CMS proposes small boost to inpatient rehab facility payments

The CMS is proposing to raise the estimated payments per discharge for inpatient rehabilitation facilities in federal fiscal 2020 by 2.3%, or $195 million, compared with 2019.

The proposed rule also would boost payments in urban areas by 2.2% and rural areas by 4.3% compared with the year before.

However, payments per discharge for free-standing rehabilitation hospitals are estimated to not increase or decrease in urban areas and decrease by 2% in rural areas, the rule said.

The agency is seeking comments on several changes to the calculation of the wage index for inpatient rehab facilities. The proposal calls for moving the wage index to the same one used for hospitals under the Inpatient Prospective Payment System in order to better align the wage index methodology across post-acute care settings. The fiscal 2020 wage index will use a pre-floor, pre-reclassified IPPS wage index.

"We are proposing to implement these revisions in a budget-neutral manner," the proposed rule said.

The wage index used for inpatient rehabilitation facilities under the rule will be assigned on the basis of the labor market area where the facility is based in, the rule added.

It also clarifies the definition of a rehab physician, leaving it up to the facility to determine if a licensed physician can qualify as a rehab physician.

The CMS suggested changing the calculation of the inpatient rehab facility marketbasket, which is the cost for a collection of goods and services related to rehabilitation. Previously the marketbasket was pegged to costs from 2012, but the proposal wants to update it to 2016.

To calculate the marketbasket, the CMS will look at prices and costs for services in the basket from that year and create a baseline for the facilities to follow.

The agency is also proposing to adopt a number of standardized patient assessment data elements, used to assess items such as cognitive function and mental status, which it claims will improve coordination of care.