Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2005 - Prohibits the Secretary of Health and Human Services, during the period between July 1, 2005, and the date two years after the enactment of this Act, from: (1) requiring a compliance rate, pursuant to the criterion (commonly known as the "75 percent rule") used to determine whether a hospital or hospital unit is an inpatient rehabilitation facility, that is greater than the 50 percent compliance threshold that became effective on July 1, 2004; (2) changing the designation of any inpatient rehabilitation facility in compliance with the 50 percent threshold; or (3) conducting medical necessity review of inpatient rehabilitation facilities using any guidelines other than the national criteria established in the Medicare Benefits Policy Manual.
Directs the Secretary to establish procedures for: (1) making any necessary retroactive adjustment to restore the status of a facility as an inpatient rehabilitation facility as a result of this Act; (2) making any necessary payments to inpatient rehabilitation facilities based on such adjustment for discharges occurring on or after July 1, 2005, and before enactment of this Act; and (3) developing and implementing an appeals process that provides for expedited review of any adjustment to the status of a facility as an inpatient rehabilitation facility made during such period
Directs the Secretary to establish the National Advisory Council on Medical Rehabilitation to provide advice and recommendations to: (1) Congress and the Secretary concerning the coverage of rehabilitation services under title XVIII (Medicare) of the Social Security Act; and (2) appropriate federal agencies on how best to utilize available research funds and authorities focused on medical rehabilitation research.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 1405 Introduced in Senate (IS)]
109th CONGRESS
1st Session
S. 1405
To extend the 50 percent compliance threshold used to determine whether
a hospital or unit of a hospital is an inpatient rehabilitation
facility and to establish the National Advisory Council on Medical
Rehabilitation.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 14, 2005
Mr. Nelson of Nebraska (for himself, Mr. Santorum, and Mr. Corzine)
introduced the following bill; which was read twice and referred to the
Committee on Finance
_______________________________________________________________________
A BILL
To extend the 50 percent compliance threshold used to determine whether
a hospital or unit of a hospital is an inpatient rehabilitation
facility and to establish the National Advisory Council on Medical
Rehabilitation.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Preserving Patient Access to
Inpatient Rehabilitation Hospitals Act of 2005''.
SEC. 2. EFFECT ON ENFORCEMENT OF REGULATIONS.
(a) In General.--Notwithstanding section 412.23(b)(2) of title 42,
Code of Federal Regulations, during the period beginning on July 1,
2005, and ending on the date that is 2 years after the date of
enactment of this Act, the Secretary of Health and Human Services
(referred to in this Act as the ``Secretary'') shall not--
(1) require a compliance rate, pursuant to the criterion
(commonly known as the ``75 percent rule'') that is used to
determine whether a hospital or unit of a hospital is an
inpatient rehabilitation facility (as defined in the rule
published in the Federal Register on May 7, 2004, entitled
``Medicare Program; Final Rule; Changes to the Criteria for
Being Classified as an Inpatient Rehabilitation Facility'' (69
Fed. Reg. 25752)), that is greater than the 50 percent
compliance threshold that became effective on July 1, 2004;
(2) change the designation of an inpatient rehabilitation
facility in compliance with the 50 percent threshold; or
(3) conduct medical necessity review of inpatient
rehabilitation facilities using any guidelines, such as fiscal
intermediary Local Coverage Determinations, other than the
national criteria established in chapter 1, section 110 of the
Medicare Benefits Policy Manual.
(b) Retroactive Status as an Inpatient Rehabilitation Facility;
Payments; Expedited Review.--The Secretary shall establish procedures
for--
(1) making any necessary retroactive adjustment to restore
the status of a facility as an inpatient rehabilitation
facility as a result of subsection (a);
(2) making any necessary payments to inpatient
rehabilitation facilities based on such adjustment for
discharges occurring on or after July 1, 2005, and before the
date of enactment of this Act; and
(3) developing and implementing an appeals process that
provides for expedited review of any adjustment to the status
of a facility as an inpatient rehabilitation facility made
during the period beginning on July 1, 2005, and ending on the
date that is 2 years after the date of enactment of this Act.
SEC. 3. NATIONAL ADVISORY COUNCIL ON MEDICAL REHABILITATION.
(a) Definitions.--In this section:
(1) Advisory council.--The term ``Advisory Council'' means
the National Advisory Council on Medical Rehabilitation
established under subsection (b).
(2) Appropriate federal agencies.--The term ``appropriate
Federal agencies'' means--
(A) the Agency for Healthcare Research and Quality;
(B) the Centers for Medicare & Medicaid Services;
(C) the National Institute on Disability and
Rehabilitation Research; and
(D) the National Center for Medical Rehabilitation
Research.
(b) Establishment.--Pursuant to section 222 of the Public Health
Service Act (42 U.S.C. 217a), the Secretary shall establish an advisory
panel to be known as the ``National Advisory Council on Medical
Rehabilitation''.
(c) Membership.--
(1) Appointment.--The Advisory Council shall be composed of
17 members, of whom--
(A) 9 members shall be appointed by the Secretary,
in consultation with the medical rehabilitation
community, from a diversity of backgrounds, including--
(i) physicians;
(ii) medicare beneficiaries;
(iii) representatives of inpatient
rehabilitation facilities; and
(iv) other practitioners experienced in
rehabilitative care; and
(B) 8 members, not more than 4 of whom are members
of the same political party, shall be appointed jointly
by--
(i) the majority leader of the Senate;
(ii) the minority leader of the Senate;
(iii) the Speaker of the House of
Representatives;
(iv) the minority leader of the House of
Representatives;
(v) the Chairman and the Ranking Member of
the Committee on Finance of the Senate; and
(vi) the Chairman and the Ranking Member of
the Committee on Ways and Means of the House of
Representatives.
(2) Date.--Members of the Advisory Council shall be
appointed not later than 30 days after the date of enactment of
this Act.
(3) Period of appointment; vacancies.--Members shall be
appointed for the life of the Council. A vacancy on the
Advisory Council shall be filled not later than 30 days after
the date on which the Advisory Council is given notice of the
vacancy, in the same manner as the original appointment.
(4) Meetings.--
(A) Initial meeting.--The Advisory Council shall
conduct an initial meeting not later than 120 days
after the date of enactment of this Act.
(B) Meetings.--The Advisory Council shall conduct
such meetings as the Council determines to be necessary
to carry out its duties but shall meet not less
frequently than 2 times during each calendar year.
(d) Duties.--The duties of the Advisory Council shall include the
following:
(1) Advice and recommendations.--Providing advice and
recommendations to--
(A) Congress and the Secretary concerning the
coverage of rehabilitation services under the medicare
program, including--
(i) policy issues related to rehabilitative
treatment and reimbursement for rehabilitative
care, such as issues relating to any rulemaking
relating to, or impacting, rehabilitation
hospitals and units;
(ii) the appropriate criteria for--
(I) determining clinical
appropriateness of inpatient
rehabilitation facility admissions; and
(II) distinguishing an inpatient
rehabilitation facility from an acute
care hospital and other providers of
intensive medical rehabilitation;
(iii) the efficacy of inpatient
rehabilitation services, as opposed to other
post-acute inpatient settings, through a
comparison of quality and cost, controlling for
patient characteristics (such as medical
severity and motor and cognitive function) and
discharge destination;
(iv) the effect of any medicare regulations
on access to inpatient rehabilitation care by
medicare beneficiaries and the clinical
effectiveness of care available to such
beneficiaries in other health care settings;
and
(v) any other topic or issue that the
Secretary or Congress requests the Advisory
Council to provide advice and recommendations
on; and
(B) appropriate Federal agencies (as defined in
subsection (a)(3)) on how to best utilize available
research funds and authorities focused on medical
rehabilitation research, including post-acute care site
of service and outcomes research.
(e) Periodic Reports.--The Advisory Council shall provide the
Secretary with periodic reports that summarize--
(1) the Council's activities; and
(2) any recommendations for legislation or administrative
action the Council considers to be appropriate.
(f) Termination.--The Advisory Council shall terminate on September
30, 2010.
(g) Authorization of Appropriations.--There are authorized to be
appropriated such sums as may be necessary to carry out the purposes of
this section.
(h) Effective Date.--This section shall take effect on the date of
enactment of this Act.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S8318-8319)
Read twice and referred to the Committee on Finance. (text of measure as introduced: CR S8319-8320)
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