On August 6, 2009, the Center for Medicare & Medicaid Services (CMS) published its updated final rule governing the payment rates for inpatient rehabilitation facilities (IRFs) for Federal fiscal year (FY) 2010. The provisions of the final rule generally are effective October 1, 2009 and will apply to IRF discharges occurring on or after October 1, 2009 and on or before September 30, 2010 (FY 2010). However, amendments to Sections 412.23, 412.29, and 412.622 don’t take effect until January 1, 2010.
Among other things, the final rule:
- Updates the FY 2010 IRF PPS relative weights and average length of stay values using the most current and complete Medicare claims and cost report data in a budget neutral manner;
- Updates the FY 2010 IRF facility level adjustments (rural, LIP, and teaching status adjustments) using the most current and complete Medicare claims and cost report data in a budget neutral manner;
- Updates the FY 2010 IRF PPS payment rates by the proposed market basket;
- Updates the FY 2010 IRF PPS payment rates by the wage index and labor-related share in a budget neutral manner;
- Updates the outlier threshold amount for FY 2010;
- Updates the cost-to-charge ratio ceiling and the national average urban and rural cost-to-charge ratios for purposes of determining the outlier payments under the IRF PPS for FY 2010;
- Removes the words “or assessment” from Sections 412.23(b)(3) and 412.29(b) to indicate that CMS is no longer providing for a 3 to 10 day inpatient assessment period after admission to an IRF to assess the appropriateness of the IRF admission;
- Amends paragraphs Section 412.23(b)(4) and Section 412.29(c) to require that IRFs “furnish, through the use of qualified personnel, rehabilitation nursing, physical therapy, and occupational therapy, plus, as needed, speech-language pathology, social services, psychological services (including neuropsychological services), and orthotic and prosthetic services;”
- Replaces the word “multidisciplinary” with the word “interdisciplinary” in Section 412.23(b)(7) and Section 412.29(e) to make the terminology consistent with the new IRF coverage criteria in Section 412.622(a);
- Requires in both Section 412.23(b)(7) and Section 412.29(e) that the interdisciplinary team meetings occur at least once per week (rather than once every two weeks) to be consistent with the new IRF coverage criteria in Section 412.622(a);
- Adds new paragraphs (3), (4), and (5) to Section 412.622(a) to implement new IRF coverage requirements;
- With respect to Sections 412.604, 412.606, 412.610, 412.614 and 412.618, removes from Section 412.614(a) current subparagraph (3); and
- In Section 412.614(d), makes a technical correction to the paragraph formerly designated as paragraph and assigns the revised language to a new paragraph (1)(a), redesignates paragraph (2) as (1)(b), and adds a new paragraph (2).
You can review the actual text of the final rule here.
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