CMS continues to support 75% Rule

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The Centers for Medicare & Medicaid Services has once again endorsed the progress of the 75% Rule, re-igniting an old debate between hospitals and nursing homes.

Ongoing implementation of the rule "continues to have the desired effect of ensuring that the most appropriate Medicare beneficiaries have access to care in IRFs (inpatient rehabilitation facilities)," CMS said in an update released last week. The 75% rule requires that 75% of IRF admissions have one of 13 qualifying conditions to receive higher Medicare payments. Nursing homes, among other settings, receive those patients who are not treated in IRFs. The percentage, currently at 60%, will increase to 65% on July 1 and 75% in July 2008.

Meanwhile, hospitals are urging Congress to pass legislation that would prevent the threshold from rising on July 1. The American Hospital Association, among others, believes that patients with certain conditions are not receiving care in the right setting.