Health Reform WK-EDGE CMS updates IRF PPS, coverage requirements for FY 2021
Monday, August 17, 2020

CMS updates IRF PPS, coverage requirements for FY 2021

By Sheila Lynch-Afryl, J.D., M.A.

CMS updated various coverage requirements to allow nonphysician practitioners to perform certain duties.

Payments to inpatient rehabilitation facilities (IRFs) will increase by $260 million in fiscal year (FY) 2021, according to an advance release of the FY 2021 IRF prospective payment system (PPS) final rule. CMS also updated IRF coverage requirements, but it did not make any changes to quality measures for FY 2021 (Final rule, 85 FR 48424, August 10, 2020).

Payment update. CMS will update IRF PPS payment rates in FY 2021 by 2.4 percent (2.4 percent market basket update reduced by a 0.0 percentage point productivity adjustment mandated by section 3401(d) of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148)). CMS had proposed an update of 2.5 percent—2.9 percent market basket update, less 0.4 percentage point productivity adjustment (see IRFs could see $270M reimbursement increase in FY 2021, April 17, 2020); however, more recent data became available after the publication of the proposed rule, particularly regarding the economic impacts of the COVID-19 pandemic. In addition, CMS updated the outlier threshold amount to $7,906 to maintain estimated outlier payments at approximately 3 percent of total estimated aggregate IRF payments for FY 2021.

Wage index. CMS adopted the Office of Management and Budget (OMB) labor market area delineations issued in OMB Bulletin 18-04 for the FY 2021 IRF PPS wage index. CMS noted that approximately 5 percent of IRFs would experience decreases in their area wage index values as a result of this change. For FY 2021, IRFs that experience negative impacts due to this implementation are subject to a 5 percent cap on the decrease in their wage index versus FY 2020.

IRF coverage requirements. Beginning with FY 2021, CMS removed the post-admission physician evaluation documentation requirement at 42 C.F.R. §412.622(a)(4)(ii) and rescinded the policy described in Medicare Benefit Policy Manual, Pub. 100-02, Ch. 1, section 110.1.2. In addition, CMS amended 42 C.F.R. §412.622(a)(4)(i)(B) and (D) to codify existing documentation instructions and guidance on the preadmission screening and 42 C.F.R. §412.622(c) to clarify the definition of a "week" as a period of "7 consecutive calendar days beginning with the date of admission to the IRF." 42 C.F.R. §412.622(a)(3)(iv) was also amended to allow non-physician practitioners to conduct one of the three required rehabilitation physician visits in every week of the IRF stay, except for the first week.

IRF Quality Reporting Program. CMS did not make any changes to the IRF Quality Reporting Program.

FederalRegisterIssuances: FinalRules NewsFeed AgencyNews InpatientFacilityNews MedicarePartANews QualityNews

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