An Analysis and Commentary on Federal Health Care Issues by Larry Goldberg

CMS Issues Final Inpatient Rehabilitation Facility FY 2020 PPS Update

The Centers for Medicare and Medicaid Services (CMS) have released a final rule that will update the payment rates and quality reporting items for inpatient rehabilitation facilities (IRFs) for Federal fiscal year (FY) 2020.

The rule includes the classification and weighting factors for the IRF PPS’s case-mix groups and a description of the methodologies and data used in computing the prospective payment rates for FY 2020. This rule will also rebase and revise the IRF market basket to reflect a 2016 base year, rather than the current 2012 base year.

Additionally, the rule will not, as proposed, replace the previously finalized unweighted motor score with a weighted motor score to assign patients to CMGs. CMS will remove one item—(GG0170A1 Roll left to right)—from the score beginning in FY 2020 and to revise the CMGs and update the CMG relative weights and average length of stay values, based on analysis of 2 years of data (FY 2017 and FY 2018).

CMS will update the IRF wage index to use the concurrent IPPS wage index for the IRF PPS beginning with FY 2020. Currently, CMS uses wage index data from the prior year.

The 382-page document is scheduled for publication in the Federal Register on August 8. A copy is currently available at: https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-16603.pdf. This link will change upon publication.

The IRF PPS Addenda along with other supporting documents and tables referenced in the final rule are available on the CMS website at: http://www.cms.hhs.gov/Medicare/Medicare-Fee-for-Service- Payment/InpatientRehabFacPPS/.


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