• Changes Proposed In Eligibility Criteria For Inpatient Rehabilitation Facilities Receiving Medicare Reimbursement
  • October 14, 2003 | Author: R. Christopher Raphaely
  • Law Firm: Duane Morris LLP - Philadelphia Office
  • On September 9, 2003, the Centers for Medicare and Medicaid Services (CMS) proposed changes in the eligibility criteria for hospital and other inpatient units to qualify for the inpatient rehabilitation prospective payment system (PPS) and its additional reimbursement. The proposed rule includes a change to the 10 specific conditions that have historically been used to determine eligibility for inpatient rehabilitation PPS (the HCFA- 10). The change includes expanding the list of 10 conditions to 12 by eliminating the single standard for polyarthritis and replacing it with three new conditions describing specific forms of arthritis-related conditions. In perhaps its least "provider friendly" aspect, however, the proposed rule could also significantly restrict providers' ability to use joint replacement patients to meet the eligibility criteria.