-compliance notification letter
- Information supporting the LTCH belief that the non-compliance finding is an error, or evidence of the impact of extraordinary circumstances that prevented timely submission of data
The request for reconsideration must be accompanied by supporting documentation demonstrating compliance. CMS will be unable to review requests that fail to provide the necessary documentation or accept any files that are larger than 20 MB (megabytes). Supporting documentation may include any or all of the following:
- Proof of submission
- Email communications
- Data submission reports from iQIES
- Data submission reports from the National Healthcare Safety Network (NHSN)
- Proof of previous waiver approvals (including disaster exceptions/exemptions)
- Notification of the CCN activation letter to prove that the CCN was not activated by the end of the reporting quarter
- Other documentation supporting the rationale for seeking reconsideration
Never include patient information (i.e., protected health information (PHI), patient identifiable information (PII), or other Health Insurance Portability and Accountability Act (HIPAA) violation) in the documentation being submitted to CMS for review. Submitting patient-level data or PHI may be a violation of your facilities’ policies and procedures as well as a violation of federal regulations (HIPAA).
Any documentation submitted for review that includes PHI will not be accepted or reviewed for reconsideration. Please redact any PHI prior to sending. If any of the documents included in a reconsideration request contain PHI, the entire request will be rejected.
Review Data Submission Requirements
Please refer to the LTCH Quality Reporting Data Submission Deadlines webpage for more information about data submission requirements.
Reconsideration Request Process Timeline
Below is the estimated reconsideration process timeline for payment determination:
- June – July: CMS issues notices of non-compliance to LTCHs that failed to meet quality reporting requirements via a letter sent using at least one of the following methods:
- The iQIES
- The United States Postal Service (USPS)
- The Medicare Administrative Contractor (MAC)
- July – August: Reconsideration requests are due to CMS by the date indicated on the notification of non-compliance from CMS.
- July – August: CMS provides an email acknowledgment within five (5) business days upon receipt of reconsideration request.
- Please Note: The LTCHQRPReconsiderations@cms.hhs.gov email account will send an auto-reply upon receipt of your email. This email auto-reply is not the CMS acknowledgment of receipt. If you do not receive a follow-up acknowledgment of receipt within five (5) business days, please resubmit your request.
- September: LTCHs are notified of the agency’s decision on the reconsideration requests via a letter from the MACs and CMS.
- October: APU penalty will be imposed on all providers found to be non-compliant with quality reporting requirements.
Filing an Appeal
LTCHs dissatisfied with the reconsideration ruling may file a claim under 42 CFR Part 405, Subpart R (a Provider Reimbursement Review Board (PRRB) appeal). Details are available on the CMS.gov PRRB Review Instructions webpage. You must follow the instructions listed on that website to file with the PRRB.
If the estimated impact of your penalty is $10,000 or below, you should file the appeal with Federal Specialized Services, the Appeal Support Contractor (ASC). These appeals are called Contractor Appeals. Information on these appeals is available on your MAC’s web site.
Exception and Extension
Exception and Extension Requests Overview
CMS provides LTCHs an opportunity to request an exception or extension from the program’s reporting requirements in the event they are unable to submit quality data due to extraordinary circumstances beyond their control. LTCHs affected by a natural or man-made disaster or other extraordinary circumstances may request an exception or extension by filing a Request for Reconsideration Due to Disaster or Extraordinary Circumstance.
Submission of Exception and/or Extension Process
All LTCHs requesting an exception or extension must submit the request within ninety (90) days of the event. CMS may grant the exception or extension for one or more quarters. CMS may also grant the exception or extension to LTCHs that have not requested one when an extraordinary circumstance, such as an act of nature, affects an entire region or locale. CMS will communicate through routine channels when such determination is made.
LTCHs must request an exception or extension via email with the subject line “Disaster Exception or Extension Request” and send it to: LTCHQRPReconsiderations@cms.hhs.gov. The email must include the following information:
- LTCH CCN
- LTCH Business Name
- LTCH Business Address
- CEO or CEO-designated personnel contact information including name, email address, telephone number, and physical mailing address
- Description of the event (examples provided above) associated with the reason for requesting the exception or extension
- A date when the LTCH believes that it will again be able to submit LTCH QRP data and a justification for the proposed date.
Response from CMS
CMS will provide a written acknowledgment upon receipt of the exception and extension request. CMS will notify the CEO or CEO-designated contact provided in the request with the decision via USPS mail and/or email.
For additional assistance, LTCHs may submit questions related to the reconsideration request or waiver requirements to the following email address: LTCHQRPReconsiderations@cms.hhs.gov.