Charles Rangel--DC

July 16, 2008 Mr. Kerry N. Weems Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS 1493-IFC2 Mail Stop C4-26-05 7500 Security Boulevard Baltimore, MD 21244-1850 Calvary Hospital and (CMS-1493-IFC2) Comments on “Medicare Program; Changes for Long-Term Care Hospitals Required by Certain Provisions of the Medicare, Medicaid, SCHIP Extension Act of 2007: 3-Year Moratorium on the Establishment of New Long-Term Care Hospitals and Long-Term Care Hospital Satellite Facilities; and Increases in Beds in Existing Long-Term Care Hospitals and Long-Term Care Hospital Satellite Facilities; and 3-Year Delay in the Application of Certain Payment Adjustments.” Dear Mr. Weems: These comments on the above referenced interim final rule are submitted on behalf of one of my constituents, the Calvary Hospital, a long-term care hospital which is located at 1740 Eastchester Road in New York. Calvary Hospital’s singular and unique mission is dedicated exclusively to providing medical care and treatment to advanced and terminally ill cancer patients who require specialized hospital services. As such it offers vital and unique services for Medicare patients in the New York region. CMS has recently adopted an interim final rule which, among other things, implements the exceptions to the 3-year moratorium on new long-term care hospitals and new long- term care hospital satellites and bed expansions set forth in Section 114(d) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (“MMSEA”). One of the exceptions applies to an approved Certificate of Need (CON) which was obtained as of the date of enactment of MMSEA in a State where a CON is required to establish a new long-term care hospital or a new long-term care hospital satellite. See Section 114(d)(2)(C). I am urging CMS to clarify, in its final rule, that the exception set forth in Section 114(d)(2)(C) also applies where the CON is subsequently modified, amended or replaced, after the date of enactment of MMSEA, to allow for a change in location of the new long-term care hospital or new long-term care hospital satellite facility. The clarification is important so that Calvary Hospital may proceed with its project without any further delay due to uncertainties as to how CMS will interpret the CON exception. Calvary Hospital obtained a CON on April 7, 2005 to establish a 37-bed satellite facility at Saint Vincent’s Midtown Hospital in New York, New York. The Saint Vincent’s Midtown Hospital subsequently closed. As a result of the Hospital’s closure, the location for the satellite facility specified in the CON became unavailable. Calvary Hospital has identified a new location for the satellite facility and would like to proceed to request a modification or an amendment to its CON from the State to provide for a change in location of the satellite without an increase in beds. I believe that when Congress enacted the exceptions to the 3-year moratorium, it intended that an approved CON obtained prior to the enactment of MMSEA that is subsequently “modified” or “amended” to provide for a change in location without an increase in beds would fall within the exception set forth in Section 114(d)(2)(C) of MMSEA. Any other result would be unfair and inequitable. Long-term care hospitals like the Calvary Hospital, which have acted in good faith, in accordance with the State CON process, and which have obtained a CON prior to the date of enactment of MMSEA, should not be adversely affected if they are required to amend or modify the originally approved CON after the date of enactment of MMSEA. Accordingly, I respectfully urge CMS to provide clarification on this issue in the final rule Sincerely, CHARLES B. RANGEL Chairman of the Committee on Ways and Means CBR:jrs