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October 16, 2003 The Honorable Susan Collins The Honorable Olympia Snowe The Honorable Tom Allen The Honorable Michael Michaud Dear Senators Collins & Snowe, Representatives Allen and Michaud: We are writing to you on behalf of Maine's rehabilitation providers and the patients they serve regarding Medicare's 75 percent rule for Inpatient Rehabilitation Hospitals (IRFs). For over 20 years, IRFs have been providing specialized care for patients recovering from conditions requiring intensive inpatient rehabilitative therapy such as stroke, spinal cord injury, traumatic brain injury or orthopedic conditions. Under current rules, to qualify as an Inpatient Rehabilitation Facility, an institution must show that at least 75% of its inpatients require intensive rehabilitation to treat one of only ten listed conditions. However, due to dramatic advances in medical practice and technology, the types of patients served in rehabilitation hospitals have changed tremendously. Most recently the Centers for Medicare and Medicaid Services' (CMS) published proposed changes to the criteria for classifying hospitals as IRFs. Unfortunately these modifications to the 20 year-old CMS rule did not address the problems identified and most certainly failed to effectively modernize the rule to reflect current patient needs for inpatient rehabilitation and the medical complexity of this patient population. In a rural state with a rapidly aging population, access to health care services is critical. Maine's senior citizens simply cannot afford for CMS to bureaucratically address eligibility for rehabilitation services and ignore more than 20 years of medical developments that have greatly impacted the patients who now require inpatient rehabilitation services. Maine's seniors must have access to these rehabilitation services in a timely fashion to ensure the best possible outcomes. The proposal if adopted would severely impact access to inpatient rehabilitation services for many elderly, services that can mean the difference between being able to return to independent living or not. If this rule is implemented as proposed, Maine's rehabilitation hospitals will be forced to close beds and reduce staff-an outcome that is to no one's benefit, least of all Maine's Medicare beneficiaries. We support the MedPAC recommendations of July 7, 2003, that call upon
Secretary Thompson to convene an expert panel of clinicians to reach
a consensus on the diagnoses to be included in the 75% rule with a report
due by October 2004; and call upon CMS to lower the threshold to 50%
for one year while under review, and move away from a simple diagnosis-based
criteria to a patient-based criteria. On behalf of Maine's rehabilitation community, we ask for your assistance and support. Please sign Senator Ben Nelson's Dear Colleague Letter in support of report language requesting that CMS abide by the MedPAC recommendations. We would also ask that you consider co-sponsoring S.1222, Medicare Beneficiary Access to Rehabilitation Facilities Act of 2003, to demonstrate your support for addressing the antiquated CMS 75% rule. (Please sign Representatives LoBiondo, Tanner, and Lowey's Dear Colleague Letter expressing concern to Secretary Thompson and Administrator Scully regarding the recently proposed rehabilitation rule. We would also ask that you consider co-sponsoring HR 2246, Medicare Beneficiary Access to Rehabilitation Facilities Act of 2003, to demonstrate your support for addressing the antiquated CMS 75% rule.) Finally, we would strongly encourage you to personally communicate with Administrator Scully regarding these concerns with the rule, the need for a reduced threshold of 50%, and the importance of a clinical study to more appropriately inform the modernization of the rule. We appreciate your consideration of our requests and for your support on this issue of utmost importance to Maine's rehabilitation hospitals. Sincerely, Steven Michaud, President Amy Morse, Chief Executive Officer Scott Bullock, President
Peter Chalke, President Vincent Conti, President Norman Ledwin, President Shaping the Future of Health
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©2003 Maine Hospital Association www.themha.org