The Centers for Medicare & Medicaid Services (CMS), Washington, proposes a rule that would update payment rates and clarify the framework for Medicare patient selection and care in inpatient rehabilitation facilities (IRFs) during fiscal year (FY) 2010. The proposed rule would apply to more than 200 freestanding IRFs and more than 1,000 IRF units in acute care hospitals, and would be effective for discharges occurring on or after October 1, 2009.

The proposed rule’s patient selection and care provisions are intended to ensure that Medicare beneficiaries who need the intensive rehabilitation services provided in IRFs continue to have access to high-quality care. In addition to the proposed rule, CMS is posting draft revisions to the Medicare Benefit Policy Manual (MBPM) for public comment. The draft makes conforming changes to the manual based on the proposed rule; it provides detailed policy guidance regarding the selection of patients for admission to IRFs, and the development and implementation of individual treatment plans. The proposals aim to create a framework that incorporates current best practices in rehabilitative medicine, while promoting more efficient and focused medical review by Medicare’s fiscal intermediaries and administrative contractors.

Comments on the draft MBPM revisions should be submitted through a link that will be supplied on the CMS Web site, rather than through the site used for the submission of comments on proposed regulatory language. CMS plans to issue final updated MBPM policies concurrently with the issuance of the final IRF PPS rule.

The proposed revisions would clarify requirements for preadmission screening to determine whether a patient should receive rehabilitation services in an IRF or in another, less-intensive setting, post-admission treatment planning, and ongoing care coordination throughout the inpatient stay.  

A major reason for updating the coverage policies is to help IRFs select appropriate patients who need the comprehensive and more costly rehabilitation services furnished in the IRF setting. 

In other provisions, CMS projects that the payment rate update for IRFs will be 2.4% in FY 2010, based on the Rehabilitation, Psychiatric, and Long-term Care (RPL) market basket, and that, if finalized as proposed, the market basket update would increase total payments to IRFs in FY 2010 by $140 million. The RPL market basket was developed to measure the rate of inflation for the resources used in treating the specific types of patients served by these facilities. Also, CMS is proposing to set the outlier threshold for FY 2010 at $9,976, the amount estimated to maintain estimated outlier payments equal to 3% of total estimated payments under the IRF PPS for FY 2010. The change to the outlier threshold would increase overall IRF payments by $10 million. The total increase in IRF payments under this proposed rule is $150 million.

CMS will accept comments on the proposed rule until June 29 (click on "Special Filings"), and will address all comments in a final rule to be issued by August 1. For more information, including information about how to submit comments on the draft MBPM provisions, click here.

[Source: CMS]