[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 1405 Introduced in Senate (IS)]







109th CONGRESS
  1st Session
                                S. 1405

To extend the 50 percent compliance threshold used to determine whether 
    a hospital or unit of a hospital is an inpatient rehabilitation 
  facility and to establish the National Advisory Council on Medical 
                            Rehabilitation.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 14, 2005

  Mr. Nelson of Nebraska (for himself, Mr. Santorum, and Mr. Corzine) 
introduced the following bill; which was read twice and referred to the 
                          Committee on Finance

_______________________________________________________________________

                                 A BILL


 
To extend the 50 percent compliance threshold used to determine whether 
    a hospital or unit of a hospital is an inpatient rehabilitation 
  facility and to establish the National Advisory Council on Medical 
                            Rehabilitation.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Preserving Patient Access to 
Inpatient Rehabilitation Hospitals Act of 2005''.

SEC. 2. EFFECT ON ENFORCEMENT OF REGULATIONS.

    (a) In General.--Notwithstanding section 412.23(b)(2) of title 42, 
Code of Federal Regulations, during the period beginning on July 1, 
2005, and ending on the date that is 2 years after the date of 
enactment of this Act, the Secretary of Health and Human Services 
(referred to in this Act as the ``Secretary'') shall not--
            (1) require a compliance rate, pursuant to the criterion 
        (commonly known as the ``75 percent rule'') that is used to 
        determine whether a hospital or unit of a hospital is an 
        inpatient rehabilitation facility (as defined in the rule 
        published in the Federal Register on May 7, 2004, entitled 
        ``Medicare Program; Final Rule; Changes to the Criteria for 
        Being Classified as an Inpatient Rehabilitation Facility'' (69 
        Fed. Reg. 25752)), that is greater than the 50 percent 
        compliance threshold that became effective on July 1, 2004;
            (2) change the designation of an inpatient rehabilitation 
        facility in compliance with the 50 percent threshold; or
            (3) conduct medical necessity review of inpatient 
        rehabilitation facilities using any guidelines, such as fiscal 
        intermediary Local Coverage Determinations, other than the 
        national criteria established in chapter 1, section 110 of the 
        Medicare Benefits Policy Manual.
    (b) Retroactive Status as an Inpatient Rehabilitation Facility; 
Payments; Expedited Review.--The Secretary shall establish procedures 
for--
            (1) making any necessary retroactive adjustment to restore 
        the status of a facility as an inpatient rehabilitation 
        facility as a result of subsection (a);
            (2) making any necessary payments to inpatient 
        rehabilitation facilities based on such adjustment for 
        discharges occurring on or after July 1, 2005, and before the 
        date of enactment of this Act; and
            (3) developing and implementing an appeals process that 
        provides for expedited review of any adjustment to the status 
        of a facility as an inpatient rehabilitation facility made 
        during the period beginning on July 1, 2005, and ending on the 
        date that is 2 years after the date of enactment of this Act.

SEC. 3. NATIONAL ADVISORY COUNCIL ON MEDICAL REHABILITATION.

    (a) Definitions.--In this section:
            (1) Advisory council.--The term ``Advisory Council'' means 
        the National Advisory Council on Medical Rehabilitation 
        established under subsection (b).
            (2) Appropriate federal agencies.--The term ``appropriate 
        Federal agencies'' means--
                    (A) the Agency for Healthcare Research and Quality;
                    (B) the Centers for Medicare & Medicaid Services;
                    (C) the National Institute on Disability and 
                Rehabilitation Research; and
                    (D) the National Center for Medical Rehabilitation 
                Research.
    (b) Establishment.--Pursuant to section 222 of the Public Health 
Service Act (42 U.S.C. 217a), the Secretary shall establish an advisory 
panel to be known as the ``National Advisory Council on Medical 
Rehabilitation''.
    (c) Membership.--
            (1) Appointment.--The Advisory Council shall be composed of 
        17 members, of whom--
                    (A) 9 members shall be appointed by the Secretary, 
                in consultation with the medical rehabilitation 
                community, from a diversity of backgrounds, including--
                            (i) physicians;
                            (ii) medicare beneficiaries;
                            (iii) representatives of inpatient 
                        rehabilitation facilities; and
                            (iv) other practitioners experienced in 
                        rehabilitative care; and
                    (B) 8 members, not more than 4 of whom are members 
                of the same political party, shall be appointed jointly 
                by--
                            (i) the majority leader of the Senate;
                            (ii) the minority leader of the Senate;
                            (iii) the Speaker of the House of 
                        Representatives;
                            (iv) the minority leader of the House of 
                        Representatives;
                            (v) the Chairman and the Ranking Member of 
                        the Committee on Finance of the Senate; and
                            (vi) the Chairman and the Ranking Member of 
                        the Committee on Ways and Means of the House of 
                        Representatives.
            (2) Date.--Members of the Advisory Council shall be 
        appointed not later than 30 days after the date of enactment of 
        this Act.
            (3) Period of appointment; vacancies.--Members shall be 
        appointed for the life of the Council. A vacancy on the 
        Advisory Council shall be filled not later than 30 days after 
        the date on which the Advisory Council is given notice of the 
        vacancy, in the same manner as the original appointment.
            (4) Meetings.--
                    (A) Initial meeting.--The Advisory Council shall 
                conduct an initial meeting not later than 120 days 
                after the date of enactment of this Act.
                    (B) Meetings.--The Advisory Council shall conduct 
                such meetings as the Council determines to be necessary 
                to carry out its duties but shall meet not less 
                frequently than 2 times during each calendar year.
    (d) Duties.--The duties of the Advisory Council shall include the 
following:
            (1) Advice and recommendations.--Providing advice and 
        recommendations to--
                    (A) Congress and the Secretary concerning the 
                coverage of rehabilitation services under the medicare 
                program, including--
                            (i) policy issues related to rehabilitative 
                        treatment and reimbursement for rehabilitative 
                        care, such as issues relating to any rulemaking 
                        relating to, or impacting, rehabilitation 
                        hospitals and units;
                            (ii) the appropriate criteria for--
                                    (I) determining clinical 
                                appropriateness of inpatient 
                                rehabilitation facility admissions; and
                                    (II) distinguishing an inpatient 
                                rehabilitation facility from an acute 
                                care hospital and other providers of 
                                intensive medical rehabilitation;
                            (iii) the efficacy of inpatient 
                        rehabilitation services, as opposed to other 
                        post-acute inpatient settings, through a 
                        comparison of quality and cost, controlling for 
                        patient characteristics (such as medical 
                        severity and motor and cognitive function) and 
                        discharge destination;
                            (iv) the effect of any medicare regulations 
                        on access to inpatient rehabilitation care by 
                        medicare beneficiaries and the clinical 
                        effectiveness of care available to such 
                        beneficiaries in other health care settings; 
                        and
                            (v) any other topic or issue that the 
                        Secretary or Congress requests the Advisory 
                        Council to provide advice and recommendations 
                        on; and
                    (B) appropriate Federal agencies (as defined in 
                subsection (a)(3)) on how to best utilize available 
                research funds and authorities focused on medical 
                rehabilitation research, including post-acute care site 
                of service and outcomes research.
    (e) Periodic Reports.--The Advisory Council shall provide the 
Secretary with periodic reports that summarize--
            (1) the Council's activities; and
            (2) any recommendations for legislation or administrative 
        action the Council considers to be appropriate.
    (f) Termination.--The Advisory Council shall terminate on September 
30, 2010.
    (g) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out the purposes of 
this section.
    (h) Effective Date.--This section shall take effect on the date of 
enactment of this Act.
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