Research

Report to Congress: Unified Payment for Medicare-Covered Post-Acute Care 

Unified PAC Report to Congress (PDF) | Unified PAC Report to Congress Appendices (ZIP)

Section 2(b)(2)(A) of the Improving Post-Acute Care Transformation (IMPACT) Act of 2014 requires a report to Congress on unified payment for Medicare post-acute care (PAC).  Medicare PAC services are provided to beneficiaries by PAC providers defined as skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), long-term care hospitals (LTCHs), and home health agencies (HHAs).  Each PAC provider setting has a separate Medicare fee-for-service (FFS) prospective payment system (PPS). A goal of unified PAC payment is to base the payment on patient characteristics instead of the PAC setting.  

The Centers for Medicare and Medicaid Services (CMS) and the Office of the Assistant Secretary for Planning and Evaluation (ASPE) contracted with Research Triangle Institute (RTI) to provide analysis for this study and report.  RTI convened external technical expert panel meetings to obtain input on the study and report.  In the report, the framework applies a uniform approach to case-mix adjustment across Medicare beneficiaries receiving PAC services for different types of PAC providers while accounting for factors independent of patient need that are important drivers of cost across PAC providers.  The unified approach to case-mix adjustment includes standardized patient assessment data collected by the four PAC providers.  The report does not include legislative recommendations, as additional analyses would need to be done prior to testing or universal implementation of a unified PAC payment system.
 

Technical Report: “Analyses to Inform the Use of Standardized Patient Assessment Data Elements in the Inpatient Rehabilitation Facility Prospective Payment System (PDF)” (March 2019)

In developing our proposed policies related to refinements of the inpatient rehabilitation facility (IRF) case-mix classification system beginning in FY 2020, CMS extended their contract with Research Triangle Institute (RTI) to conduct additional analysis (using FY 2017 and FY 2018 data) on the incorporation of certain data elements collected on the IRF Patient Assessment Instrument (IRF-PAI) into the IRF prospective payment system (IRF PPS). This updated technical report discusses the relevant data and methodologies related to this analysis.

Technical Report: “Analyses to Inform the Potential use of Standardized Patient Assessment Data Elements in the Inpatient Rehabilitation Facility Prospective Payment System (PDF)”

In developing our proposed policies related to refinements of the inpatient rehabilitation facility (IRF) case-mix classification system beginning in FY 2020, CMS contracted with Research Triangle Institute (RTI) to analyze the potential incorporation of certain data elements collected on the IRF Patient Assessment Instrument (IRF-PAI) into the IRF prospective payment system (IRF PPS). This technical report discusses the relevant data and methodologies related to this analysis.  

Special Open Door Forum (ODF):  Tier Comorbidity Updates (ZIP)

Link to the Special ODF on Tier Comorbidity Updates transcript and audio file downloads.  This Special ODF, held July 16, 2016, was to allow inpatient rehabilitation facilities (IRFs) and other stakeholders to provide input and suggestions to CMS regarding the areas of most concern or interest for updating the tier comorbidity portion of IRF payments.  

Special Open Door Forum (ODF):  Tier Comorbidity Updates (PDF)

This file contains presentation slides for the Special ODF on Tier Comorbidity Updates. This Special ODF is to allow inpatient rehabilitation facilities (IRFs) and other stakeholders to provide input and suggestions to CMS regarding the areas of most concern or interest for updating the tier comorbidity portion of IRF payments. 

IRFPPS Average Length of Stay Methodology (PDF)

This document, available for download below, contains the methodology used to calculate the average length of stay values published in the IRF PPS proposed and final rules for each fiscal year.

IRF PPS Facility-Level Payment Adjustments Methodology (PDF)

This document, available for download below, contains the original facility-level payment adjustments methodology developed by the RAND Corporation.

Report to Congress: “Analysis of the Classification Criteria for Inpatient Rehabilitation Facilities (IRFs) (PDF)”

In 2007, Congress directed CMS, through section 115(c) of the Medicare, Medicaid and SCHIP Extension Act (MMSEA, Public Law 110—173), to develop a Report to Congress with the following:

1. An analysis of Medicare beneficiaries' access to medically necessary rehabilitation services, including the potential effect of the 75 percent rule (now known as the “60 percent rule”) on access to care.
2. An analysis of alternatives or refinements to the 75 percent rule (now known as the “60 percent rule”) policy for determining criteria for inpatient rehabilitation hospital or unit designation under the Medicare program, including alternative criteria which would consider a patient's functional status, diagnosis, co-morbidities, or other relevant factors.
3. An analysis of the conditions for which individuals are commonly admitted to inpatient rehabilitation hospitals that are not included as a condition formerly described in section 412.23(b)(2)(iii) (redesignated as 412.23(b)(2)(ii) in the FY 2009 IRF PPS final rule (73 FR 46370 at 46391 through 46392)) of title 42, Code of Federal Regulations, to determine the appropriate setting of care, and any variation in patient outcomes and costs, across settings of care, for treatment of such conditions.

This report, which was prepared by the Research Triangle Institute International under contract with CMS, has been submitted to Congress in response to the requirements of section 115(c) of the MMSEA.

Memorandums on the IRF PPS and the 75 Percent Rule 

On November 30, 2005, CMS released a memorandum to the public entitled “The Inpatient Rehabilitation Facility PPS and the 75 Percent Rule.”  This memorandum provided an overview of our analysis of how inpatient rehabilitation facility (IRF) spending and utilization trends changed over time with the introduction of the IRF prospective payment system (IRF PPS) in 2002 and the suspension of the 75 percent rule from 2002 to 2004.  On June 8, 2007, we issued a follow-up memorandum to update the analyses.  These memorandums are available for download below.   

RAND Reports on the IRF PPS

In developing our proposed and final policies related to the IRF PPS effective for cost reporting periods beginning on or after January 1, 2002, CMS contracted with the RAND Corporation to perform analysis of available patient and IRF data. In addition, RAND's monitoring and refinement reports published in 2005, used in developing the proposed and final refinements to the IRF PPS effective for discharges occurring on or after October 1, 2005, are also available below. To download the reports, you will be redirected to RAND's website.