[Congressional Record Volume 153, Number 41 (Friday, March 9, 2007)]
[Extensions of Remarks]
[Page E510]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




    PRESERVING PATIENT ACCESS TO INPATIENT REHABILITATION HOSPITALS

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                          HON. JOHN S. TANNER

                              of tennessee

                    in the house of representatives

                         Friday, March 9, 2007

  Mr. TANNER. Madam Speaker, today I, along with my colleagues Reps. 
Nita Lowey (D-NY), Kenny Hulshof (R-MO), Frank LoBiondo (R-NJ) and with 
70 co-sponsors, rise to introduce the Preserving Patient Access to 
Inpatient Rehabilitation Hospitals Act of 2007 to ensure that the 
Centers for Medicare and Medicaid Services, CMS, does not continue to 
implement the misguided 75 Percent Rule and unnecessarily compromise 
the ability of rehabilitation hospitals and units to continue to 
provide much-need critical rehabilitation care.
  The 75 Percent Rule is one of seven criteria inpatient rehabilitation 
hospitals and units must meet in order to be paid under the inpatient 
rehabilitation facilities prospective payment system, IRF-PPS, rather 
than the inpatient prospective payment system, IPPS, under which 
general acute care hospitals are paid. The rule was first issued in 
January 1984 pursuant to the Social Security Act Amendments of 1983, 
and has faced minimal revision to date. Simply put, to qualify as an 
IRF under the 75 Percent Rule, 75 percent of a facility's patients must 
be receiving treatment in one of 13 specified conditions. The result is 
that inpatient rehabilitation hospitals and units are the only Medicare 
providers that are classified on the basis on patient condition rather 
than the services provided to patients admitted to their care.
  Inpatient rehabilitation hospitals and units provide specialized 
programs and services for patients who have suffered brain injuries, 
strokes, spinal cord injuries, and other rehabilitating injuries. 
However, CMS has consistently refused to update the 75 Percent Rule to 
reflect medical advances made over the 20 years since the 
classification criteria were first developed.
  It is shocking how many patients have been turned away because of 
this rule. The 75 Percent Rule functions as a quota system without any 
foundation in clinical or scientific evidence, which makes it just that 
much more frustrating to watch the inpatient hospitals and units in my 
home state struggle to comply with the regulation without jeopardizing 
patient access to crucial rehabilitative care.
  Our legislation will ensure that patients across America will 
continue to have access to the rehabilitative care they need, and that 
CMS will take a long, hard look at the impact this policy is having on 
Medicare beneficiaries and the Medicare system itself. The legislation 
would freeze the compliance threshold at 60 percent indefinitely, 
allowing facilities to continue to provide care to Medicare 
beneficiaries in need of intensive inpatient rehabilitation therapy. 
The legislation also codifies medical necessity standards and requires 
CMS to provide Congress with a comprehensive assessment of what is 
happening to patients that are denied care in this specialized health 
care setting.
  Congress has year after year called on CMS to modernize the 75 
Percent Rule. This year we face a time-sensitive imperative. Unless 
Congress acts by July 1, 2007, the CMS rule automatically imposes a 65 
percent compliance threshold. It is abundantly clear that this chamber 
will have to take legislative action if we hope to stop implementation 
of this policy and ensure that our constituents have access to intense 
rehabilitative care in the appropriate inpatient setting.
  We urge our colleagues to support this legislation.

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