Medicare Extenders (MDH/LVA) Proposal

CAH swing beds in the crosshairs

November 17, 2017

On November 15, the U.S. House Ways & Means Committee released a statement that the Chair and Ranking Democrat had reached a bipartisan agreement on a package of what are called Medicare payment “extender” policies. Several of the polices in this package are the Medicare Dependent Hospital (MDH) and the Low-Volume Adjustment (LVA), both of which expired September 30.

The MDH and LVA payments affect roughly 15-20 of Wisconsin’s rural, non-critical access hospitals each year, and WHA strongly supports their continuation. The Ways & Means Committee proposes extending both MDH and LVA out an additional two years.
Several other extenders in this package include:

  • Two-year straight extension of the Medicare geographic payment cost index for physician payments;
  • Permanent extension of exceptions process for Medicare with the repeal of the therapy caps;
  • Five-year straight extension of the home health rural add-on; and,
  • Five-year extension of the ground ambulance add-ons and ground ambulance payment modifications.

However, in order to help pay for these extensions, the Ways & Means Committee is proposing to modify the payment for critical access hospital (CAH) swing beds. WHA has already engaged with Members of Wisconsin’s Delegation in opposition to this potential cut to swing beds and will also be in Washington, D.C. November 29 to discuss.

WHA will continue to advocate against this pay-for and further analyze the proposal as more details emerge. If you would like to express concerns to your Member of Congress, log onto

This story originally appeared in the November 17, 2017 edition of WHA Newsletter