WASHINGTON – The House Appropriations Committee today approved an amendment by Congresswoman Nita Lowey (D-Westchester/Rockland) to delay the implementation of a rule that would reduce Medicare payments for some rehabilitation hospitals. The amendment was approved by voice vote.
On July 1, 2004, the Centers for Medicare and Medicaid Services (CMS) reinstated a rule that requires Inpatient Rehabilitation Facilities (IRFs) to prove that at least 75 percent of their patients require services to treat one of a limited set of conditions. Those conditions were first defined in 1984 but the rule was not strictly enforced and was suspended altogether in 2002.
CMS decided in September of 2003 to change, reinstate, and enforce the rule. The number of qualifying conditions would be increased by expanding the definition of polyarthritis, and the compliance threshold would be phased in over the next three years from 50% in 2004 to 75% after July 1, 2007. While, rehabilitation is used to treat a much wider range of illnesses today than it was when this rule was first implemented, the agency failed to update the rule to adequately reflect medical advances over the last twenty years. For example, patients who routinely receive rehabilitative care, such as those recovering from knee and hip replacement as well as those suffering from rheumatoid arthritis and pulmonary disease, would be denied coverage by Medicare.
“Our hospitals are struggling to comply with a rule that reflects treatment options in 1984, not 2004,” said Lowey, a member of the Appropriations Committee. “If this rule is not updated to reflect today’s practices, it will put our local rehab facilities on life support.”
Lowey’s amendment would prohibit the Centers for Medicare and Medicaid Services (CMS) from implementing the 75% Rule until an Institute of Medicine (IOM) study is completed on the issue. Despite repeated requests from Lowey and other lawmakers, CMS declined to conduct an independent review of the issue prior to the rule’s implementation.
“This amendment would inject common sense into the process by requiring that this new rule – a rule that could have potentially devastating effects on rehabilitation hospitals and patients – be studied before it is put into effect,” said Lowey. “New York has been on the forefront of medical technology. We should be applauded for our efforts to create new, more effective treatments, not penalized by an outdated, unfair regulation. An independent evaluation will provide confidence that any new regulation is based on science and a thorough understanding of current medical practices.”
