HAP Letter to PA Congressional Delegation on 60 Percent Rule
February 24, 2014
Members of the Pennsylvania Delegation:
behalf of The Hospital & Healthsystem Association of Pennsylvania (HAP),
which represents and advocates for nearly 240 acute and specialty care
hospitals and health systems across the state and the patients they serve, we
appreciate the opportunity to express serious concerns about a policy proposal
that would negatively impact patients’ access to the 77 inpatient
rehabilitation facilities (IRFs) that reside in the Commonwealth.
These IRFs provide
highly specialized and intensive medical rehabilitation for patients with
critical conditions such as strokes, spinal cord and traumatic brain injuries.
an extensive, multi-year debate, Congress passed legislation in 2007 to
permanently establish a “60 Percent Rule” for IRFs. Under this policy, 60
percent of an IRF’s cases must fall within 13 qualifying conditions or have
Through regulatory action the Centers for Medicare
& Medicaid Services (CMS) has further tightened already stringent
admissions controls by removing hundreds of codes that previously counted
toward presumptive compliance, to ensure the proper patient population is
served by these specialized providers.
As a result of these policy changes and
multiple annual market-basket reductions, IRF patient volume and payments from
Medicare have been virtually flat since 2004.
Congress continues to face budget pressures and looks for ways to offset the
costs of other policy proposals including repealing the sustainable growth
rate, HAP urges you to reject proposals
to arbitrarily increase the threshold regulating IRFs from 60 percent to 75
This policy does not serve clinical purposes and in fact, will
threaten access to IRF services for patients that require intense medical
management. Maintaining the 60 percent rule at 60 percent will help promote
quality of life for those with serious rehabilitation needs by preserving
access to specialized, intensive rehabilitation care in a hospital setting.
strongly supports efforts to ensure beneficiaries are receiving the most
appropriate care in the most appropriate post-acute setting. However, the
proposal to elevate the current 60 percent threshold to 75 percent does not
serve that purpose.
The Pennsylvania Congressional Delegation has a long
history of strongly supporting beneficiary access to medical rehabilitation.
Thank you for your continued attention and efforts on this issue.
and Chief Executive Officer