LTCHs are among the smallest number of PAC providers. These hospitals treat medically complex cases often following discharge from an acute intensive care unit (Gage et al, 2007). They are not available in all parts of the nation, although they have grown immensely over the past 20 years, more than doubling in number. The majority are located in the Northeast and Southern parts of the United States. In 2007, there were 397 LTCHs in the United States, the majority of which were freestanding (258, or 65.0 percent) as opposed to being located with acute hospitals, so-called hospital within hospitals (HWH). It is notable that the majority of states in the West region and a large proportion of states in the Midwest region had fewer than 9 LTCHs per state in 2007. The exception was California, which had 14 LTCHs (all freestanding) and Oklahoma, which also had 14 LTCHs (11 of which were freestanding). Most notably, the states of Montana, New Hampshire, Alaska, Iowa, Maine, Vermont, and Oregon had no LTCHs in 2007. Although overall, most LTCHs were freestanding in 2007, Texas, Ohio, and Pennsylvania, were the states with the most colocated HWH LTCHs, with 26, 13, and 12, respectively. HWHs include colocated providers and satellite facilities. Texas also had the most freestanding LTCHs (46), followed by Louisiana (31). Overall, between 2006 and 2007, there was a slight shift in the number of freestanding versus HwH LTCHs. The number of HWH LTCHs decreased 6.0 percent from 148 to 139 and the number of freestanding LTCHs increased from 244 to 257.