Medicare Compliance & Reimbursement

The City of Brotherly Love is showing no love for the proposed "fix" to the 75 percent rule. A coalition of senior citizens, patients, doctors, health care workers and rehab advocates from Pennsylvania, New Jersey and Delaware Nov. 6 held a "Rally for Independence" in Philadelphia. Carrying signs saying "Make Medicare care" and "Stop the reg," the group called on Congress to stop the proposed changes. Participants in the rally also signed a "Declaration of Physical Independence" stating that "all patients are created equal and possess the inalienable rights to life, liberty, and physical independence." Copies of the signed Declaration, which calls for a moratorium on enforcement of the Medicare changes, will be sent to President Bush and Pennsylvania Senators Arlen Specter and Rick Santorum, reports the Hospital & Healthsystem Association of Pennsylvania (HAP). A coalition has been formed, bringing together HAP, the Philadelphia Stroke Council, the Delaware Valley Healthcare Council, the Pennsylvania Association of Rehabilitation Facilities, the New Jersey Hospital Association, the Delaware Healthcare Association, the Greater Philadelphia Chapter of the Association of Rehabilitation Nurses, Disabled in Action and other groups. The coalition demands the Bush Administration stop the proposed rule and asks that the congressional delegations of Pennsylvania, New Jersey and Delaware work to include key legislative language barring the rule in pending legislation before Congress, according to HAP.

AMPRA Weighs In  Ask and you shall receive ... especially when you ask for comments on something like the proposed fix to the 75 percent rule. The American Medicare Rehabilitation Providers Association Oct. 30 submitted a full 50 pages of comments to the Centers for Medicare & Medicaid Services regarding the proposed changes to the criteria for being classified as an inpatient rehab facility. After noting its appreciation for CMS' efforts to update the 75 percent rule in an introductory letter to CMS Administrator Tom Scully, AMRPA points out that "CMS' proposal is inadequate and simply will not prevent a significant negative impact on rehabilitation patients and providers." The association argues that the 75 percent rule is "unnecessary" and urges CMS to repeal it altogether. Otherwise, AMRPA suggests a further, one-year study before the rule is changed. While this study is underway, CMS should reduce the threshold from 75 to 50 percent and should continue to adhere to the "industry's historical interpretation of the term 'polyarthritis,'" the letter states. AMRPA's official comments focus on the fact that the proposed rule narrows the scope of conditions considered to count toward the 75 percent mark, that the rule is "arbitrary and capricious," and that "CMS is mired in a diagnosis-based model that does not fit with rehabilitation." The complete document is at www.amrpa.org/PDF_Files/AMRPA_Final_Comment_Letter_on_Amended_75%25_Rule.pdf.