The Centers for Medicare and Medicaid Services' (CMS) proposed inpatient rehabilitation facility (IRF) prospective payment system (PPS) rule for fiscal year 2014 includes a 2% increase. The increase is based on a marketbasket update to payments of 1.8% and a 0.2% increase to the outlier threshold. CMS estimates the fiscal impact to be $150 million.
The proposed rule, issued May 2, would further restrict which facilities qualify for the higher IRF PPS rates, as opposed to the lower the hospital inpatient PPS rates. To qualify, 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 1 or more of 13 listed conditions that presume the need for intensive inpatient rehabilitation. CMS proposes to drop several diagnostic codes from the "presumptive compliance" list, saying these conditions "would not prove compliance in the absence of additional facts that would have to be pulled from a patient's medical record."
Elsewhere in the proposed ruling, CMS plans to continue to use the catheter-associated urinary tract infection (CAUTI) outcome measure endorsed by NQF, which recently was updated from a non-endorsed measure; and to adopt a risk-adjusted pressure ulcer measure, dropping a non-risk adjusted version. In addition, CMS proposes to add 3 new quality measures to the IRF Quality Reporting Program, 2 related to flu vaccine and 1 to readmissions.
CMS will accept comments regarding the provisions of the proposed rule until July 1, 2013. APTA will provide a comprehensive summary of the proposed rule in the coming days and will submit comments on behalf of the membership.
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