LTACH admission requires a physician referral and documentation that the patient requires an extended acute care stay due to medical complexity. Medicare has specific criteria for LTACH coverage, including that the patient must be admitted from a hospital (typically an acute care or critical access hospital). The LTACH’s admissions team reviews the clinical record to confirm appropriateness and insurance authorization.

Yes, though they are fewer than SNFs. Major Texas metros have LTACH facilities. Houston has several, including Kindred Hospital Houston and others. Dallas, Austin, and San Antonio also have LTACH options. TIRR Memorial Hermann in Houston specializes in neurological rehabilitation at an IRF level (not technically an LTACH) and is nationally recognized for stroke and TBI rehabilitation.

Some LTACH patients are discharged home with home health services when they have stabilized sufficiently. More commonly, LTACH patients progress to a SNF for additional skilled nursing and rehabilitation before returning to the community. The LTACH social worker typically coordinates the discharge planning process and identifies appropriate next settings.

LTACHs are paid under a separate federal prospective payment system from both acute care hospitals and SNFs. Medicare covers LTACH care for qualifying patients, but coverage criteria are complex and require documentation of medical necessity. After Medicare coverage ends, LTACH care is very expensive — families should understand the coverage period and plan accordingly.