CMS Proposes Payment and Policy Changes for IRFs

CMS has proposed changes to the inpatient rehabilitation facilities (IRF) prospective payment rules that would result in a 3.3% increase in payments for fiscal year (FY) 2008. The proposed rule would also increase the outlier threshold from $5,534 to $7,522 in FY 2007. This would decrease overall outlier payments by 0.9%. CMS states that while the higher threshold would cause fewer cases to qualify for outlier payments, maintaining the current threshold would require a decrease in the base payment for an IRF stay in order to maintain budget neutrality.

CMS is seeking comments regarding the current, but temporary, measure that allows IRF admissions to qualify under the 75% Rule if patients do not have one of the 13 CMS-designated medical conditions for which intensive inpatient rehabilitation services are deemed medically necessary. Under this exception, if a patient has a comorbidity that is on the list, that admission would qualify under the 75% Rule. This has been a temporary measure since July 1, 2004, and is set to expire on July 1, 2008. The proposed rule does not specifically extend this provision.

AAPM&R has completed its review of the proposed rule and submitted comments to CMS. To view these comments please click here. (PDF Download)

For more information on this proposal, visit the CMS Web site.