Proposed Rule Released for FY 2018 Inpatient Rehab Facilities Medicare Payment

Posted on May 11, 2017

In a recently proposed rule for fiscal year (FY) 2018, the Centers for Medicare & Medicaid Services (CMS) recommended updates to the Medicare fee-for-service (FFS) prospective payment system (PPS) for inpatient rehabilitation facilities (IRFs). Highlights of the proposed rule include:

  • A 1 percent marketbasket increase mandated by the Medicare Access and CHIP Reauthorization Act of 2015.
  • A base payment rate of $15,835, up from $15,708, for IRFs that comply with IRF quality reporting program requirements.
  • An 8 percent increase in the high-cost outlier threshold from $7,984 to $8,656, which will result in fewer cases qualifying for an outlier payment.
  • Removal of the 25 percent payment penalty for late IRF Patient Assessment Instrument (IRF-PAI) submissions. Since the Medicare FFS claims system will reimburse IRF claims only if accompanied by an IRF-PAI, the CMS has concluded that the penalty is no longer necessary.
  • Refinement of the ICD-10-CM codes used to assess facility compliance with the 60 percent rule via the presumptive methodology. To be paid under the IRF PPS, this rule requires that at least 60 percent of a facility’s total inpatient population require IRF treatment for one or more of 13 medical conditions. Otherwise, the facility would be paid under the inpatient PPS. The proposed changes pertain to traumatic brain injury, hip fracture, major multiple trauma, nonspecific arthritis and unspecified myopathies codes.
  • Changes to the FY 2020 IRF quality reporting program. The CMS would replace a measure that addresses pressure ulcer changes and remove the all-cause unplanned readmission measure and the voluntary status item on the IRF-PAI regarding swallowing status. To meet the requirements of the Improving Medicare Post-acute Care Transformation Act of 2014, the CMS would require IRFs to collect certain standardized patient assessment data upon admission and discharge for all Medicare Part A and Medicare Advantage patients, beginning with those discharged between Oct. 1 and Dec. 31, 2018. Specifically, the CMS would require IRFs to collect data on functional status, cognitive function, and several types of special treatments and services, such as cancer and respiratory treatments and transfusions.

In the next few weeks, the MHA will distribute a facility-specific impact analysis to IRFs and encourages members to contact Vickie Kunz by June 16 regarding issues or concerns identified. The MHA will submit comments to the CMS by the June 26 deadline. The CMS is expected to release a final rule by Aug. 1 for the Oct. 1 effective date. Members with questions should contact Vickie Kunz at the MHA. 

Tags: proposed rule, CMS, PPS, IRF

Posted in: Member News

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