Inpatient Rehabilitation Facility PPS

Spotlight

CMS-1748-P:  Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2022 and Updates to the IRF Quality Reporting Program is on public display at the Office of Federal Register and will publish on April 12, 2021.  The rule and associated wage index file is available on the IRF Rules and Related Files web page

CMG Version 5.00 Final (ZIP)This version 5.00 Final, effective October 1, 2020, replaces the v5.00 Beta posted previously. In addition to the change from a DLL to JAR library from IRF v4.01 to v5.00, there were several processing changes with Version 5.00. Three ICD-10-CM codes, J82, J84.17 and T86.842 were removed from Tier 3 (D) and seventeen ICD-10-CM codes were added to Tier 3 (D).

CMG Version 5.00 Beta Release 2 - This second beta release addresses the issue encountered by Ventera in regards to error code 9 and is available for download from the IRF Grouper webpage.

CMG Version 4.01 Final (ZIP) - This new version adds support for the new ICD-10-CM code for COVID-19.  The new code, U07.1, can be used for assessments with a discharge date of April 1, 2020 and beyond.

 

Section 4421 of the Balanced Budget Act of 1997 (Public Law 105-33), as amended by section 125 of the Medicare, Medicaid, and SCHIP (State Children's Health Insurance Program) Balanced Budget Refinement Act of 1999 (Public Law 106-113), and by section 305 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (Public Law 106-554), authorizes the implementation of a per discharge prospective payment system (PPS), through section 1886(j) of the Social Security Act, for inpatient rehabilitation hospitals and rehabilitation units - referred to as inpatient rehabilitation facilities (IRFs). The IRF PPS will utilize information from a patient assessment instrument (IRF PAI) to classify patients into distinct groups based on clinical characteristics and expected resource needs. Separate payments are calculated for each group, including the application of case and facility level adjustments.

Hospital Center

For a one-stop resource web page focused on the informational needs and interests of Medicare Fee-for-Service (FFS) hospitals, go to the Hospital Center (see under "Related Links Inside CMS" below).

Section 3004 of the Affordable Care Act 

CMS has created a website to support Section 3004 of the Affordable Care Act, Quality Reporting for Long Term Care Hospitals, Inpatient Rehabilitation Hospitals and Hospice Programs. This site has been created so that  the public can view information, and communications, related to Section 3004. This site is expected to expand as more information is provided. There is also provided a link for emailing comments, questions or ideas to CMS pertaining to Quality Reporting and Section 3004.

IRF Legislative History

 Historically, each rule or update notice issued under the annual Inpatient Rehabilitation Facility (IRF) prospective payment system (PPS) rulemaking cycle included a detailed reiteration of the various legislative provisions that have affected the IRF PPS over the years.  This document (PDF) now serves to provide that discussion and will be updated when we find it necessary.

Page Last Modified:
04/07/2021 12:00 PM