On Mar. 29, CMS proposed inpatient rehab facility payment rules.
CMS proposed rule to update Medicare payment policies and rates under the fiscal year 2025 Inpatient rehabilitation facility (IRF) prospective payment system (PPS).
Required to update Medicare payment policies for IRFs on an annual basis.
CMS proposed to update IRF PPS payment rates by 2.8% based on the proposed IRF market basket update of 3.2%, less a proposed 0.4% productivity adjustment.
Update to outlier threshold to maintain outlier payments at 3.0% of total payments.
Annual updates to prospective payment rates, outlier threshold, case-mix-group weights, average length of stay values, wage index, associated impact analysis.
Update IRF PPS wage index using core-based statistical areas (CBSAs), provide a transition for IRFs who lose rural adjustment due to labor market area transitioning.
For FY 2028 IRF quality reporting program, beginning with patients admitted on Oct. 1, 2026, proposal to adopt new items in IRF-PAI as standardized patient assessment data
Elements include categories living situation, food, utilities beginning Oct. 1, 2026.
For FY 2028, remove the admission class assessment item from the IRF-PAI item set.
Consultation
Comments on the proposed rule must be submitted by May 28, 2024.
Jul. 2024 CMS Final Rule
On Jul. 31, 2024, CMS issued final rule updating the policies for IRF PPS for FY 2025.
CMS finalized the update to the IRF PPS payment rates by 3.0% based on the final IRF market basket update of 3.5%, less a 0.5 percentage point productivity adjustment.
Technical rate setting changes will result in estimated $280mn increase for FY 2025.
Will not be required to collect the item beginning with patients admitted Oct. 1, 2024.
Also sought feedback re concepts of vaccination composite, pain management, and depression, feedback on creating IRF QRP Star Rating System for consumers to use.
Plans to use feedback to inform future measure development, future rating system.
Final rule scheduled to be published in fed register on Aug. 6, effective Oct. 1, 2024.
Aug. 2024 HHS Final Rule
On Aug. 6, 2024, HHS CMS published final rule re IRF PPS policies for FY 2025.
