Research

Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) Facility-Level Payment Adjustments Methodology. 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)” – 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:

A. 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.

B. 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.

C.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.