Inpatient rehabilitation facilities are getting a payment increase of 2.9{f08ff3a0ad7db12f5b424ba38f473ff67b97b420df338baa81683bbacd458fca} for 2021.

Because of the COVID-19 public health emergency, the Centers for Medicare and Medicaid Services in its proposed rule has limited the annual rulemaking to payment and essential policies.

CMS is proposing updates to the payment rates using the most recent data to reflect an estimated 2.5{f08ff3a0ad7db12f5b424ba38f473ff67b97b420df338baa81683bbacd458fca} increase factor. This is the inpatient rehabilitation facility market basket increase factor of 2.9{f08ff3a0ad7db12f5b424ba38f473ff67b97b420df338baa81683bbacd458fca}, reduced by a 0.4{f08ff3a0ad7db12f5b424ba38f473ff67b97b420df338baa81683bbacd458fca} multifactor productivity adjustment.

However, an additional 0.4{f08ff3a0ad7db12f5b424ba38f473ff67b97b420df338baa81683bbacd458fca} increase to aggregate payments — due to updating the outlier threshold to maintain estimated outlier payments at 3{f08ff3a0ad7db12f5b424ba38f473ff67b97b420df338baa81683bbacd458fca} of total payments — results in an overall update of 2.9{f08ff3a0ad7db12f5b424ba38f473ff67b97b420df338baa81683bbacd458fca}, or $270 million. 

CMS is also proposing to adopt the most recent Office of Management and Budget statistical area delineations and apply a 5{f08ff3a0ad7db12f5b424ba38f473ff67b97b420df338baa81683bbacd458fca} cap on wage index decreases from 2020 to 2021.

In another move to ease physician burden, CMS is proposing to allow non-physician practitioners to perform any of the inpatient rehabilitation facility coverage service and documentation duties that are currently required to be performed by a rehabilitation physician.

IRFs are usually required to conduct a post-admission physician evaluation within the first 24 hours of the patient’s admission to confirm that no changes have occurred since the preadmission screening, and that the patient is still appropriate for admission to an inpatient rehabilitation facility.

CMS is proposing to no longer require a post-admission physician evaluation since the post-admission evaluation covers much of the same information and continues to be included in the pre-admission screening of the patient and the patient’s plan of care.  

IRFs, in consultation with the patient’s physician or other treating clinician, would still have the flexibility to conduct patient visits within the first 24 hours of an admission if the patient’s condition warrants it.

CMS is proposing no changes to the inpatient rehabilitation facility quality reporting program.


Due to the COVID-19 public health emergency, healthcare providers have limited capacity to review and provide comments on extensive proposals, CMS said.

CMS is also soliciting comments from stakeholders on further ideas to reduce provider burden, as well as on proposals to codify subregulatory guidance on preadmission screening documentation and certain other IRF coverage requirements.

CMS will accept comments until June 15.


CMS has recently issued an array of temporary regulatory waivers and new rules to give providers maximum flexibility to respond to the COVID-19 pandemic.

This includes waiving the 60{f08ff3a0ad7db12f5b424ba38f473ff67b97b420df338baa81683bbacd458fca} rule that requires each IRF to discharge at least 60{f08ff3a0ad7db12f5b424ba38f473ff67b97b420df338baa81683bbacd458fca} of its patients with one of 13 qualifying conditions.

New flexibility also allows the required face-to-face physician visits in IRFs to be done using telehealth.

The IRH proposed rule is one of five proposed Medicare payment rules released in a fiscal year cycle to define payment and policy for inpatient hospitals, long-term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, skilled nursing facilities and hospices.

Twitter: @SusanJMorse
Email the writer: [email protected]



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