Proposed IRF Rule

By Margaret Schmidt

Earlier this year, on May 2, 2013, the Centers for Medicare and Medicaid Services (CMS) proposed changes to the Inpatient Rehabilitation Facility (IRF) Medicare reimbursement system as well as regulatory changes for fiscal year 2014. The proposed rule included provisions to increase aggregate pay to IRFs by 2 percent, remove several codes from the presumptive compliance list for the 60 percent threshold, add three reportable quality measures, and revise the IRF Patient Assessment Instrument (IRF PAI).

On behalf of RehabCare’s nearly 110 hospital-based or freestanding IRFs, we took advantage of the 60-day comment period to submit formal comments regarding the CMS “Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2014, Proposed Rule” which goes into effect on October 1, 2013.

RehabCare’s top priority in commenting is to have CMS withdraw the proposals pertaining to changing the codes allowed under the presumptive compliance methodology for the 60% classification criterion in the final rule. In our extensive and data-supported comments, we also used the opportunity to respond to several other items in the proposed rule:

  • Presumptive Compliance – We first advocated that CMS withdraw the proposed changes to the presumptive compliance criteria methodology as the CMS proposal is inconsistent with the letter and the spirit of the authorizing legislation. We further noted that if CMS decides to move forward with the changes, it should allow providers adequate time for implementation, establish modifiers for arthritis, appropriately target record review, and preserve certain codes. Specifically, we recommended that there be –at a minimum – a six month transition for providers to implement the changes.
  • Facility Level Adjustment Factors – In our comments, we noted that RehabCare is aware that any changes to the facility adjustment factors are redistributed within the payment system. Therefore, we advocated that any facility adjustments CMS may make should adhere to several basic principles, including:
    • They should be fair and accurate. If there are meaningful differences as a result of analyzing new data, then any adjustment should be fair and accurate.
    • The adjustment factors should be stable, consistent, and not subject to wide annual swings in value.
    • Any change in an adjustment factor should be phased in over time if full implementation of the change would have a significant impact on an individual provider and the field.
  • IRF Quality Measures – We recommend that CMS delay the implementation of a 30-day readmission (rehospitalization) measure for hospital-based and freestanding IRFs until the measure is endorsed by the National Quality Forum (NQF) and vetted by expert panels to ensure that it is appropriate for the setting before application. We also took the opportunity to provide reaction to the flu vaccine and pressure ulcer measures.

We will continue to use appropriate opportunities – including comments on CMS proposed rules and in reaction to Congressional proposals and actions – to advocate on behalf of the hospital-based and freestanding IRF provider community.

RehabCare will provide updates in August when the final payment rule is issued by CMS and will also update you periodically about ongoing discussions in Congress around post-acute reform.

By Margaret Schmidt