"75 Percent Rule" Would Be
Changed Under Medicare Rehabilitation Proposed Rule
September 12, 2003 - A Medicare proposed rule
published by the Centers for Medicare and Medicaid Services
(CMS) in the Sept. 9 Federal Register [68 FR 53266]
would revise the criteria (commonly known as the "75
percent rule") used to classify a hospital as an inpatient
rehabilitation facility (IRF) for Medicare purposes. Hospitals
that have the IRF classification receive Medicare payments
according to the rehabilitation prospective payment system
(PPS), rather than the acute inpatient PPS
Currently to be classified as an IRF, 75 percent of the total
patient population in a rehabilitation hospital must require
treatment for one or more of 10 specified conditions.
The 75 percent rule has been hotly debated over the recent
year. Several analyses done by CMS indicated that less than
half of current IRFs did not meet the criteria. CMS had received
numerous comments noting that, in large part, noncompliance
was because the current 10 conditions have not been updated
in 20 years and do not adequately reflect the current care
provided in rehabilitation facilities.
The proposed rule would reduce the percentage of patients
needed to meet the qualifying criteria from 75 percent to
65 percent, remove one of the existing qualifying conditions;
and add three new qualifying conditions. The result is that
the proposed "65 percent rule" would apply to a
total of 12 medical conditions. CMS also stated that it would
not enforce any criteria until the date specified in the final
rule, which CMS anticipates will be Jan. 1, 2004.
Comments on the proposed rule are due Nov. 3.
Karen Fisher, Senior Associate Vice President
AAMC Health Care Affairs
kfisher@aamc.org
(202) 862-6140
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