Medicare Long-Term Care Hospital Improvement Act of 2009

Medicare Long-Term Care Hospital Improvement Act of 2009 - Amends the Medicare, Medicaid, and SCHIP Extension Act of 2007, as amended by the American Recovery and Reinvestment Act of 2009, to extend from three years to five years the delay in application of: (1) the 25% patient threshold payment adjustment to freestanding and grandfathered long-term care hospitals (LTCHs); (2) any payment adjustment, in certain circumstances, to any applicable LTCH or satellite facility located in a rural area or co-located with an urban single or metropolitan statistical area (MSA) dominant hospital; (3) the very short-stay outlier policy; and (4) a specified one-time prospective adjustment to LTCH prospective payment rates.

Extends from three years to five years the moratorium on: (1) the establishment and classification of a LTCH or satellite facility, other than an existing one; and (2) an increase of LTCH beds in existing LTCHs or satellite facilities.

Establishes a formula for annual adjustment of the base prospective payment rate for LTCHs for rate years 2011 through 2015 in order to implement a budget neutrality offset of the costs of implementing this Act.