Last July both houses of Congress proposed bills to suspend the enforcement of the "75% rule," which would have required inpatient rehabilitation facilities and free-standing rehabilitation clinics to have 75% of their patient population have one of 13 specific medical conditions in order to receive Medicare and Medicaid coverage. Set forth by the Centers for Medicare and Medicaid Services (CMS), the conditions include, among other conditions, stroke, spinal cord injury, congenital deformity, hip fracture, neurologic disorders, and burns. Now, a bill entitled "Preserving Patient Access to Inpatient Rehabilitation Hospitals Act of 2005" (HR 3373 and S 1405) proposes to extend the current 50% compliance threshold for two years.

The bill has dismayed some organizations and delighted others. The National Center for Assisted Living (part of the American Health Care Association, one of the country's leading long-term care organizations) would like to see the 75% rule reinstated, arguing that many patients currently treated in rehabilitation facilities could be receiving care of similar quality in skilled nursing facilities-for a fraction of the price.

But other organizations, such as the American Association of People with Disabilities, believe that many patients who have conditions not included on the CMS list would still benefit from the level of care and attention offered in a rehabilitation facility. The 75% rule, they say, imposes a quota, and the same patient might be admitted to a rehabilitation facility one month but not the next, simply because of space constraints. The Association of Rehabilitation Nurses, which opposes the 75% rule, likewise favors the proposed bills. As of this writing, the outcome had not been determined.