Fact Sheets
Fiscal Year 2014 Payment and Policy Changes for Medicare Inpatient Rehabilitation Facilities
Fiscal Year 2014 Payment and Policy Changes for Medicare Inpatient Rehabilitation Facilities
Overview
On July 31, 2013 the Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1448-F] updating fiscal year (FY) 2014 Medicare payment policies and rates for the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) and the IRF Quality Reporting Program (IRF QRP). The FY 2014 changes are summarized below.
Changes to the IRF Payment Policies and Rates
FY 2014 Updates to the payment rates under the IRF PPS
CMS estimates that aggregate payments to IRFs will increase in FY 2014 by $170 million, or 2.3 percent, relative to payments in FY 2013. This estimated increase is attributable to a 1.8 percent payment update, which includes a 2.6 percent estimated market basket, reduced by a 0.5 percentage point multi-factor productivity adjustment and an additional 0.3 percentage point reduction as required by law. In addition, CMS will update the outlier threshold, increasing IRF PPS payments by an estimated 0.5 percent.
Facility-level adjustment updates
CMS will update the rural, low-income percentage and teaching status adjustments in FY 2014. In order to improve the accuracy of the adjustments, CMS will include 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. CMS continues to base the adjustments on three years of data instead of one year of data, which improves 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 IRF must demonstrate that at least 60 percent of its patients require intensive inpatient rehabilitation services for one or more of 13 conditions specified in regulation. Most IRFs are first evaluated for compliance with the rule using the “presumptive compliance” method, in which a patient’s diagnosis codes are compared to the presumptive compliance list. If an IRF does not meet the requirements with the presumptive compliance method, it must then be evaluated using medical review. CMS will remove a number of codes from the presumptive compliance list in FY 2014, because the presence of the codes alone does not prove compliance in the absence of additional facts that must be obtained from a patient’s medical record. The revisions fall in the following categories: nonâspecific diagnosis codes, arthritis diagnosis codes, unilateral upper extremity diagnosis codes, some congenital anomaly diagnosis codes and miscellaneous diagnosis codes. CMS is delaying the effective date of these changes one year in order to give IRFs enough time to adjust to the changes in the final rule. These changes will be effective for compliance review periods beginning on or after October 1, 2014.
Changes to the IRF Quality Reporting Program
Prior-Year Quality Measures
CMS will continue to use the NQF-endorsed National Healthcare Safety Network (NHSN) Catheter-Associated Urinary Tract Infection (CAUTI) outcome measure (NQF #0138) that we adopted in the CY 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 also will adopt the NQF-endorsed version of the Percent of Residents or Patients with Pressure Ulcers that are New or Worsened (Short Stay) measure (NQF #0678) and will stop using a non-risk adjusted version of this measure.
New Quality Measures
CMS will 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 30 Days Post Discharge from Inpatient Rehabilitation Facilities measure.
Changes to the IRF Patient Assessment Instrument (IRF-PAI)
In order to adopt the NQF-endorsed pressure ulcer measure—a risk-adjusted measure—CMS will 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 will revise the pressure ulcer question set on the IRF-PAI, in order to better reflect up-to-date medical practice and allow providers to better assess patients’ needs. In addition, this information will help CMS in performing future assessments of the adequacy of the pressure ulcer measure CMS has adopted.
CMS will add new patient influenza vaccination data elements to the IRF-PAI and change the assessment instrument data collection period from a calendar year to a fiscal year. Data that are not collected using the IRF-PAI, but are instead reported to the National Health Safety Network (NHSN) will continue to be collected during a calendar year. Quarterly data submission deadlines will also be added.
New Reconsideration and Disaster Waiver Processes for Quality Reporting
CMS will implement both a voluntary reconsideration and a disaster waiver process for the IRF Quality Reporting Program. The reconsideration process will allow IRFs to dispute a finding of non-compliance with quality reporting requirements. The disaster waiver process will allow providers that experienced a natural or man-made disaster to request a waiver of quality reporting requirements under a disaster waiver application or through the reconsideration process.
The rule went on display at the Office of the Federal Register’s Public Inspection Desk and can be downloaded at www.ofr.gov/inspection.aspx?AspxAutoDetectCookieSupport=1. It will appear in the August 6, 2013 Federal Register.
For more information, please see www.cms.hhs.gov/InpatientRehabFacPPS
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