FACT SHEET
FOR IMMEDIATE RELEASE Contact: CMS Media Relations
May 2, 2013
Proposed Fiscal Year 2014 Payment and Policy Changes for Medicare Inpatient Rehabilitation Facilities
Overview. On
May 2, 2013, the Centers for Medicare & Medicaid Services (CMS)
issued a proposed rule outlining proposed fiscal year (FY) 2014 Medicare
payment policies and rates for the inpatient rehabilitation facilities
(IRFs) Prospective Payment System (PPS), as well as updates and changes
for the IRF Quality Reporting Program (QRP). The FY 2014 proposals are
summarized below.
PROPOSED CHANGES TO IRF PAYMENT POLICIES AND RATES:
Updates to the payment rates under the IRF PPS. Based
on proposed changes contained within this rule, CMS estimates that
aggregate payments to IRFs will increase by $150 million, or 2.0
percent. This estimated increase is attributable to a 1.8 percent
payment update, which includes a 2.5 percent market basket increase
factor, reduced by a 0.4 percent multi-factor productivity adjustment
and an additional 0.3 percentage point reduction as required under the
Affordable Care Act. In addition, CMS is proposing an update to the
outlier threshold, which would increase IRF PPS payments by an estimated
0.2 percent.
Facility-level adjustment updates. CMS is proposing
updates to the IRF facility-level rural, low-income percentage, and
teaching status adjustments, including a new variable in the regression
methodology to indicate whether the IRF is a freestanding hospital or a
unit of an acute care hospital (or critical access hospital). The
updated methodology enhances the accuracy of the adjustments. CMS
continues to base the adjustments on three years’ worth of data, instead
of one year, to improve the stability of the adjustments over time.
“60-percent rule” Presumptive Methodology Code List Updates In
order to be excluded from the hospital inpatient PPS and be paid at the
higher IRF PPS rates, an inpatient hospital must demonstrate that at
least 60 percent of its patients meet the criteria specified in the
regulations, including the need for intensive inpatient rehabilitation
services for one or more of the 13 listed conditions, representing a
presumptive need for intensive inpatient rehabilitation. Compliance is
demonstrated through either medical review or the “presumptive” method,
in which a patient’s diagnosis codes are compared to a “presumptive
compliance” list. For
FY 2014, CMS proposes to remove a number of codes from the “presumptive
compliance” list because the described conditions would not prove
compliance in the absence of additional facts that would have to be
pulled from a patient’s medical record. We have not updated the presumptive methodology policies since 2004, and we welcome comments on this proposal.
CMS
is proposing to revise the list of codes so that it reflects only those
codes which can be identified presumptively as both representing the 13
conditions and requiring intensive rehabilitation. The
proposed revisions fall in the following categories: non‑specific
diagnosis codes, arthritis diagnosis codes, unilateral upper extremity
diagnosis, some congenital anomalies diagnosis codes, other
miscellaneous diagnosis codes.
PROPOSED CHANGES TO THE IRF QUALITY REPORTING PROGRAM:
Prior-Year Quality Measures. CMS
proposes to continue to use the NQF-endorsed National Healthcare Safety
Network (NHSN) Catheter-Associated Urinary Tract Infection (CAUTI)
outcome measure that we adopted in the FY 2013 OPPS/ASC PPS final rule.
This measure had been updated from a non-endorsed measure we adopted in
the FY 2012 IRF PPS final rule. CMS proposes to adopt the NQF-endorsed
version of the “Percent
of Residents or Patients with Pressure Ulcers that are New or Worsened
(Short Stay)” measure, and to stop using the non-risk adjusted version
of this measure.
New Quality Measures. In
this rule, CMS is proposing to add three new quality measures to the
IRF Quality Reporting Program: NQF #0680: Percent of Residents or
Patients Who Were Assessed and Appropriately Given the Seasonal
Influenza Vaccine (Short-Stay); NQF #0431: Influenza Vaccination
Coverage among Healthcare Personnel; and an All-Cause Unplanned Readmission Measure for an Unplanned Readmission Measure for 30 Days Post Discharge from Inpatient Rehabilitation Facilities.
Proposed Changes to the IRF Patient Assessment Instrument. In
order to adopt the NQF-endorsed pressure ulcer measure, which is a
risk-adjusted measure, CMS has proposed to revise the IRF-PAI to include
the data elements necessary to accommodate risk adjustment. Also, based
on feedback CMS received from wound care experts and IRF providers, CMS
is proposing to revise the pressure ulcer question set on the IRF Patient Assessment Instrument, in order to better reflect up-to-date medical practice and better assess patients’ needs.
CMS
proposes to add new patient influenza vaccination data elements to the
Quality Indicator section of the assessment instrument, and to change
the assessment instrument data collection period from a calendar year to
a fiscal year. Data that is reported to the National Health Safety
Network (NHSN) would continue data collection based on a calendar year
period.
Proposed Reconsideration and Disaster Waiver Processes for Quality Reporting. In
this rule, CMS is proposing to implement both a reconsideration and
disaster waiver process for Quality Reporting. The reconsideration
process would allow IRFs to dispute a finding of non-compliance with quality reporting requirements. The proposed disaster
waiver process would allow providers that experienced a natural or
man-made disaster to request a waiver of quality reporting requirements
under a disaster waiver statute or through the reconsideration process.
The proposed rule went on display at the Office of the Federal Register’s Public Inspection Desk and can be downloaded at:
It will appear in the May 8, 2013 Federal Register. Public comments on the proposals will be accepted until July 1, 2013.
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