2026 FINAL RULES INPATIENT REHAB
An Analysis and Commentary on Federal Health Care Issues by Larry Goldberg
CMS Finalizes Inpatient Rehabilitation Facility FY 2026 PPS Update
The Centers for Medicare and Medicaid Services (CMS) have released a final rule to update the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) for FY 2026.
A copy of the 137-page document is available at: https://public-inspection.federalregister.gov/2025-14780.pdf.
The rule is scheduled for publication in the Federal Register on August 5.
This final rule includes the classification and weighting factors for the IRF prospective payment system (PPS) case-mix groups (CMGs), and a description of the methodologies and data used in computing the prospective payment rates for FY 2026.
For the IRF Quality Reporting Program (QRP), this rule finalizes CMS’ proposals to remove two quality measures: (1) the COVID-19 Vaccination Coverage among Healthcare Personnel (HCP) measure, beginning with the FY 2026 IRF QRP, and (2) the COVID-19 Vaccine: Percent of Patients/Residents Who Are Up to Date measure, beginning with the FY 2028 IRF QRP.
CMS is finalizing its proposals to remove four Standardized Patient Assessment Data Elements under the Social Determinant of Health (SDOH) category from the IRF Patient Assessment Instrument (IRF-PAI) beginning with the FY 2028 IRF QRP. CMS is also finalizing its proposals amending its reconsideration policy.
Finally, CMS provides summaries of the comments received in response to a Request for Information (RFI) on four separate considerations: (1) future measure concepts for the IRF QRP; (2) potential revisions to the IRF Patient Assessment Instrument (PAI); (3) potential revisions to the data submission deadlines for assessment data collected for the IRF QRP; and (4) advancing digital quality measurement in IRFs.
The rule includes the classification and weighting factors for the IRF PPS’s case-mix groups (CMGs), a description of the methodologies and data used in computing the prospective payment rates for FY 2026.