On April 16, 2020, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule for inpatient rehabilitation facilities (IRFs) for fiscal year (FY) 2021. The rule includes proposals related to payment, documentation requirements, and use of non-physician practitioners.
Comments on the proposed rule are due on June 15, 2020.
Payments to Inpatient Rehabilitation Facilities to Increase in FY 2021
Overall, CMS is estimating that IRF payments will increase by $270 million in FY 2021. CMS is proposing an IRF update of 2.5 percent, which accounts for a market basket increase of 2.9 percent less a multifactor productivity adjustment of 0.4 percent. A 2-percentage point reduction will be applied to payments for IRFs that fail to meet data submission requirements.
CMS will continue to update the relative weights and average lengths of stays for various conditions within the case-mix group (CMG) system based on the latest data available. Currently, that data is FY 2019 IRF claims and FY 2018 IRF cost report data. The updates are budget neutral and CMS anticipates that over 99 percent of IRF cases are in CMGs that will experience a less than 5 percent change. The methodology for calculating IRF outlier threshold amounts will also remain the same in FY 2021.
CMS is not proposing any changes to the IRF Quality Reporting Program for FY 2021.
CMS Proposes Adopting Revised Geographic Delineations
Similar to proposals for other post-acute care providers for FY 2021, CMS is proposing to adopt for FY 2021 updated delineations for Metropolitan Statistical Areas (MSAs), Micropolitan Statistical Areas, and Combined Statistical Areas. These delineations are determined by the Office of Management and Budget (OMB).
To prevent any major disruptions, CMS is proposing a 5-percent cap on any decreases in an IRF’s wage index for FY 2021 to allow the effects of the revised delineations to be phased in. The changes to area wage level from the updated delineations will be made in a budget neutral manner so that there will not be any change in estimated aggregate IRF payments.
CMS Proposes Removing Documentation Requirements for Post-Admission Physician Evaluation
CMS is proposing the remove the post-admission physician evaluation documentation requirement for IRFs beginning in FY 2021. The rule notes that this would not prevent an IRF patient from being evaluated but instead, post-admission physician evaluation would no longer be an IRF documentation requirement. This proposal also does not remove the separate requirement that a rehabilitation physician visit during the first week of a patient’s stay in the IRF.
CMS has waived this requirement during the ongoing COVID-19 public health emergency, and the agency believes this will provide them and stakeholders with the experience to determine whether the requirement can be removed permanently in an effort to reduce the paperwork burden.
The rule also proposes to codify existing documentation instructions and guidance related to pre-admission screening into regulation text and to clarify the definition of the term “week” in the regulatory text.
Finally, CMS is also seeking stakeholder feedback on further ways to possibly remove some pre-admission screening documentation requirements in order to reduce burden on rehab physicians.
Non-Physician Practitioners May be Permitted to Perform Certain IRF Coverage Requirements
CMS is proposing that a non-physician practitioner who is determined by an IRF to have specialized training and experience in inpatient rehabilitation may perform any of the duties that are required to be performed by a rehabilitation physician. Any duties taken on by a non-physician practitioner must be within the practitioner’s scope of practice under applicable state law. CMS is requesting stakeholder feedback on this proposal.