II 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Preserving Patient Ac5 cess to Inpatient Rehabilitation Hospitals Act of 2005’’. 

6 SEC. 2. EFFECT ON ENFORCEMENT OF REGULATIONS. 

7 (a) IN GENERAL.—Notwithstanding section 

8 412.23(b)(2) of title 42, Code of Federal Regulations, dur-
2 

•S 1405 IS

1 ing the period beginning on July 1, 2005, and ending on 

2 the date that is 2 years after the date of enactment of 

3 this Act, the Secretary of Health and Human Services (re4 ferred to in this Act as the ‘‘Secretary’’) shall not— 

5 (1) require a compliance rate, pursuant to the 

6 criterion (commonly known as the ‘‘75 percent 

7 rule’’) that is used to determine whether a hospital 

8 or unit of a hospital is an inpatient rehabilitation fa9 cility (as defined in the rule published in the Federal 

10 Register on May 7, 2004, entitled ‘‘Medicare Pro11 gram; Final Rule; Changes to the Criteria for Being 

12 Classified as an Inpatient Rehabilitation Facility’’ 

13 (69 Fed. Reg. 25752)), that is greater than the 50 

14 percent compliance threshold that became effective 

15 on July 1, 2004; 

16 (2) change the designation of an inpatient reha17 bilitation facility in compliance with the 50 percent 

18 threshold; or 

19 (3) conduct medical necessity review of inpa20 tient rehabilitation facilities using any guidelines, 

21 such as fiscal intermediary Local Coverage Deter22 minations, other than the national criteria estab23 lished in chapter 1, section 110 of the Medicare 

24 Benefits Policy Manual. 
3 

•S 1405 IS

1 (b) RETROACTIVE STATUS AS AN INPATIENT REHA2 BILITATION FACILITY; PAYMENTS; EXPEDITED RE3 VIEW.—The Secretary shall establish procedures for— 

4 (1) making any necessary retroactive adjust5 ment to restore the status of a facility as an inpa6 tient rehabilitation facility as a result of subsection 

7 (a); 

8 (2) making any necessary payments to inpatient 

9 rehabilitation facilities based on such adjustment for 

10 discharges occurring on or after July 1, 2005, and 

11 before the date of enactment of this Act; and 

12 (3) developing and implementing an appeals 

13 process that provides for expedited review of any ad14 justment to the status of a facility as an inpatient 

15 rehabilitation facility made during the period begin16 ning on July 1, 2005, and ending on the date that 

17 is 2 years after the date of enactment of this Act. 

18 SEC. 3. NATIONAL ADVISORY COUNCIL ON MEDICAL REHA19 BILITATION. 

20 (a) DEFINITIONS.—In this section: 

21 (1) ADVISORY COUNCIL.—The term ‘‘Advisory 

22 Council’’ means the National Advisory Council on 

23 Medical Rehabilitation established under subsection 

24 (b). 
4 

•S 1405 IS

1 (2) APPROPRIATE FEDERAL AGENCIES.—The 

2 term ‘‘appropriate Federal agencies’’ means— 

3 (A) the Agency for Healthcare Research 

4 and Quality; 

5 (B) the Centers for Medicare & Medicaid 

6 Services; 

7 (C) the National Institute on Disability 

8 and Rehabilitation Research; and 

9 (D) the National Center for Medical Reha10 bilitation Research. 

11 (b) ESTABLISHMENT.—Pursuant to section 222 of 

12 the Public Health Service Act (42 U.S.C. 217a), the Sec13 retary shall establish an advisory panel to be known as 

14 the ‘‘National Advisory Council on Medical Rehabilita15 tion’’. 

16 (c) MEMBERSHIP.— 

17 (1) APPOINTMENT.—The Advisory Council shall 

18 be composed of 17 members, of whom— 

19 (A) 9 members shall be appointed by the 

20 Secretary, in consultation with the medical re21 habilitation community, from a diversity of 

22 backgrounds, including— 

23 (i) physicians; 

24 (ii) medicare beneficiaries; 
5 

•S 1405 IS

1 (iii) representatives of inpatient reha2 bilitation facilities; and 

3 (iv) other practitioners experienced in 

4 rehabilitative care; and 

5 (B) 8 members, not more than 4 of whom 

6 are members of the same political party, shall 

7 be appointed jointly by— 

8 (i) the majority leader of the Senate; 

9 (ii) the minority leader of the Senate; 

10 (iii) the Speaker of the House of Rep11 resentatives; 

12 (iv) the minority leader of the House 

13 of Representatives; 

14 (v) the Chairman and the Ranking 

15 Member of the Committee on Finance of 

16 the Senate; and 

17 (vi) the Chairman and the Ranking 

18 Member of the Committee on Ways and 

19 Means of the House of Representatives. 

20 (2) DATE.—Members of the Advisory Council 

21 shall be appointed not later than 30 days after the 

22 date of enactment of this Act. 

23 (3) PERIOD OF APPOINTMENT; VACANCIES.— 

24 Members shall be appointed for the life of the Coun25 cil. A vacancy on the Advisory Council shall be filled 
6 

•S 1405 IS

1 not later than 30 days after the date on which the 

2 Advisory Council is given notice of the vacancy, in 

3 the same manner as the original appointment. 

4 (4) MEETINGS.— 

5 (A) INITIAL MEETING.—The Advisory 

6 Council shall conduct an initial meeting not 

7 later than 120 days after the date of enactment 

8 of this Act. 

9 (B) MEETINGS.—The Advisory Council 

10 shall conduct such meetings as the Council de11 termines to be necessary to carry out its duties 

12 but shall meet not less frequently than 2 times 

13 during each calendar year. 

14 (d) DUTIES.—The duties of the Advisory Council 

15 shall include the following: 

16 (1) ADVICE AND RECOMMENDATIONS.—Pro17 viding advice and recommendations to— 

18 (A) Congress and the Secretary concerning 

19 the coverage of rehabilitation services under the 

20 medicare program, including— 

21 (i) policy issues related to rehabilita22 tive treatment and reimbursement for re23 habilitative care, such as issues relating to 

24 any rulemaking relating to, or impacting, 

25 rehabilitation hospitals and units; 
7 

•S 1405 IS

1 (ii) the appropriate criteria for— 

2 (I) determining clinical appro3 priateness of inpatient rehabilitation 

4 facility admissions; and 

5 (II) distinguishing an inpatient 

6 rehabilitation facility from an acute 

7 care hospital and other providers of 

8 intensive medical rehabilitation; 

9 (iii) the efficacy of inpatient rehabili10 tation services, as opposed to other post11 acute inpatient settings, through a com12 parison of quality and cost, controlling for 

13 patient characteristics (such as medical se14 verity and motor and cognitive function) 

15 and discharge destination; 

16 (iv) the effect of any medicare regula17 tions on access to inpatient rehabilitation 

18 care by medicare beneficiaries and the clin19 ical effectiveness of care available to such 

20 beneficiaries in other health care settings; 

21 and 

22 (v) any other topic or issue that the 

23 Secretary or Congress requests the Advi24 sory Council to provide advice and rec25 ommendations on; and 
8 

•S 1405 IS

1 (B) appropriate Federal agencies (as de2 fined in subsection (a)(3)) on how to best uti3 lize available research funds and authorities fo4 cused on medical rehabilitation research, includ5 ing post-acute care site of service and outcomes 

6 research. 

7 (e) PERIODIC REPORTS.—The Advisory Council shall 

8 provide the Secretary with periodic reports that summa9 rize— 

10 (1) the Council’s activities; and 

11 (2) any recommendations for legislation or ad12 ministrative action the Council considers to be ap13 propriate. 

14 (f) TERMINATION.—The Advisory Council shall ter15 minate on September 30, 2010. 

16 (g) AUTHORIZATION OF APPROPRIATIONS.—There 

17 are authorized to be appropriated such sums as may be 

18 necessary to carry out the purposes of this section. 

19 (h) EFFECTIVE DATE.—This section shall take effect 

20 on the date of enactment of this Act. 

Æ