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Inpatient Rehabilitation Facility PPS


IRF Payment and Coverage Policies: FY 2019 Final Rule Call

Thursday, November 15 from 1:30 to 3 pm

Register for Medicare Learning Network events.

During this call, learn about changes finalized in the FY 2019 Inpatient Rehabilitation Facility (IRF) Prospective Payment System final rule, including:

  • Revisions to coverage criteria
  • Removal of the Functional Independence Measure (FIM) and Associated Function Modifiers from the IRF - Patient Assessment Instrument
  • Refinements to the case mix classification

Prior to the call, participants are encouraged to review the Medicare Benefit Policy Manual, Chapter 1, Section 110. A question and answer session follows the presentation; however, attendees may email questions in advance to with “November 15 Call” in the subject line. These questions may be addressed during the call or used for other materials following the call.

Target Audience: IRF providers.


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.