Manual Revisions for Inpatient Rehabilitation Facilities

The Centers for Medicare & Medicaid Services (CMS) has published revised manual provisions in the Benefits Policy Manual regarding inpatient rehabilitation facility (IRF) coverage requirements. These coverage revisions are based on the new IRF requirements adopted by CMS in the FY 2010 final rule (74 Fed. Reg. 39762 (August 7, 2009) and reflect changes that have occurred in medical practice during the past 25 years. The new IRF coverage requirements are effective for IRF discharges occurring on or after January 1, 2010.

Under the new coverage polices, the decision to admit the patient to the IRF is the key to determining whether the admission is reasonable and necessary. CMS has stressed that the manual revisions are designed to assess patients, not facilities. In other words, the revisions are not intended to threaten an IRF's classification.

The manual revisions include the following subjects: documentation requirements; required pre-admission screening; required post-admission physician evaluation; required individualized overall plan of care; required admission orders; required inpatient rehabilitation facility patient assessment instrument (IRF-PAI); inpatient rehabilitation facility medical necessity criteria; multiple therapy disciplines; intensive level of rehabilitation services; ability to actively participate in intensive rehabilitation therapy program; physician supervision; interdisciplinary team approach to the delivery of care; and definition of measurable improvement.