The Centers for Medicare & Medicaid Services(CMS) has just issued a proposed rule that would update payment rates and clarify the framework for Medicare patient selection and care in inpatient rehabilitation facilities (IRFs) during fiscal year 2010. According to the CMS' press release, the proposed rule would apply to more than 200 freestanding IRFs and over 1,000 IRF units in acute care hospitals. The rule would be effective for discharges occurring on or after October 1, 2009.

In addition to the proposed rule, CMS says it is posting draft revisions to the Medicare Benefit Policy Manual (MBPM) for public comment. The draft revisions will be based on the proposed rule and provide detailed policy guidance regarding the selection of patients for admission to IRFs, as well as the development and implementation of individual treatment plans.

"CMS is proposing updates to the current IRF coverage criteria that would better reflect industry-wide best practices, and improve understanding and consistency of medical necessity guidelines," said CMS Acting Administrator Charlene Frizzera in the press release. "The proposed policies were developed by CMS working closely with the National Institutes of Health and medical directors from several fiscal intermediaries, and taking into account input from the rehabilitation community."

The proposed revisions involve clarifying requirements for preadmission screening. This would determine a patient receiving rehabilitation services in an IRF or in another, less-intensive setting. The revisions also include post-admission treatment planning and ongoing care coordination throughout the inpatient stay. Specific CMS proposals include:

--IRF admission criteria would be updated and clarified to specify that the patient should be able and willing to actively participate in an intensive rehabilitation program and expected to make measurable improvement in functional capacity or adaptation to impairments.

--A requirement that IRF services be ordered by a rehabilitation physician with specialized training and experience in rehabilitation services and be coordinated by an interdisciplinary team. The rehabilitation physician would be responsible for making the final decisions regarding the patient's treatment in the IRF.

--A specification that IRFs use qualified personnel to provide required rehabilitation nursing, physical therapy, occupational therapy, speech-language pathology, social services, psychological services, and prosthetic and orthotic services.

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