Medicare Compliance & Reimbursement

Congress may put quick end to controversial regulation.

Rehab providers still have reason to hold out hope for an end to the much-maligned 75-percent rule.

The U.S. House of Representatives Sept. 8 passed an amendment to the 2005 Departments of Labor, Health and Human Services, and Education Appropriations bill (H.R. 5006) that would halt the Centers for Medicare & Medicaid Services' implementation of the 75-percent rule. The originally proposed amendment sought to delay the rule's implementation pending a study by the Institute of Medicine on the effect the restrictive rule would have on patient access to rehab services.

The finalized amendment hands that study over to the Government Accountability Office, rather than the IOM. The House Ways and Means Committee made this change to the original amendment. Having the GAO conduct the study "is not 100 percent favorable to the industry," admits attorney Jeffrey Micklos with Foley & Lardner in Washington, DC. "But the fact that [the amendment] is still in the appropriations bill is very positive," he tells MLR.

As currently written, the 75 percent rule (which was published in the Federal Register May 7) would shut too many patients out in the cold, believes Rep. Fran LoBiondo (R-NJ), who sponsored the bill along with Reps. Zach Wamp (R-TN) and Nita Lowey (D-NY). By 2007, 75 percent of an inpatient rehab facility's admissions would have to fall within a list of 13 qualifying conditions. "It is imperative that physicians and medical professionals have input to change these outdated [inclusion] criteria," LoBiondo says.

The amendment is "a good thing for the therapy profession and rehab in general," cheers Rick Gawenda, director of rehab services at Detroit Receiving Hospital in Detroit. Although support for the amendment is strong in the House, the appropriations bill still must make its way through the Senate before providers have a final cause for celebration, Gawenda reminds providers.

And no one knows when the Senate might vote on the bill. Congress is often slow to move on healthcare legislation approaching an election, observers note. "It'll be interesting to see if they vote on it before November," Gawenda muses.