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ASHA and a coalition of hospital rehabilitation groups are urging Congress to pass H.R. 3373 and S.1405, the "Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2005", that would freeze implementation of the 75% Rule at the 50 percent level and protect patient access to inpatient rehabilitation facility (IRF) care. The legislation would prohibit CMS from requiring a compliance rate greater than 50% and restrict the use of medical necessity reviews in IRFs to the criteria established in the Medicare Benefit Policy Manual. ASHA is seeking to have these provisions included in budget reconciliation legislation scheduled to be considered this fall. An advertisement to support H.R. 3373 and S. 1405 (PDF format)advertisement to support H.R. 3373 and S. 1405 (PDF format) appeared in Capitol Hill newspapers supporting the bills.
The 75% rule allows CMS to disqualify a rehabilitation facility from participation in the Medicare program if, annually, less than 75% of its admitted patients (phased in by 2007 from the current 50%) do not fall within one of 13 diagnoses/conditions. The 13 conditions are mainly orthopedic, but do include stroke, spinal cord injury, brain injury, and neurological disorders. The rule disqualifies certain prospective new admissions based on their primary diagnosis, even though the patient may have a severe communication disorder that could benefit from intensive rehabilitation services. For further information, please contact Mark Kander, ASHA's Director of Health Care Regulatory Analysis, at mkander@asha.org or by phone at 800-498-2071, ext. 4139.
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