Access to & Coverage of Inpatient Rehabiltiation Services

Under certain conditions, Medicare covers rehabilitation services provided in inpatient rehabilitation facilities. In 2009, 361,000 Medicare beneficiaries received care from 1,180 certified inpatient rehabilitation facilities (IRFs). These Medicare beneficiaries accounted for about 60 percent of all IRF cases. Currently, a number of Congressional proposals threaten access for Medicare beneficiaries to inpatient rehabilitation facility services.

Dobson & DaVanzo Study Patient Resource Center

A study  commissioned by the American Medical Rehabilitation Providers Association (AMRPA) was recently released regarding outcomes of patients who have received rehabilitative care in inpatient rehabilitation hospitals.  The results of the study indicate that complex, intensive rehabilitation – such as that delivered by Inpatient Rehabilitation Facilities – can minimize disability in those impacted by a traumatic health event and help patients regain a maximum level of independence.

The Coalition to Preserve Rehab has assembled a set of useful links and documents  to help advocates familiarize themselves with the results of the study and understand the implications the study for patients and how it adds to the ongoing policy debate about rehabilitation care settings.

See our toolkit Here.

Related Issues

The 75 Percent Rule

In 2004, CMS began phasing in regulations that would require 75% of IRF patients to have one of 13 specified conditions before the hospital or unit could qualify as an IRF and receive Medicare funding.  Congress recognized that the 75% Rule was adversely affecting access to medically necessary rehabilitation services for patients not diagnosed with the 13 conditions, and that IRFs were forced to decline admission of patients based on their condition category rather than their clinical needs.  Congress enacted statutory language to permanently reduce the compliance threshold to 60% in 2007.

As a way to increase decrease Medicare costs, some policymakers have proposed reinstating the 75% Rule compliance threshold for IRFs. The Coalition to Preserve Rehabilitation believes Congress should not relitigate the outdated 75% Rule proposal which was rejected overwhelmingly on a bipartisan basis by previous Congresses.

Cuts to Rehabilitation Funding

Currently, there are efforts to impose additional Medicare cuts or freezes for Inpatient Rehabilitation Facilities (IRFs).  Acute inpatient rehabilitation hospitals offer an array of critical services, including services related to brain injury and stroke, spinal cord injury, heart conditions, musculoskeletal disorders, neuromuscular disease, acute and chronic pain management, amputee, work injuries, and therapy.  Despite the critical care provided in these hospitals, IRFs have been subject to numerous payment cuts in recent years, threatening patient access when the  need for rehabiliative services is only growing.

Site-Neutral Payment Policy

IRFs are not the sole provider of rehabilitation services in communities; skilled nursing facilities (SNFs), home health agencies, comprehensive outpatient rehabilitation facilities, and independent therapy providers also furnish rehabilitation services.

Patients are referred to IRFs for a very intensive level of inpatient rehabilitation care. Because of the requirements that IRFs provide intensive inpatient rehabilitation care, these facilities often receive higher Medicare payments compared to other rehabilitation settings. However, in its proposed budget, the administration has called for neutralizing Medicare payments between these settings. CPR believes site neutral payments would result in patients that need intensive inpatient rehabilitation being treated in settings that provide less intensive care than an IRF. Rather than this level of care, these patients would be, in some instances, inappropriately diverted to a lesser intensive rehabilitation setting, contrary to the clinical needs of the patient. CPR opposes including the site-neutral payment policy in any future legislation.

7/10/13  Jenkins Letter to Secretary Sebelius Opposing Budget Cuts to Inpatient Rehabilitation Facilities (IRFs)

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