Report to the General Assembly on the Nursing Home Care Reform Act of 1979 as amended.

Description based on: 1986 (April 1, 1987); title from cover.

The impact of Medicare, Medicaid and Schip Extension Act of 2007 (MMSEA) on the long term acute care hospitals

The Long Term Acute Care Hospitals (LTACH), which serve medically complex patients, have grown tremendously in recent years, by expanding the number of Medicare patient admissions and thus increasing Medicare expenditures (Stark 2004). In an attempt to mitigate the rapid growth of the LTACHs and reduce related Medicare expenditures, Congress enacted Section 114 of P.L. 110-173 (§114) of the Medicare, Medicaid and SCHIP Extension Act (MMSEA) in December 29, 2007 to regulate the LTCAHs industry. MMSEA increased the medical necessity reviews for Medicare admissions, imposed a moratorium on new LTCAHs, and allowed the Centers for Medicare and Medicaid Services (CMS) to recoup Medicare overpayments for unnecessary admissions. ^ This study examines whether MMSEA impacted LTACH admissions, operating margins and efficiency. These objectives were analyzed by comparing LTACH data for 2008 (post MMSEA) and data for 2006-2007 (pre-MMSEA). Secondary data were utilized from the American Hospital Association (AHA) database and the American Hospital Directory (AHD).^ This is a longitudinal retrospective study with a total sample of 55 LTACHs, selected from 396 LTACHs facilities that were fully operational during the study period of 2006-2008. The results of the research found no statistically significant change in total Medicare admissions; instead there was a small but not statistically significant reduction of 5% in Medicare admissions for 2008 in comparison to those for 2006. A statistically significant decrease in mean operating margins was confirmed between the years 2006 and 2008. The LTACHs' Technical Efficiency (TE), as computed by Data Envelopment Analysis (DEA), showed significant decrease in efficiency over the same period. Thirteen of the 55 LTACHs in the sample (24%) in 2006 were calculated as “efficient” utilizing the DEA analysis. This dropped to 13% (7/55) in 2008. Longitudinally, the decrease in efficiency using the DEA extension technique (Malmquist Index or MI) indicated a deterioration of 10% in efficiency over the same period. Interestingly, however, when the sample was stratified into high efficient versus low efficient subgroups (approximately 25% in each group), a comparison of the MIs suggested a significant improvement in Efficiency Change (EC) for the least efficient (MI 0.92022) and reduction in efficiency for the most efficient LTACHs (MI = 1.38761) over same period. While a reduction in efficiency for the most efficient is unexpected, it is not particularly surprising, since efficiency measure can vary over time. An improvement in efficiency, however, for the least efficient should be expected as those LTACHs begin to manage expenses (and controllable resources) more carefully to offset the payment/reimbursement pressures on their margins from MMSEA.^

Oversight of the Anti-Drug Abuse Act of 1986 and the federal drug strategy [microform] : hearing before the Select Committee on Narcotics Abuse and Control, House of Representatives, One Hundredth Congress, first session, December 8, 1987.

"SCNAC-100-1-19."

Vegetation Management Reform Act of 1981 [microform] : hearing before the Subcommittee on Forests, Family Farms, and Energy of the Committee on Agriculture, House of Representatives, Ninety-seventh Congress, first session, on H.R. 2900, April 16, 1981, Eugene, Oreg.

"Serial no. 97-I."

Report to the members of the eighty-fifth General Assembly on the wastepaper collection pilot program, Solid Waste Management Act of 1986.

Program development a cooperative effort by the Dept. of Central Management Services, the Dept. of Energy and Natural Resources, and the Governor's Office.

Regulatory reform and the Federal Aviation Act of 1975 : report of the Fifth Workshop on National Transportation Problems /

Mode of access: Internet.

An Analysis of the National Health Care Reform Act of 1981 (H.R. 850) : background for the statement of Alice M. Rivlin before the Subcommittee on Health , Committee on Ways and Means.

"September 30, 1981."

Short-term evaluation and research issues for the Job Training Partnership Act of 1982 : impact of different forms of private sector participation on client characteristics and program outcomes : final report /

"December, 1983."

Accounting reform and investor protection : hearings before the Committee on Banking, Housing, and Urban Affairs, United States Senate, One Hundred Seventh Congress, second session, on the legislative history of the Sarbanes-Oxley Act of 2002, accounting reform and investor protection issues raised by Enron and other public companies.

Shipping list number: 2003-0249-P (volumes 1-2, 4), 2003-0247-P (volume 3).

Watergate reorganization and reform act of 1975 : hearings before the Committee on Government Operations, United States Senate, Ninety-fourth Congress, first session.

Reuse of record except for individual research requires license from Congressional Information Service, Inc.

Oil Pollution Liability and Compensation Act of 1986 : hearing before the Committee on Environment and Public Works, United States Senate, Ninety-ninth Congress, second session, on S. 2340 ... and S. 2799 ...

Mode of access: Internet.

Mining Law Reform Act of 1991 and the Minerals Policy Review Commission Act of 1991 : hearing before the Subcommittee on Mineral Resources Development and Production of the Committee on Energy and Natural Resources, United States Senate, One Hundred Second Congress, first session, on S. 433 ... S. 785 ... June 11, 1991.

Item 1040-A, 1040-B (MF).

Superfund Reform Act of 1994 : hearings before the Subcommittee on Superfund, Recycling, and Solid Waste Management of the Committee on Environment and Public Works, United States Senate, One Hundred Third Congress, second session, on S. 1834, a bill to amend the Comprehensive Environmental Response, Compensation, and Liability Act of 1980, and for other purposes, February 10; March 2; and April 12, 1994-< >

Shipping list no.: 94-0216-P.

Unemployment insurance : comments on HR. 3896, the Unemployment Compensation Reform Act of 1990 /

"February 22, 1990."

Illinois submission for ... under Public law 99-660 "The State Comprehensive Mental Health Services Plan Act of 1986" and Public law 601-639 "Mental Health Amendments of 1990" for adults with serious mental illness.

Description based on: Sept. 30,1991.