|  About the “75% Inpatient Rehab Rule”
This Center for Medicare and Medicaid Services (CMS) rule states that 75% of a facility’s inpatients must receive rehab services for one or more of 10 conditions in order to retain status as an inpatient rehab facility. The rule has been in place since 1984, but never strictly enforced and was suspended in 2002. In 2003, the CMS decided to take a look at this current rule and propose changes to it, as a way to rein in Medicare costs. The result was a proposed revised rule set forth in September 2003. This revised rule replaces one of the conditions under the current rule, polyarthritis, with three specific and narrowly defined arthritic conditions, and essentially, disallows reimbursement for the majority of hip and joint replacements. The proposed rule also temporarily drops the qualifying threshold to 65% for three years, in an effort to enable inpatient rehab facilities to comply. In addition, the proposed rule also ignores advances in medicine and surgery during the past two decades that allow patients suffering from cardiac and pulmonary diseases, as well as cancer and pain patients, to recover more quickly and completely with post-acute rehab care. During the CMS comment period regarding this rule, providers and lawmakers expressed their concern about reduced patient access. At final count, 218 representatives and 75 senators signed on to a “Dear Colleague” letter addressed to the CMS administrator and Health and Human Services secretary, denouncing the proposed regulation. At present, the CMS has not published a final ruling on any proposed changes in the Federal Register and the issue remains unresolved. However, the current rule exists on the books and implementation of this rule could happen at any time. Statute requires that the revised rule be published in the Federal Register 30 days before it becomes effective. The CMS is the federal agency responsible for overseeing Medicare and setting rates. Medicare beneficiaries (mostly seniors) are the ones who would lose coverage. In Nassau and Suffolk counties there are six hospitals with inpatient rehab units. They are: Long Beach Medical Center; North Shore at Glen Cove; Southside Hospital; Nassau University Medical Center; St. Charles Hospital; and Mercy Medical Center. The collective Medicare revenue loss to these hospitals would be $35 to $40 million annually.  Health Insurance Portability and Accountability Act (HIPAA)
This federal legislation was enacted in 1996 and mandates regulations that govern the privacy of patient health information. HIPAA's privacy standards (the Privacy Rule) have been in effect since April 14, 2001 and hospitals must be in full compliance with the privacy standards by April 14, 2003. Initially, HIPAA was crafted as a means to enable employees to carry health insurance with them -- "portability." However, privacy issues slipped into the legislation as it neared finalization. HIPAA's privacy standards affect virtually every department within a hospital. The regulations specify the purposes for which patient health information may or may not be released without authorization from the patient. Specifically, HIPAA seeks to 1) simplify administrative tasks by using the same codes and claim forms; 2) tighten security of information; and 3) guarantee a patient's right to privacy and how his/her medical information is used and shared. The Nassau Suffolk Hospital Council has held HIPAA educational meetings to help members understand the complexities of this law and to bring hospitals into full compliance.
 Workforce Issues
The workforce shortage is one of the most pressing concerns facing member hospitals of the Nassau Suffolk Hospital Council. The health care workforce shortage is a national problem. Studies have documented shortages of: - Registered Nurses
- Pharmacists
- Radiology Technologists
- Laboratory Technologists
Additional shortages are growing among medical records staff, nursing aides, and billing and coding specialists. Our hospitals continually offer on-site training and skills upgrading for their employees. We assist them in this effort via workforce retraining programs we designed under the guise of the state's workforce Retraining Grants program that was enacted in 1996. The NSHC is the recipient of three separate Workforce Retraining Grant Awards. The goal is to staff hospitals with workers who have the appropriate skills and training to meet the needs of our ever-changing health care workforce environment. Click here for more information about Grants and required Documentation Tools for the 2000 Grant. | 
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