II 

110TH CONGRESS 

1ST SESSION S. 543 

To improve Medicare beneficiary access by extending the 60 percent compliance threshold used to determine whether a hospital or unit of a hospital 

is an inpatient rehabilitation facility under the Medicare program. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 12, 2007 

Mr. NELSON of Nebraska (for himself, Mr. BUNNING, Ms. STABENOW, Ms. 

SNOWE, Mr. KERRY, Ms. COLLINS, Mr. REED, Mrs. CLINTON, and Mr. 

MENENDEZ) introduced the following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To improve Medicare beneficiary access by extending the 

60 percent compliance threshold used to determine 

whether a hospital or unit of a hospital is an inpatient 

rehabilitation facility under the Medicare program. 

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 2007’’. 


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•S 543 IS

1 SEC. 2. EXTENSION OF THE 60 PERCENT COMPLIANCE 

2 THRESHOLD USED TO DETERMINE WHETHER 

3 A HOSPITAL OR UNIT OF A HOSPITAL IS AN 

4 INPATIENT REHABILITATION FACILITY 

5 UNDER THE MEDICARE PROGRAM. 

6 (a) IN GENERAL.—Section 5005 of the Deficit Re7 duction Act of 2005 (42 U.S.C. 1395ww note) is amend8 ed— 

9 (1) in subsection (a), by striking ‘‘apply the ap10 plicable percent specified in subsection (b)’’ and in11 serting ‘‘require a compliance rate that is no greater 

12 than the 60 percent compliance rate that became ef13 fective for cost reporting periods beginning on or 

14 after July 1, 2005’’; and 

15 (2) by striking subsection (b) and inserting the 

16 following new subsection: 

17 ‘‘(b) CONTINUED USE OF COMORBIDITIES.—For cost 

18 reporting periods beginning on or after July 1, 2007, the 

19 Secretary shall include patients with comorbidity as de20 scribed in section 412.23(b)(2)(i) of title 42, Code of Fed21 eral Regulations, in the inpatient population that counts 

22 towards the percent specified in subsection (a).’’. 

23 (b) EFFECTIVE DATE.—The amendment made by 

24 subsection (a)(1) shall take effect on June 30, 2007. 


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•S 543 IS

1 SEC. 3. MEDICAL NECESSITY CRITERIA FOR BENE2 FICIARIES SERVED IN REHABILITATION HOS3 PITALS AND UNITS. 

4 On and after June 30, 2007, the Secretary of Health 

5 and Human Services, the Centers for Medicare & Medicaid 

6 Services, fiscal intermediaries under section 1816 of the 

7 Social Security Act (42 U.S.C. 1395h), medicare adminis8 trative contractors under section 1874A of such Act (42 

9 U.S.C. 1395kk), recovery audit contractors under section 

10 1893(h) of such Act (42 U.S.C. 1395ddd(h)) or section 

11 306 of the Medicare Prescription Drug, Improvement, and 

12 Modernization Act of 2003, and other government agents 

13 shall use and apply the criteria established in HCFA Rul14 ing 85–2, as issued on July 31, 1985 (50 Fed. Reg. 

15 31040), as the sole standard for determining the medical 

16 necessity of services provided by inpatient rehabilitation 

17 hospitals and units to beneficiaries under the Medicare 

18 program under title XVIII of the Social Security Act. 

Æ 


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