[Congressional Record Volume 153, Number 128 (Saturday, August 4, 2007)]
[Extensions of Remarks]
[Page E1754]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




         CHILDREN'S HEALTH AND MEDICARE PROTECTION ACT OF 2007

                                 ______
                                 

                               speech of

                          HON. JOHN S. TANNER

                              of tennessee

                    in the house of representatives

                       Wednesday, August 1, 2007

  Mr. TANNER. Mr. Speaker, I rise today with regard to H.R. 3162, The 
Children's Health and Medicare Protection Act of 2007, and in 
particular with regard to Section 502, ``Payment Inpatient 
Rehabilitation Facility (IRF) Services.''
  Section 502 takes critically important steps towards ensuring that 
Medicare beneficiaries have access to medically necessary inpatient 
rehabilitation in an appropriate treatment setting by permanently 
extending the 60 percent compliance threshold and by retaining co-
morbidities in these provisions. Section 502 prevents further negative 
impacts from the Centers for Medicare and Medicaid Services' (CMS) 70 
Percent Rule policy, which since the Rule's implementation, has 
deprived more than 100,000 Medicare beneficiaries access to inpatient 
rehabilitation care despite their meeting medical necessity standards. 
I strongly support this permanent extension of the 60 percent 
compliance threshold.
  Section 502 also provides for a permanent extension in co-morbidities 
policy in ascertaining compliance with the rule. An estimated seven 
percent of the inpatient rehabilitation cases obtain eligibility 
through co-morbidities. Reversing this policy would adversely impact 
both beneficiaries and providers. CMS, in promulgating its Final Rule 
for the Inpatient Rehabilitation Facility (IRF) Prospective Payment 
System (PPS) which will be published in the Federal Register on August 
7, 2007, has determined that effective July 1, 2008, co-morbidities may 
no longer be used to determine whether a provider meets the compliance 
threshold. The importance of Section 502 is particularly urgent in 
light of this recent regulatory action.
  I urge the House to take a firm stance when conferencing with respect 
to the inpatient rehabilitation provisions of Section 502. More than 
half of the House has joined as co-sponsors of H.R. 1459, which I--
along with my Colleagues Mr. Hulshof of Missouri, Mrs. Lowey of New 
York, and Mr. LoBiondo of New Jersey--introduced to ensure that the 60 
percent compliance threshold is made permanent and that the co-
morbidities provision is extended. I take seriously the trust that has 
been placed in me by these other 221 House co-sponsors, and I ask that 
the Conferees do the same.
  I also ask that the House safeguard the important provisions of H.R. 
3162 that will yield critically important new information and data by 
requiring the Secretary to report on beneficiaries' access to medically 
necessary rehabilitative care and variation in that care across 
treatment settings. The reporting requirements also call for 
consideration of patients' length of stay and the frequency of 
readmission in evaluating cost effectiveness for an entire episode of 
care. These requirements accurately reflect the information necessary 
for educated decision-making, and we commend their inclusion in Section 
502.

  There are two issues related to the legislation which I respectfully 
request our colleagues consider in any future conference negotiations. 
The House bill currently fails to fix Local Coverage Determinations 
(LCD) and medical necessity criteria issues which have become apparent 
in various areas throughout the country. We should not deliver a bill 
that addresses the compliance threshold but fails to deal with the 
simultaneous problems apparent in large areas of the country--where 
Medicare Fiscal Intermediaries are imposing narrow and restrictive 
interpretations which further limit access to medically necessary 
rehabilitation care and disregard physician judgments. I appreciate the 
commitment to addressing these issues demonstrated in Committee. As CMS 
and its contractors persist in imposing oversight requirements on the 
inpatient rehabilitation field which are far in excess of those imposed 
on any other health care sector under Medicare, a more reasonable 
approach is needed. Congress should codify Ruling 85-2, as called for 
in H.R. 1459. I appreciate that Chairman Stark has shown his 
willingness to continue working towards a resolution of our concerns.
  In addition, we strongly believe that Section 502 moves in precisely 
the wrong direction in making radical changes to payment rates for hip 
and knee replacement and hip fracture cases. We believe neither CMS nor 
Congress has the clinical data and comparative research necessary 
either on which to base this policy or to understand the impact of this 
decision. We should support accurate payments by the Medicare program 
that are based on sound analysis, clinical evidence, and aligned with 
the actual cost of providing high quality care. Instead, Section 502 
uses the average per-stay skilled nursing facility payment rate as a 
baseline for calculating repayment in the inpatient rehabilitation 
context. Inpatient rehabilitation is fundamentally different and 
clinically more advanced than skilled nursing care. For patients 
requiring medical rehabilitation, these settings are not 
interchangeable. Therefore, the payments should not be interchangeable. 
Paying inpatient rehabilitation providers a lower amount bases on the 
rate for nursing facilities is contrary to the principles of pay-for-
performance.
  Finally, we believe that the overall changes in payment rates called 
for in Section 502 results in a disproportionate financial impact for 
the rehabilitation hospital sector. Inpatient medical rehabilitation 
accounts for $6 billion in annual Medicare spending out of a total 
estimated $437 billion in 2007. Scoring by the Congressional Budget 
Office (CBO) confirms that payments to the sector will be reduced by 
$2.4 billion over a 5-year period, and $6.6 billion over 10 years. In 
other words, inpatient rehabilitation hospital reductions represent 41 
percent of Part A spending cuts currently in the bill for a sector that 
represents a mere 1.4 percent of total Medicare spending. Inflicting 41 
percent of the Part A spending cuts on this sector appears to be 
disproportionate.
  In addition, it should be noted that the rehab hospital sector has 
already absorbed substantial cuts as a result of the phased 
implementation of the 75 Percent Rule policy. Data from the Centers 
from Medicare and Medicaid Services (CMS) confirm that rehabilitation 
providers experienced cuts of at least $300 million in the first year 
of implementation alone.

  The Department of Health and Human Services and CMS initiated the 75 
Percent Rule without direction from Congress, and have moved forward 
with the policy in an unbridled way. It is imperative that this 
Congress take the necessary steps to protect patient access to 
inpatient rehabilitation hospital-level services. A final bill must be 
more reasonable for the rehabilitation sector and fairer to Medicare 
beneficiaries.
  I look forward to continuing to work with my colleagues to retain the 
60 percent compliance threshold and co-morbidities and address the 
remaining problematic issues relating to local coverage determinations 
and medical necessity criteria, and our payment policies for hip and 
knee conditions, as the legislative process moves forward.




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