Increase Access to Care for Individuals with Brain Injury
Ensure Patient-Centered Access to Rehabilitation
When an individual sustains a brain injury, life-saving treatment is only the first step in recovery. Post-acute rehabilitation services of sufficient scope, duration, and intensity delivered in inpatient rehabilitation hospitals and units (IRFs), residential/transitional rehabilitation facilities, and community-based outpatient programs is vital for regaining and maximizing health, function, and independence. Each day it becomes more difficult for patients with individual and group health insurance plans, as well as Medicare and Medicaid beneficiaries, to access the rehabilitation they need.
Ways to Overcome Barriers to Access:
- Oppose efforts to restrict access to rehabilitative services and devices in all settings of care.
- Reform the use of prior authorization in Medicare Advantage by passing the Improving Seniors’ Timely Access to Care Act (H.R. 3173/S. 3018), and reject the use of prior authorization for IRF patients in traditional (Fee-For-Service) Medicare.
- Oppose the proposed Medicare “Review Choice Demonstration” project that seeks to impose pre-claim or post-claim review of 100% of IRF claims in half of the rehabilitation hospitals across the country.
- Ensure that efforts to design and implement a Medicare unified post-acute care (PAC) payment system do not negatively impact access for people with brain injury and other complex conditions.
- Extend tele-rehabilitation flexibilities and authorities after the COVID-19 public health emergency ends while ensuring that access to in-person care is maintained and improved.
- Develop a permanent fix for pending reimbursement cuts to therapists and other providers under the Physician Fee Schedule, Medicare sequester, and “PAYGO” scorecard system.
- Revise the so-called “three-hour rule” to expand access to all appropriate skilled therapies provided in IRFs (Access to Inpatient Rehabilitation Therapy Act).