Legislation and respiratory rehabilitation

The provision of respiratory rehabilitation services has been frustrated by legislative and regulatory omissions and struggles. The original Medicare and Medicaid statutes did not mention respiratory therapy services, a fact that has excluded reimbursement for such services in the home. However, the Health Care Financing Administration (HCFA) has ruled that outpatient rehabilitation is a reimbursable service, a point about which third-party payers sometimes have to be reminded. In 1980 the Medicare program was adjusted to provide for the creation of comprehensive outpatient rehabilitation facilities (CORFs); the statute written then is the first to mention "respiratory therapy" as a reimbursable service. In 1982 regulations were published that included a detailed definition of recognized respiratory therapy services, and more recently HCFA released implementing regulations to fiscal intermediaries. However, the home care aspect of respiratory rehabilitation remains a legislative stepchild, permitting only one home evaluation visit, even though it has been reported in the literature that home respiratory care can be a cost saver. Home care by respiratory therapists probably will come, but experience shows that the Federal regulation maze can be very difficult to negotiate, especially in the face of opposition by the Administration.