The CMS issued final regulations to change criteria used to determine whether a facility receives inpatient rehabilitation rates and, separately, to define details of a prospective payment system for long-term, acute-care hospitals. Among other changes to the rehab criteria, the CMS eliminated polyarthritis from a list of 10 qualifying patient conditions and added four other arthritis-related conditions and post-surgical care for certain joint replacements. Providers vehemently opposed the CMS' initial proposal issued late last year, particularly the elimination of polyarthritis, saying many legitimate rehab hospitals would not meet the new criteria. The American Hospital Association said it wasn't much happier with the final regulation than with the proposal and would seek congressional intervention. Because of the services required, Medicare pays higher rates to facilities that meet its definition of rehab hospitals. The regulation takes effect July 1.
The PPS regulation, also effective July 1, raises the 2004-05 increase in Medicare payments to long-term, acute-care hospitals to 3.1% instead of the 2.9% projected in January. The agency attributed the higher increase to more facilities than anticipated switching to the PPS immediately instead of opting for a transition period. Some 93% of the nation's more than 300 long-term, acute-care hospitals -- instead of the projected 70% -- have chosen to be paid under the new system, the CMS said. As a result, Medicare payments to long-term, acute-care hospitals are expected to total $2.96 billion in fiscal 2005. Both final regulations will be published in the May 7 Federal Register. -- by Tony Fong