CMS Releases IRF Proposed Rule FY2020

On April 4 the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule for the Inpatient Rehabilitation Facility (IRF) prospective payment system for fiscal year 2020. CMS is proposing to boost Medicare payments to inpatient rehabilitation facilities by an estimated $195 million for fiscal 2020. Under the rule, net payments for IRFs would increase by 2.3 percent relative to FY 2019 payments:

  • 3.0 percent market-basket update;
  • Statutorily mandated cut of 0.5 percentage points for productivity;
  • 0.2 percent decrease in outlier payments.

This update reflects the proposed revision and rebasing of the market basket using data from 2016 as the base year instead of 2012.

The rule provides more detail about the revised IRF Case Mix Groups (CMG) that take effect in FY 2020, CMS provides updated impact data per IRF on the refined CMGs including updated CMG relative weights and average length of stay values based on FY 2017 and 2018 data. CMS proposes to update the IRF wage index in FY 2020 using the concurrent FY inpatient PPS wage index data.

CMS also proposes to modify one measure and adopt two new process measures to the IRF Quality Reporting Program and to adopt 22 standardized patient assessment data elements, plus seven more data elements related to social determinants of health. CMS proposes to require IRFs to report patient assessment data for the QRP for all patients, regardless of payer.

SDAHO is currently reviewing the proposed rule, a summary brief and an impact analysis will be sent to member facilities in a few weeks.​