Despite efforts by the CMS to more thoroughly determine who should be admitted to inpatient rehabilitation facilities, greater refinement of the rules are needed, a report from the Government Accountability Office said. Last year, the CMS issued new criteria for the so-called "75% rule" under which facilities could be classified as inpatient rehabilitation facilities and be eligible for higher Medicare reimbursements if at least 75% of their total patient population had at least one of 13 clinical conditions. The new rule was to be phased in over three years, beginning last July, but Congress delayed implementation, asking the GAO to study the issue.
The GAO report found that less than half of Medicare patients in IRFs during 2003 had a qualifying condition under the rule and few facilities met the 75% threshold. While acknowledging that some Medicare patients may be admitted to facilities unnecessarily, the report said the CMS needs to refine its criteria, possibly by describing more thoroughly the subgroups of patients within a condition that require inpatient rehabilitation services and taking into consideration functional status in deciding whether a patient should qualify for those services. View the report. -- by Tony Fong