[Congressional Record Volume 153, Number 26 (Monday, February 12, 2007)]
[Senate]
[Page S1850]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. NELSON of Nebraska (for himself, Mr. Bunning, Ms. 
        Stabenow, Ms. Snowe, Mr. Kerry, Ms. Collins, Mr. Reed, Mrs. 
        Clinton, and Mr. Menendez):
  S. 543. 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; to the Committee on Finance.
  Mr. NELSON of Nebraska. Mr. President, today I am introducing the 
Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 
2007 to make changes to a rule issued by the Centers for Medicare and 
Medicaid Services, CMS, which has restricted the ability of 
rehabilitation hospitals to provide critical care.
  In my home State of Nebraska, Madonna Rehabilitation Hospital in 
Lincoln is a nationally recognized premier rehabilitation facility 
offering specialized programs and services for those who have suffered 
brain injuries, strokes, spinal cord injuries, and the latest care for 
cardiac, pulmonary, cancer, pain, and joint replacement patients. If 
the CMS rule is not updated, Madonna and other facilities will not be 
able to continue to offer critical care to patients eager to restore 
their past health and physical function.
  When CMS first looked at whether facilities would qualify as 
inpatient rehabilitation facilities, IRFs, a list of criteria were 
created to determine eligibility. The narrow criteria, generally 
referred to as the ``75-percent rule,'' were first established in 1984, 
but were never strictly enforced and ultimately suspended in 2002 due 
to inconsistencies in accurately determining medical necessity.
  Since establishing strict enforcement of the 75-percent rule in 2004, 
field data estimates that as many as 88,000 Medicare patients have been 
denied critical IRF services. The rule will, by CMS's own estimate, 
shift thousands of patients both Medicare and non-Medicare into 
alternative care settings which may be inappropriate and inadequate. 
Bipartisan Congressional efforts have repeatedly petitioned both the 
U.S. Department of Health and Human Services and CMS for cooperation in 
averting an escalation of the 75-percent threshold, which currently 
stands at 60 percent.
  For cost-reporting periods beginning July 1, 2007, the compliance 
threshold is scheduled to jump to 65 percent, with full 75-percent 
implementation scheduled for July 2008. If legislative action is not 
taken, IRFs will be forced to turn away more and more patients in order 
to operate as rehabilitation hospitals or units. By freezing the 
compliance threshold at 60 percent and ending the inconsistent and 
unpredictable use of fiscal intermediaries' local coverage 
determinations, our efforts will ensure that patients across America 
will continue to have access to the rehabilitative care they need.
  I am pleased a bipartisan group of Senate Finance Committee; Health, 
Education, Labor, and Pension Committee; and Special Committee on Aging 
members have joined me in supporting this legislation. In addition, the 
American Association of People with Disabilities, the American Academy 
of Physical Medicine and Rehabilitation, the American Hospital 
Association, the American Medical Rehabilitation Providers Association, 
the Federation of American Hospitals, and numerous other associations 
and advocacy groups have endorsed our bill. Just as I have heard from 
patients and medical providers who have experienced problems with the 
75-percent Rule, my colleagues and the members of these associations 
have witnessed the devastating effect this rule is having on those who 
need this type of critical care.
  I urge my colleagues to join Senators Jim Bunning, Debbie Stabenow, 
Olympia Snowe, John Kerry, Susan Collins, Jack Reed, Hillary Clinton, 
Robert Menendez and me in supporting this important bill. My colleagues 
and I are determined to resolve this lingering problem and return 
medical necessity decisions back into the hands of medical providers, 
while ensuring access to improved inpatient rehabilitation care. The 
Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 
2007 is a top priority, and I look forward to its passage this year.
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