CMS Proposes Payment and Policy Changes for Inpatient Rehabilitation Facilities

The Centers for Medicare and Medicaid Services (CMS) has proposed changes to the Inpatient Rehabilitation Facilities (IRF) prospective payment rules which 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 have the effect of decreasing overall outlier payments by 0.9%. CMS states that while the higher threshold would result in fewer cases that would 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 also seeking comments regarding the current, but temporary, measure allowing for 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 is currently reviewing the proposed rule in order to identify specific areas where it may submit comments. The comment period for this rule ends on July 2, 2007. Please check back to the AAPM&R web site for updates on this matter.

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