1.This Act may be cited as the
Preserving Patient Access to Inpatient
Rehabilitation Hospitals Act of 2005
.
2.Effect on enforcement
of regulations
(a)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
reviewThe 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.
3.National advisory
council on medical rehabilitation
(a)In this section:
(1)The term
Advisory Council
means the National Advisory Council on Medical
Rehabilitation established under subsection (b).
(2)Appropriate
Federal agenciesThe 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)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)
(1)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)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; VacanciesMembers 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)
(A)The Advisory Council
shall conduct an initial meeting not later than 120 days after the date of
enactment of this Act.
(B)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)The duties of the Advisory Council shall
include the following:
(1)Advice and
recommendationsProviding
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)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)The Advisory Council shall terminate on
September 30, 2010.
(g)Authorization
of appropriationsThere are
authorized to be appropriated such sums as may be necessary to carry out the
purposes of this section.
(h)This section shall take
effect on the date of enactment of this Act.