CMS has issued a proposed rule that would update payment rates for services by inpatient rehabilitation facilities and modify payment policies for fiscal year 2007. The proposed rule would update the IRF PPS by the full market basket of 3.4%, but most of that increase will be reversed by a 2.9% reduction in the standard payment amount for FY07 to offset the effect of changes in coding that do not reflect real changes in patient acuity. Payments to IRFs would remain virtually flat in 2007, increasing by $40 million for the approximately 1,240 IRFs. The proposed rule would also increase the outlier threshold for high cost outlier cases from $5,129 to $5,609.
In addition, the proposed rule would amend existing regulations regarding the three-year phase-in of a 75% compliance threshold, which requires at least 75% of an IRF’s patient population have one of the 13 designated medical conditions, as well as a need for intensive inpatient rehabilitation services. As provided in the Deficit Reduction Act, the proposed rule delays the imposition of the full 75% threshold by one year.
