CMS issues FFY 2019 inpatient rehabilitation facility PPS final rule

The Centers for Medicare & Medicaid Services (CMS) on July 31 released the federal fiscal year (FFY) 2019 final payment rule for the inpatient rehabilitation facility (IRF) prospective payment system (PPS). A SDAHO brief of the final rule outlines the program changes finalized by CMS which are effective for discharges on or after Oct. 1 unless otherwise noted.

Highlights

CMS finalized a 1.35 percent increase factor for payment rates. After factoring in an additional approximate 0.1 percent decrease to aggregate payments due to updating the outlier threshold, the overall estimated update for FFY 2019 is approximately 1.3 percent, or $105 million, relative to payments in FFY 2018.

Notably, CMS finalized a number of its proposals to remove the functional independence measure instrument and associated modifiers from the inpatient rehabilitation facility patient assessment instrument (IRF-PAI) and revised the case-mix classification system.

CMS also finalized its proposal to incorporate certain data items located in the quality indicators section of the IRF-PAI into the IRF case-mix classification system, as well as the use of these data items to assign patients into a case-mix group for payment purposes under the IRF PPS for discharges on or after Oct. 1, 2019.

In response to stakeholder comments, CMS will base its analysis for revising the case mix group definitions on two full years of data (FFYs 2017 and 2018), rather than one; these definitions will become effective in FFY 2020.