A proposed rule would adjust the 2009 inpatient rehabilitation facilities (IRF) prospective payment system relative weights and average length of stay values with the most current Medicare claims and cost report data while not increasing the IRF standard payment conversion factor in accordance with section 115 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (PubLNo 110-173). The IRF standard payment will remain at $13,034.
The proposed combined budget neutrality factor for the 2009 wage index and labor related share will be 1.0004, for a standard payment amount of $13,039. With a factor of 0.9969, the proposed budget neutrality factor for the case mix groups (CMG) relative weights would result in a standard payment factor conversion of $12,999. In 2009, the IRF outlier payments as a percentage of total estimated payments would be at 3.7 percent. CMS proposes an outlier threshold payment amount of $9,191. CMS would update the national IRF cost-to-charge ratio (CCR) ceiling to 0.016 for rural IRFs and to 0.486 for urban IRFs. The CCR ceiling would be set at 1.58.
IRF payments include inpatient operating and capitals costs for rehabilitation services. Direct graduate medical education costs, approved nursing costs, allied health education, bad debts are not included because the are outside the scope of the IRF program. Given the 2009 changes, more than 96 percent of the IRF cases are in CMGs that would change by less than five percent. The inpatient prospective payment system (IPPS) wage date will also be used again for the IRF prospective payment system.
Source: Proposed rule, 73 FR 22673, April 25, 2008.
For more information on this and related topics, consult the CCH® Medicare and Medicaid Guide.
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