The proposed rule also further restricted the types of patients who would allow a facility to qualify for the higher IRF pay rates, instead of lower inpatient prospective payment system hospital rates. Specifically, the rule proposed dropping diagnostic codes under the categories of “non specific diagnosis codes, arthritis diagnosis codes, unilateral upper extremity diagnosis, some congenital anomalies diagnosis codes, other miscellaneous diagnosis codes” from the list of conditions that would allow a facility to meet the definition of an IRF.
The first such change since 2004 was proposed because the affected conditions “would not prove compliance in the absence of additional facts that would have to be pulled from a patient's medical record,” according to a CMS factsheet.
The agency also proposed to revise the IRF quality reporting program by adding three new measures: tracking flu vaccine administration to patients; chronicling flu vaccine use by employees; and an unplanned readmissions measure.
Additionally, the agency proposed adopting a National Quality Forum-endorsed pressure-ulcer measure.
In order to adopt that measure, the CMS would revise IRFs' Patient Assessment Instrument to include the data elements necessary to accommodate risk adjustment. The pressure-ulcer question would be revised—based on provider feedback—to “better reflect up-to-date medical practice and better assess patients' needs,” according to the factsheet.
Additionally, the assessment tool would be revised to add new patient flu vaccination data and require data collection based on fiscal years, instead of calendar years.
Other new proposals include an allowance for providers that suffer a natural or man-made disaster to request a waiver from quality reporting requirements, under the rule.
Follow Rich Daly on Twitter: @MHrdaly