For many individuals, medical rehabilitation is a lifeline to improved health and abilities, and enhanced quality of life. In 2011 alone, more than 371,000 Medicare beneficiaries received care from inpatient rehabilitation hospitals or units.
As Congress considers permanent changes to Medicare’s sustainable growth rate, also known as the “doc fix,” some proposals would unfairly cut these Medicare services in hospitals where medical rehabilitation is provided, such as Sheltering Arms. This would severely limit patient access for Medicare beneficiaries, people with disabilities, and others who need this intensive level of care.
There are three main proposals that would negatively impact inpatient rehabilitation:
1) Medical Rehabilitation Medicare Reimbursement Cuts
- Currently, there are efforts to cut or freeze Medicare reimbursement for inpatient rehabilitation hospitals and units. Despite the critical care they provide, inpatient rehabilitation hospitals and units have been subject to numerous payment cuts in recent years, threatening patient access when the need for medical rehabilitative services is growing.
- Inpatient medical rehabilitation represents a very small portion – one percent – of total Medicare spending, and total Medicare spending for services provided at inpatient rehabilitation hospitals and units has been relatively flat since 2004.
- Inpatient rehabilitation hospitals and units spend 90 percent of every Medicare dollar they receive on patients – that’s more than at other settings, such as nursing homes or home healthcare.
2) Reinstatement of the 75 Percent Rule
- In 2004, the Centers for Medicare and Medicaid Services began phasing in new regulations that would require 75 percent of patients being treated in an inpatient rehabilitation hospital or unit to have one of 13 specific conditions in order to receive Medicare funding. Recognizing the negative effect on patient access to critical medical rehabilitation services based on their condition rather than their clinical needs, Congress passed legislation to reduce the requirement to 60 percent in 2007.
- Today, some policy makers have proposed reinstating the arbitrary 75 percent rule as a way to decrease Medicare costs, which would negatively affect patient access to medical rehabilitation in inpatient rehabilitation hospitals and units.
- The current 60 percent requirement allows providers more flexibility to meet patients’ clinical needs.
3) Site Neutral Payments
- Nursing homes, home health agencies, comprehensive outpatient rehabilitation facilities and independent therapists also provide rehabilitation services, but not the intense, specialized treatment that patients receive in medical rehabilitation hospitals and units, and they should not be treated the same. It is important that the right patients get the right treatment in the right setting for the best possible outcomes, while reducing the likelihood of future long-term care expenses.
- The Administration’s proposed budget and Congressional proposals will likely call for making payments to inpatient rehabilitation hospitals and units and nursing homes the same. This would result in patients that need intensive inpatient rehabilitation being diverted inappropriately to less intensive settings where they will not receive the care that they require to achieve the best possible outcomes.
How can you help??
Tell Congress not to adopt misguided regulatory changes that would restrict access for many vulnerable Medicare beneficiaries and individuals with disabilities to rehabilitation hospitals and units.
Call Your Members of Congress – A toll-free line has been set up to make this easy to do. Simply dial 1-888-255-1702 where instructions and key messages will be provided before you are connected to your elected representatives’ offices.
Click here to contact your senator/representative electronically.
Click here for a sample letter which can be placed in the mail.
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