Preserving Patient Access To Inpatient Rehabilitation Hospitals

Floor Speech

PRESERVING PATIENT ACCESS TO INPATIENT REHABILITATION HOSPITALS -- (Extensions of Remarks - March 09, 2007)

* Mr. TANNER. Madam Speaker, today I, along with my colleagues Reps. NITA LOWEY (D-NY), KENNY HULSHOF (R-MO), FRANK LOBIONDO (R-NJ) and with 70 co-sponsors, rise to introduce the Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2007 to ensure that the Centers for Medicare and Medicaid Services, CMS, does not continue to implement the misguided 75 Percent Rule and unnecessarily compromise the ability of rehabilitation hospitals and units to continue to provide much-need critical rehabilitation care.

* The 75 Percent Rule is one of seven criteria inpatient rehabilitation hospitals and units must meet in order to be paid under the inpatient rehabilitation facilities prospective payment system, IRF-PPS, rather than the inpatient prospective payment system, IPPS, under which general acute care hospitals are paid. The rule was first issued in January 1984 pursuant to the Social Security Act Amendments of 1983, and has faced minimal revision to date. Simply put, to qualify as an IRF under the 75 Percent Rule, 75 percent of a facility's patients must be receiving treatment in one of 13 specified conditions. The result is that inpatient rehabilitation hospitals and units are the only Medicare providers that are classified on the basis on patient condition rather than the services provided to patients admitted to their care.

* Inpatient rehabilitation hospitals and units provide specialized programs and services for patients who have suffered brain injuries, strokes, spinal cord injuries, and other rehabilitating injuries. However, CMS has consistently refused to update the 75 Percent Rule to reflect medical advances made over the 20 years since the classification criteria were first developed.

* It is shocking how many patients have been turned away because of this rule. The 75 Percent Rule functions as a quota system without any foundation in clinical or scientific evidence, which makes it just that much more frustrating to watch the inpatient hospitals and units in my home state struggle to comply with the regulation without jeopardizing patient access to crucial rehabilitative care.

* Our legislation will ensure that patients across America will continue to have access to the rehabilitative care they need, and that CMS will take a long, hard look at the impact this policy is having on Medicare beneficiaries and the Medicare system itself. The legislation would freeze the compliance threshold at 60 percent indefinitely, allowing facilities to continue to provide care to Medicare beneficiaries in need of intensive inpatient rehabilitation therapy. The legislation also codifies medical necessity standards and requires CMS to provide Congress with a comprehensive assessment of what is happening to patients that are denied care in this specialized health care setting.

* Congress has year after year called on CMS to modernize the 75 Percent Rule. This year we face a time-sensitive imperative. Unless Congress acts by July 1, 2007, the CMS rule automatically imposes a 65 percent compliance threshold. It is abundantly clear that this chamber will have to take legislative action if we hope to stop implementation of this policy and ensure that our constituents have access to intense rehabilitative care in the appropriate inpatient setting.

* We urge our colleagues to support this legislation.

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