The three-year-long fight over Medicare's 75% rule for rehabilitation hospitals may not be over.
Although the CMS said last week it would move ahead with the regulations, lawmakers appeared ready to intervene.
The regulations set criteria for hospitals to qualify as inpatient rehabilitation facilities, which receive higher Medicare payments than acute-care hospitals. By 2007, for a hospital to qualify, 75% of its admissions would have to involve at least one of 13 conditions.
The threshold, now 50%, will rise to 60% on July 1.
Earlier this month, seven senators asked HHS Secretary Mark McClellan to hold the threshold at 50% until next summer. Legislation could be introduced as early as this week.
"There's a group of us who aren't going to let this go away," said Jen Vesey, a legislative assistant for Sen. Rick Santorum (R-Pa.); the lawmaker was one of the seven who signed the letter to McClellan. The change would mean more time for the industry to gather data and analyze the full impact of the regulations, Vesey said.
The hospital industry has fought the regulations since they were proposed in 2003 and remains unhappy with the criteria, especially stipulations that say, in part, patients receiving therapy for a single knee or hip replacement don't count toward the threshold.
The CMS decision wasn't unexpected, said Balaji Gandhi, a rehabilitation industry analyst at Pacific Growth Equities.
The last time Congress stepped in to referee the dispute, in an appropriations act for 2005, it ordered the Government Accountability Office to study the regulations' potential impact and told the CMS not to change facilities' status as rehabilitation hospitals until after the GAO report.
The GAO report, issued in April, didn't recommend suspending the criteria, the CMS said.
Officials at the CMS said they would be following the report's recommendations by enforcing the regulations and studying whether more defined subgroups of patients were necessary.