As of December 29, 2012, the moratorium preventing the designation of new long term care hospitals (LTCHs) or LTCH satellites or the addition of new LTCH beds has expired.  The moratorium, which originally established a three-year suspension on such LTCH activities, with limited exception, was established by the Medicare, Medicaid and SCHIP Extension Act on December 29, 2007. The three year time frame was later extended by the Patient Protection and Affordable Care Act until December 28, 2012.  With the expiration of the moratorium as of December 29, 2012, CMS Regional Offices and state surveyors may now process requests from hospitals to change their classification to that of an LTCH, and may also process requests from current LTCHs seeking to increase their number of certified beds, or to establish new LTCH satellites.  CMS has sent a memorandum notifying all state surveyors of the expiration of the moratorium.  The memorandum is available here.