The proposed rule updates the IRF payment rate from $12,958 to $13,587. The rate was determined by increasing the FY 2009 rate by the basket inflation adjuster (2.4 percent) and by adjusting, in a budget neutral manner, the case mix group relative weights, average length of stay values, wage index and the labor-related factors and facility level adjustments (rural (proposed decreasing from 21.3 percent to 18.27 percent, subject to a budget neutrality factor of 1.0025), low income percentage (proposed decreasing the factor from .6229 to .4372, subject to a budget neutrality factor of 1.0221), and teaching status adjustments (proposed increasing the factor from .9012 to 1.0494, subject to a budget neutrality factor of .9980)). The outlier threshold amount also has been increased for FY 2010 to $9,976.

The IRF proposed rule revises the following existing requirements to:

  • Require that a rehabilitation physician order rehabilitation nursing, physical therapy, occupational therapy, speech-language pathology, social services, psychological services and prosthetic and orthotic services.
  • Require that IRFs conduct a comprehensive preadmission screening to evaluate the appropriateness of IRF-level care.
  • Require that IRFs conduct a post-admission evaluation to compare to the pre-admission screening.
  • Increase the frequency and content of IRF interdisciplinary team meetings.
  • Implement specific parameters for admitting a patient to an IRF, including, that the patient be able to actively participate in an intensive rehabilitation program with three hours of therapy per day five days per week; requires at least two therapy disciplines, one of which must be physical therapy or outpatient therapy; and that a rehabilitation physician supervise the services at least three times per week in a face-to-face setting with the patient.

Additionally, the IRF proposed rule would (1) apply the proposed classification and payment requirements to both rehabilitation hospitals and rehabilitation units, and (2) require IRFs to submit patient assessments on MedicareAdvantage patients as well as fee-for-service Medicare patients for use in computing whether 60 percent of the IRF’s Medicare admissions have 1 of the 13 medical conditions listed in 42 C.F.R. § 412.23(b)(2)(ii) as a primary condition or comorbidity to be classified as an IRF.

The revised policies and payment rates contained in the IRF proposed rule generally become effective on October 1, 2009. Comments must be received by June 29, 2009. A final rulemaking from CMS on the IRF proposed rule is anticipated in early August.