Eighty senators asked HHS Secretary Tommy Thompson to refrain from implementing a controversial new regulation on Medicare rehabilitation payments until the Institute of Medicine completes a study on which clinical conditions should be part of the qualifying set. The regulation establishes new criteria to determine whether a facility receives inpatient rehabilitation rates, which are higher than Medicare payments for general hospitals. As of July 1, 50% of a hospital's patients must have at least one of 13 conditions for the facility to qualify for rehabilitation rates. The percentage is scheduled to rise in subsequent years, reaching 75% in 2007.
The CMS issued a final regulation in April after vehement opposition by provider groups to its initial proposal, particularly to the proposed set of qualifying conditions. The American Hospital Association vowed to seek congressional intervention, saying that despite the revisions the regulation still would deny rehabilitation rates to many legitimate rehabilitation hospitals. In a letter to Thompson, the 80 senators said they feared access to rehabilitation services would be compromised by the regulation. "These policies are critically important to our seniors and persons with disabilities . . . and consequently (the qualifying conditions) must reflect the consensus opinion of independent medical rehabilitation experts convened by the IOM," the letter said. -- by Tony Fong