HAP Letter to PA Congressional Delegation on 60 Percent Rule

February 24, 2014

Dear Members of the Pennsylvania Delegation:   

On 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.   

After 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 qualifying comorbidities. 

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.    

As 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 percent.

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.

HAP 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.   

Sincerely, 

Andy Carter
President and Chief Executive Officer