WHITE PLAINS – Congresswoman Nita M. Lowey (D-Westchester/Rockland) today announced her efforts to fight a proposed rule change that would deny rehabilitation services to Medicare recipients and threaten the operation of two local health facilities.

The Center for Medicare and Medicaid (CMS) recently proposed the reinstatement of a rule that requires Inpatient Rehabilitation Facilities (IRF) to prove that at least 75 percent of its patients require services to treat one of ten specific conditions. The “75% Rule” could result in dire financial consequences – even closure – for Helen Hayes Hospital in West Haverstraw and the Burke Rehabilitation Center in White Plains, where Lowey was joined today by hospital and local elected officials, patients, and Healthcare Association of New York State (HANYS) Vice President Raymond Sweeney.

“The 75% Rule is 100% wrong,” said Lowey. “Medicine has made great strides in the last twenty years. Yet, the federal government is proposing a payment scheme based on the treatment patients received in 1984. If this rule is not updated to reflect today’s practices, it will put our local rehab facilities on life support.”

In its original form, the 75% Rule required rehab facilities to show that 75 percent of patients required treatment for stroke, spinal cord injury, congenital deformity, amputation, major multiple trauma, fracture of femur, brain injury, polyarthritis, neurological disorders, and/or burns. The regulation, which went into effect in 1984, was not strictly enforced and was eventually suspended in 2002.

CMS decided in September of this year, however, to change, reinstate, and enforce the rule as a way of reining in rehabilitation costs for Medicare. Rehabilitation is used to treat a much wider range of illness today than it was when this rule was first implemented, yet the agency failed to update the rule to adequately reflect medical advances over the last twenty years. The number of qualifying conditions would be increased to twelve by expanding the definition of polyarthritis, and the compliance threshold would be lowered to 65% for a three-year period. However, 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.

Eunice Boehle, an 85-year-old Burke patient, spoke about the care she received after knee replacement surgery three years ago. Parker Reist, a 70-year-old college professor, also received rehabilitative care for complications resulting from multiple heart surgeries. Intensive respiratory, physical, and occupational therapy have resulted in his ability to walk with a cane and manage his respiratory disorders. Both of these patients would have been denied this essential care if the 75% Rule had been enforced.

The 75% Rule could also create serious economic crises for hospitals and employees. Non-compliance would result in the revocation of Inpatient Rehabilitation Facility (IRF) status, making facilities ineligible to receive reimbursement for services from Medicare. With such a drastic decrease in patient loads and Medicare reimbursements, many facilities would be unable to operate. According to an American Hospital Association (AHA) study, if the 75% Rule is reinstated 23 percent of the IRFs in the country would close. Westchester and Rockland Counties could lose more than 1,000 jobs if Helen Hayes Hospital and Burke Rehabilitation Center were forced to close.

HANYS estimates that the reimplementation of the 75% Rule would reduce New York State’s revenue by $200 million and District 18’s revenue by $35 million.

“We applaud Congresswoman Lowey for leading the effort to block implementation of a rule that would arbitrarily limit patients’ access to needed rehabilitation care and threaten the very existence of many rehabilitation providers,” said Ray Sweeney, Executive Vice President of HANYS, which represents 550 non-profit and public hospitals, health systems, and continuing care providers across New York State.

Burke Rehabilitation Center CEO Dr. Mary Beth Walsh said, “This proposed rule will deny inpatient rehabilitation care to many thousands of Medicare patients who need it, to recover from serious illness or surgery. No other piece of our health care system is dedicated exclusively to helping a patient achieve their maximal level of independence in function. An inpatient rehabilitation facility, just as an acute care hospital, should be defined by the services it provides, not the diagnoses of its patients.”

Lowey has authored two letters in recent months to U.S. Health and Human Services Secretary Tommy Thompson and CMS Administrator Thomas Scully urging a more thorough review of the rule before its implementation, which is expected to take effect in January 2004. Lowey is working with the American Hospital Association, which hosted a Lobby Day on Capitol Hill this week, to gather Congressional signatures on her most recent letter. She is also a leading cosponsor of a bipartisan bill, H.R. 2246, to expand the list of conditions to 21 by adding the most common conditions affecting Medicare recipients that are routinely treated with rehab services.

“This proposed rule change will leave many patients and our local rehab facilities in critical condition. CMS must delay implementation of this rule, study the consequences, and develop a system that provides the essential health services Medicare recipients need,” said Lowey. “We all expect 21st century care from our doctors. It’s time for Medicare’s bookkeepers to catch up with modern medicine.”