CMS increases payments, participation requirements for inpatient rehab

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The Centers for Medicare & Medicaid Services (CMS) have issued a rule that will require patients admitted to inpatient rehabilitation facilities (IRFs) to agree to attempt to “actively participate” in an intensive rehabilitation program that is expected to result in “measureable improvement in his or her functional capacity or adaptation to impairments.”

The provisions of the new rule go into effect Jan. 1, 2010, and will apply to more than 200 freestanding IRFs and almost 1,000 IRF units in acute-care hospitals.

“The final rule we are issuing today incorporates industry best practices into CMS coverage requirements, while promoting more consistent review of the medical necessity of IRF stays for individual patients in light of their clinical needs,” said Jonathan Blum, director of CMS' Center for Medicare Management. 

Other coverage requirements of the rule include a requirement that IRF services be ordered by a physician with “specialized training and experience in rehabilitation services” who will be responsible for making final decisions regarding the patient’s treatments. Those services are to be coordinated by an interdisciplinary team including--at a minimum--a registered nurse, a social worker or case manager, and a licensed or certified therapist who specializes in the treatment discipline. This team is to meet weekly for a progress review and decide on any treatment modifications.

Under the rule, CMS also will be setting a payment rate update of 2.5 percent in fiscal 2010 for IRFs (based on the Rehabilitation, Psychiatric, and Long-term Care market basket). This is projected to increase total payments to IRFs by $145 million in 2010.