Congress blocks CMS's 75% rehabilitation rule

Shortly before the holiday break, Congress "blocked a Medicare rule that would have forced rehabilitation hospitals nationwide to turn away thousands of patients recovering from heart or lung ailments or joint replacements." (Source: "Ben Nelson helps stop Medicare rehab rule," Omaha World-Herald, Dec. 29, 2007.) Under the blocked Centers for Medicare and Medicaid Services rule, 75% of the patients admitted to rehabilitation hospitals would have had to meet at least one of 13 medical criteria to receive Medicare reimbursements. Instead, Congress has permanently frozen the threshold at 60% and expanded the list of 13 medical criteria used to qualify patients for rehabilitation hospital care. This change will allow more patients to spend their rehabilitation time in hospitals as opposed to facilities such as nursing homes.

A CMS spokeswoman said Congress' intervention is one reason health care costs keep going up in America, with the original rule intended to "hold down costs by steering patients to less costly but effective treatment." CMS says Medicare reimbursements for services at rehabilitation hospitals are higher than at facilities such as nursing homes, and that "patients recovering from hip or knee replacements, or some cardiac or pulmonary conditions, often do not need hospital-based rehabilitation after surgery." Rehabilitation hospitals "agree that their costs are higher but say they provide a shorter-length, higher quality and more intensive treatment for patients, many of whom are senior citizens and take longer to heal." In addition, rehab hospitals worried the new rule would cause many of them to close. Under a restriction issued several years ago by CMS, rehabilitation hospitals already turn away about 100,000 patients a year.