Health Reform WK-EDGE $195M increase in IRF reimbursement proposed for FY 2020
Friday, April 26, 2019

$195M increase in IRF reimbursement proposed for FY 2020

By Sheila Lynch-Afryl, J.D., M.A.

IRFs would see $195 million reimbursement increase over previous year, along with two additional quality measure, in new CMS proposal.

Inpatient rehabilitation facilities (IRFs) would see an increase of $195 million in their reimbursement for fiscal year (FY) 2020 relative to FY 2019 under an advance release of the FY 2020 IRF prospective payment system (PPS) proposed rule. CMS also proposed to revise and rebase the market basket to reflect a 2016 base year instead of the current 2012 base year. The deadline for submitting comments is June 27, 2019 (Proposed rule, 84 FR 17244, April 24, 2019).

Payment update. CMS proposed, pursuant to Soc. Sec. Act §1886(j)(3)(C), a FY 2020 IRF update of 2.5 percent (3 percent market basket update, less 0.5 percentage point productivity adjustment mandated by sec. 3401(d) of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). CMS would also update the outlier threshold amount from $9,402 for FY 2019 to $9,935 for FY 2020 to maintain estimated outlier payments at approximately 3 percent of total estimated aggregate IRF payments for FY 2020.

Case-mix groups. In the FY 2019 IRF PPS final rule (83 FR 38514, August 6, 2018), CMS finalized the incorporation of an unweighted additive motor score derived from 19 data items located in the Quality Indicators section of the IRF Patient Assessment Instrument (IRF-PAI), beginning with FY 2020. In FY 2020, CMS proposed to replace the unweighted motor score to assign a patient to a case-mix group (CMG) with the weighted motor score. It also proposed to remove one item from the score.

IRF QRP. CMS proposed to add two measures to the IRF Quality Reporting Program (QRP) measure set: (1) Transfer of Health Information to the Provider—Post-Acute Care Measure; and (2) Transfer of Health Information to the Patient—Post-Acute Care Measure. CMS also sought input on certain measures, measure concepts, and standardized patient assessment data elements (SPADEs) under consideration for future years of the IRF QRP.

Other proposals. CMS also made the following proposals:

  • to amend 42 C.F.R. §412.622 to clarify that the IRF makes the determination as to whether a physician qualifies as a rehabilitation physician;
  • to continue to hold facility-level adjustment factors at the FY 2014 levels for FY 2020; and
  • to use the concurrent hospital inpatient prospective payment system (IPPS) wage index and the FY 2020 proposed labor-related share.

MainStory: TopStory ProposedRules AgencyNews InpatientFacilityNews MedicarePartANews QualityNews NewsFeed

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