CMS Releases Final Rule for Inpatient Rehabilitation Facility (IRF) Prospective Payment System, FY 2020

PUBLISHED: Aug 2, 2019
Relevant to: Inpatient Rehabilitation Facility

The U.S. Centers for Medicare and Medicaid Services (CMS) has released their final rule updating the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year (FY) 2020. As required by the statute, this final rule includes the classification and weighting factors for the IRF prospective payment system’s (PPS) case-mix groups (CMGs) and a description of the methodologies and data used in computing the prospective payment rates for FY 2020.

This final rule rebases and revises the IRF market basket to reflect a 2016 base year rather than the current 2012 base year. Additionally, this final rule revises the CMGs and updates the CMG relative weights and average length of stay (LOS) values beginning with FY 2020, based on analysis of 2 years of data (FYs 2017 and 2018).

Additionally, the final rule amends the regulations to:

  • Clarify that the determination as to whether a physician qualifies as a rehabilitation physician (that is, a licensed physician with specialized training and experience in inpatient rehabilitation) is made by the IRF.
  • Adopt two new measures, modify an existing measure, and adopt new standardized patient assessment data elements.
  • Areas to be assessed will include functional status, cognitive function/ mental status, special services, treatments and interventions, medical conditions and comorbidities, impairments, and social determinants of health

Included with today's notice is an example policy on patient assessment for rehabiliataion services.

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