II 110th CONGRESS 1st Session S. 543 IN THE SENATE OF THE UNITED STATES February 12, 2007 Mr. Nelson of Nebraska (for himself, Mr. Bunning, Ms. Stabenow, Ms. Snowe, Mr. Kerry, Ms. Collins, Mr. Reed, Mrs. Clinton, and Mr. Menendez) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To improve Medicare beneficiary access by extending the 60 percent compliance threshold used to determine whether a hospital or unit of a hospital is an inpatient rehabilitation facility under the Medicare program.

1.

Short title

This Act may be cited as the Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2007.

2.

Extension of the 60 percent compliance threshold used to determine whether a hospital or unit of a hospital is an inpatient rehabilitation facility under the Medicare program

(a)

In general

Section 5005 of the Deficit Reduction Act of 2005 (42 U.S.C. 1395ww note) is amended— (1)in subsection (a), by striking apply the applicable percent specified in subsection (b) and inserting require a compliance rate that is no greater than the 60 percent compliance rate that became effective for cost reporting periods beginning on or after July 1, 2005; and (2)by striking subsection (b) and inserting the following new subsection: (b)

Continued use of comorbidities

For cost reporting periods beginning on or after July 1, 2007, the Secretary shall include patients with comorbidity as described in section 412.23(b)(2)(i) of title 42, Code of Federal Regulations, in the inpatient population that counts towards the percent specified in subsection (a). . (b)

Effective date

The amendment made by subsection (a)(1) shall take effect on June 30, 2007.

3.

Medical necessity criteria for beneficiaries served in rehabilitation hospitals and units

On and after June 30, 2007, the Secretary of Health and Human Services, the Centers for Medicare & Medicaid Services, fiscal intermediaries under section 1816 of the Social Security Act (42 U.S.C. 1395h), medicare administrative contractors under section 1874A of such Act (42 U.S.C. 1395kk), recovery audit contractors under section 1893(h) of such Act (42 U.S.C. 1395ddd(h)) or section 306 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, and other government agents shall use and apply the criteria established in HCFA Ruling 85–2, as issued on July 31, 1985 (50 Fed. Reg. 31040), as the sole standard for determining the medical necessity of services provided by inpatient rehabilitation hospitals and units to beneficiaries under the Medicare program under title XVIII of the Social Security Act.