WASHINGTON, DC – As rehabilitation hospitals struggle to comply with the misguided and unfair ‘75% Rule’, Congresswoman Nita Lowey (D-Westchester/Rockland) is leading a bipartisan effort to help these hospitals and their patients by introducing legislation to give the hospitals more time to adapt to the new rule.

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 thirteen conditions.  Those conditions were first defined in 1984 and have not been significantly updated since despite medical advances, over the last two decades. 

While the rule was suspended for several months to allow completion of a General Accountability Office study, it is now in effect.  The compliance threshold for the rule is being phased in over the next three years with 50% compliance required from July 2004 to June 2005, 60% required from July 2005 to June 2006, 65% required from July 2006 to June 2007, and 75% required after July 1, 2007.  This rule will adversely affect hospitals and patients across the country, including Burke Rehabilitation Center in White Plains and Helen Hayes Rehabilitation Hospital in West Haverstraw. 

“The ‘75% Rule’ is 100% wrong, and it is hurting patients and rehabilitation facilities already,” said Lowey.  “I will continue to fight this misguided rule until the needs of our hospitals are out of danger and patients have access to treatments they need.”

"Determining the site of a patient's post-acute care (a skilled nursing facility, an inpatient rehabilitation hospital, an out-patient department, or skilled services brought to the home) based on their diagnostic label rather than their individual needs is harmful to seniors with physical impairments resulting from illness or injury,” said Dr. Mary Beth Walsh, President of Burke Rehabilitation Center.  “This determination should be made by their physician, with the patient and their family, based on their specific needs, and the available resources in their community, to maximize their functional outcome.  It is critical that this legislation become law, to insure that inpatient rehabilitation facilities survive as part of the continuum of care for seniors."

Today, Congresswoman Lowey joined members of both chambers and both parties in announcing legislation to curb the ill effects of this rule.  The Preserving Patient Access to Inpatient Rehabilitation Hospitals Act would allow hospitals additional time to ensure they are in compliance with CMS’ rule.  Specifically, the bill would hold the 50% threshold for compliance for an additional two years. 

It will also create a National Advisory Council on Medical Rehabilitation to ensure that future policies created by federal agencies and Congress reflect the realities and challenges facing the field of rehabilitative care without denying needed care to patients. 

The legislation was announced today at a press conference attended by House sponsors Lowey and Congressman Frank LoBiondo (R-NJ), Senate sponsors Ben Nelson (D-NE) and Rick Santorum (R-PA) and Dr. Walsh.

“Patients should have access to the best possible treatment in the most appropriate setting.  Unfortunately, the ‘75% Rule’ jeopardizes millions of Americans’ access to receive the best care,” said Lowey.  “Our legislation would give rehabilitation facilities the time to adapt to this new rule so that patients are not put at risk.” 

“Every day, patients throughout America are being turned away from rehabilitation hospitals because of unfair bureaucratic rules,” said Rep. LoBiondo.  “The ’75 percent rule’ is taking a toll on the health and recovery of thousands of patients, and it is essential that we change the way it is being implemented.  I look forward to continue working with Rep. Lowey to get this done.”