CMS issued a letter to State Survey Agency Directors on April 17, 2009 regarding ARRA provisions that expand the exceptions to the three-year moratorium on LTCH or LTCH satellites previously enacted in the Medicare, Medicaid, and SCHIP Extension Act. The new exception permits an increase in the number of beds in an existing LTCH or LTCH satellite when the bed increase was authorized under a Certificate of Need issued within a specified timeframe. CMS is amending its previous guidance to state survey agencies to reflect this statutory change. CMS Regional Offices will determine whether a facility qualifies for the new exception to the moratorium.