Appendix C: Change Tables V1.4 to 1.5 and V1.5 to 2.0

Change Tables for Proposed IRF-PAI Version 1.5 and Version 2.0
Table 1. Proposed IRF-PAI Version 1.5 Change Table – Effective October 1, 2017 (Changes from Version 1.4 to 1.5)
No.
1.
2.

3.
4.

5.

Item(s)
Affected

Item/Text
Affected

IRF-PAI Version 1.4

Proposed IRF-PAI Version 1.5

Rationale for
Change/Comments

Admission
Discharge
Admission
Discharge

N/A

Version 1.4

Version 1.5

Updated version number

N/A

N/A

Admission and Discharge headings

Admission
Discharge
Admission
Discharge

Footer

IRF-PAI Version 1.4 Effective October
1, 2016
White and gray font and header
background

Proposed IRF-PAI Version 1.5 Effective October
1, 2017
Black and bold font and header background

Added Admission and
Discharge heading on
each page of the
Admission and discharge
assessments, respectively,
for clarity
Updated

Swallowing Status
3 - Regular Food: solids and liquids
swallowed safely without
supervision or modified food
consistency
2 - Modified Food
Consistency/Supervision:
subject requires modified food
consistency and/or needs
supervision for safety
1 - Tube/Parenteral Feeding:
tube/parenteral feeding used
wholly or partially as a means of
sustenance

DELETED

Admission
Discharge

Quality
Indicators
Section
Headings
and Titles
27

Proposed IRF-PAI Version 1.5 Change Table – Effective October 1, 2017

Updated background and
font in headers to
increase contrast
between text and
background
This voluntary item is no
longer needed, as a new
item has been added to
Section K

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
Item(s)
Affected
Admission
Discharge
Admission
Discharge
Admission
Discharge

Item / Text
Affected
N/A

4.

5.

No.
1.
2.
3.

Footer

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
Version 1.5

(Note: Proposed modifications to existing items are
presented in BLUE font)

Version 2.0

N/A

Proposed IRF-PAI Version 1.5 Effective
October 1, 2017
N/A

Proposed IRF-PAI Version 2.0 - Effective
October 1, 2018
Punctuation and style revisions applicable
throughout the instrument

Admission

B0100

New Item

Discharge

B0100

New Item

B0100. Comatose
Persistent vegetative state/no discernible
consciousness.
0. No  Continue to B0200, Hearing.
1. Yes  Skip to GG0100, Prior Functioning:
Everyday Activities.
B0100. Comatose
Persistent vegetative state/no discernible
consciousness.
0. No  Continue to C1310, Signs and
Symptoms of Delirium.
1. Yes  Skip to G0130, Self-Care.

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

Rationale for
Change/Comments
Updated version number
Updated
Punctuation and style
revisions to be consistent
with MDS and LTCH CARE
Data Set
New item added to
indicate coma status and
to align with Minimum
Data Set and LTCH CARE
Data Set
New item added to
indicate coma status and
to align with Minimum
Data Set and LTCH CARE
Data Set
(continued)

Page 2 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
No.
6.

Item(s)
Affected
Admission

Item / Text
Affected
B0200

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
New Item

(Note: Proposed modifications to existing items are
presented in BLUE font)

B0200. Hearing (3-day assessment period)

Ability to hear (with hearing aid or hearing
appliances if normally used)
0. Adequate: No difficulty in normal
conversation, social interaction,
listening to TV.
1. Minimal difficulty: Difficulty in some
environments (e.g., when person
speaks softly or setting is noisy).
2. Moderate difficulty: Speaker has to
increase volume and speak distinctly.
3. Highly impaired: Absence of useful
hearing

Rationale for
Change/Comments
New item added to assess
Hearing in Section B –
Hearing, Speech, and
Vision and to align with
Minimum Data Set and
LTCH CARE Data Set

(continued)

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

Page 3 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
No.
7.

Item(s)
Affected
Admission

Item / Text
Affected
B1000

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
New Item

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

(Note: Proposed modifications to existing items are
presented in BLUE font)

B1000. Vision (3-day assessment period)
Ability to see in adequate light (with glasses
or other visual appliances)
0. Adequate: Sees fine detail, such as
regular print in newspapers/books
1. Impaired: Sees large print, but not
regular print in newspapers/books
2. Moderately impaired: Limited vision;
not able to see newspaper headlines
but can identify objects.
3. Highly impaired: Object identification
in question, but eyes appear to
follow objects.
4. Severely impaired: No vision or sees
only light, colors or shapes; eyes do
not appear to follow objects.

Rationale for
Change/Comments
New item added to assess
Vision in Section B –
Hearing, Speech, and
Vision and to align with
Minimum Data Set and
LTCH CARE Data Set

(continued)

Page 4 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
No.
8.

Item(s)
Affected
Admission

Item / Text
Affected
BB0800

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
BB0800. Understanding Verbal Content
(3-day assessment period)
Understanding Verbal Content (with
hearing aid or device, if used and
excluding language barriers)
4. Understands: Clear comprehension
without cues or repetitions
3. Usually Understands: Understands
most conversations, but misses some
part/intent of message. Requires cues
at times to understand
2. Sometimes Understands: Understands
only basic conversations or simple,
direct phrases. Frequently requires
cues to understand
1. Rarely/Never Understands

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

(Note: Proposed modifications to existing items are
presented in BLUE font)

BB0800. Understanding Verbal and NonVerbal Content (3-day assessment period)
Understanding Verbal and Non-Verbal
Content (with hearing aid or device, if used,
and excluding language barriers)
4. Understands: Clear comprehension
without cues or repetitions
3. Usually Understands: Understands
most conversations, but misses some
part/intent of message. Requires
cues at times to understand
2. Sometimes Understands:
Understands only basic conversations
or simple, direct phrases. Frequently
requires cues to understand
1. Rarely/Never Understands

Rationale for
Change/Comments
Added clarification that
Non-Verbal Content can
also be considered when
coding this item
Added comma for
clarification

(continued)

Page 5 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
No.
9.

Item(s)
Affected
Admission

Item / Text
Affected
C0200

Proposed IRF-PAI Version 2.0

(Note: Proposed modifications to existing items are
presented in BLUE font)

Proposed IRF-PAI Version 1.5
C0200. Repetition of Three Words.
Ask patient: “I am going to say three
words for you to remember. Please repeat
the words after I have said all three. The
words are: sock, blue, and bed. Now tell
me the three words.”

C0200. Repetition of Three Words.
Ask patient: “I am going to say three words
for you to remember. Please repeat the
words after I have said all three. The words
are: sock, blue, and bed. Now tell me the
three words.”

Number of words repeated by patient
after first attempt:
3. Three
2. Two
1. One
0. None

Number of words repeated after first
attempt
3. Three
2. Two
1. One
0. None

After the patient's first attempt, say “I will
repeat each of the three words with a cue
and ask you about them later: sock,
something to wear; blue, a color; bed, a
piece of furniture." You may repeat the
words up to two more times.

After the patient's first attempt, repeat the
words using cues ("sock, something to wear;
blue, a color; bed, a piece of furniture"). You
may repeat the words up to two more times.

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

Rationale for
Change/Comments
Instructions and response
option wording were
modified to align with
wording in Minimum Data
Set and LTCH CARE Data
Set
Response content and
codes are consistent with
Minimum Data Set and
LTCH CARE Data Set

(continued)

Page 6 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
10. Admission

Item / Text
Affected
C0300
C0300A
C0300B
C0300C

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
C0300. Temporal Orientation: Year,
Month, Day.
A. Ask patient: "Please tell me what year
it is right now."
Patient’s answer is:
3. Correct
2. Missed by 1 year.
1. Missed by 2 to 5 years
0. Missed by more than 5 years or no
answer
B. Ask patient: "What month are we in
right now?"
Patient’s answer is:
2. Accurate within 5 days
1. Missed by 6 days to 1 month
0. Missed by more than 1 month or
no answer
C. Ask patient: "What day of the week is
today?"
Patient’s answer is:
1. Correct
0. Incorrect or no answer

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

(Note: Proposed modifications to existing items are
presented in BLUE font)

C0300. Temporal Orientation (orientation
to year, month, and day)
Ask patient: "Please tell me what year it is
right now."
A. Able to report correct year.
3. Correct
2. Missed by 1 year.
1. Missed by 2-5 years
0. Missed by > 5 years or no answer
Ask patient: "What month are we in right
now?"
B. Able to report correct month.
2. Accurate within 5 days
1. Missed by 6 days to 1 month
0. Missed by > 1 month or no answer

Rationale for
Change/Comments
Instructions and response
option wording were
modified to align with
wording in Minimum Data
Set and LTCH CARE Data
Set
Response content and
codes are consistent with
Minimum Data Set and
LTCH CARE Data Set

Ask patient: "What day of the week is
today?"
C. Able to report correct day of the week.
1. Correct
0. Incorrect or no answer
(continued)

Page 7 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
11. Admission

Item / Text
Affected
C0400
C0400A
C0400B
C0400C

Proposed IRF-PAI Version 2.0

(Note: Proposed modifications to existing items are
presented in BLUE font)

Proposed IRF-PAI Version 1.5
C0400. Recall
Ask patient: "Let's go back to the first
question. What were those three words
that I asked you to repeat?" If unable to
remember a word, give cue (i.e.,
something to wear; a color; a piece of
furniture) for that word.

C0400. Recall
Ask patient: "Let's go back to an earlier
question. What were those three words that
I asked you to repeat?" If unable to
remember a word, give cue (something to
wear; a color; a piece of furniture) for that
word.

A. Recalls "sock”?
2. Yes, no cue required
1. Yes, after cueing ("something to
wear")
0. No, could not recall

A. Able to recall "sock”
2. Yes, no cue required
1. Yes, after cueing ("something to
wear")
0. No - could not recall

B. Recalls "blue"?
2. Yes, no cue required
1. Yes, after cueing ("a color")
0. No, could not recall

B. Able to recall "blue"
2. Yes, no cue required
1. Yes, after cueing ("a color")
0. No - could not recall

C. Recalls "bed"?
2. Yes, no cue required
1. Yes, after cueing ("a piece of
furniture")
0. No, could not recall

C. Able to recall "bed"
2. Yes, no cue required
1. Yes, after cueing ("a piece of
furniture")
0. No - could not recall

Rationale for
Change/Comments
Instructions and response
option wording were
modified to align with
wording in Minimum Data
Set and LTCH CARE Data
Set
Response content and
codes are consistent with
Minimum Data Set and
LTCH CARE Data Set

(continued)

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

Page 8 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
12. Admission

Item / Text
Affected
C1310
C1310A
C1310B
C1310C
C1310D

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
New Item

(Note: Proposed modifications to existing items are
presented in BLUE font)

C1310. Signs and Symptoms of Delirium (from
CAM©)
Code after completing Brief Interview for
Mental Status or Staff Assessment, and
reviewing medical record (3-day assessment
period).
A. Acute Onset Mental Status Change
Is there evidence of an acute change in mental
status from the patient's baseline?
0. No
1. Yes
Enter Codes in Boxes
B. Inattention - Did the patient have difficulty
focusing attention, for example, being easily
distractible or having difficulty keeping track of
what was being said?
C. Disorganized thinking - Was the patient's
thinking disorganized or incoherent (rambling or
irrelevant conversation, unclear or illogical flow
of ideas, or unpredictable switching from subject
to subject)?

Rationale for
Change/Comments
New item added to assess
signs and symptoms of
delirium in Section C –
Cognitive Patterns and to
align with Minimum Data
Set and LTCH CARE Data
Set
The admission item
differs from the discharge
item by specifying a “3day assessment period”
Technical expert panel
was supportive of use of
the CAM in IRFs

(continued)

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

Page 9 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
No.

Item(s)
Affected

13. Discharge

Item / Text
Affected

C1310
C1310A
C1310B
C1310C
C1310D

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5

New Item

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

(Note: Proposed modifications to existing items are
presented in BLUE font)

D. Altered level of consciousness - Did the
patient have altered level of consciousness as
indicated by any of the following criteria?
• vigilant - startled easily to any sound or
touch
• lethargic - repeatedly dozed off when
being asked questions, but responded to
voice or touch
• stuporous - very difficult to arouse and
keep aroused for the interview
• comatose - could not be aroused
Coding:
0. Behavior not present
1. Behavior continuously present, does not
fluctuate
2. Behavior present, fluctuates (comes and
goes, changes in severity)
C1310. Signs and Symptoms of Delirium (from
CAM©) (within the last seven days).
A. Acute Onset Mental Status Change
Is there evidence of an acute change in mental
status from the patient's baseline?
0. No
1. Yes

Rationale for
Change/Comments

New item added to assess
signs and symptoms of
delirium in Section C –
Cognitive Patterns to align
with Minimum Data Set
and LTCH CARE Data Set
(continued)

Page 10 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
No.

Item(s)
Affected

Item / Text
Affected

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5

(Note: Proposed modifications to existing items are
presented in BLUE font)

Enter Codes in Boxes
B. Inattention - Did the patient have difficulty
focusing attention, for example, being easily
distractible or having difficulty keeping track of
what was being said?
C. Disorganized thinking - Was the patient's
thinking disorganized or incoherent (rambling or
irrelevant conversation, unclear or illogical flow
of ideas, or unpredictable switching from subject
to subject)?
D. Altered level of consciousness - Did the
patient have altered level of consciousness as
indicated by any of the following criteria?
• vigilant - startled easily to any sound or
touch
• lethargic - repeatedly dozed off when
being asked questions, but responded to
voice or touch
• stuporous - very difficult to arouse and
keep aroused for the interview
• comatose - could not be aroused
Coding:
0. Behavior not present
1. Behavior continuously present, does not
fluctuate
2. Behavior present, fluctuates (comes and
goes, changes in severity)

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

Rationale for
Change/Comments
Technical expert panel
was supportive of the use
of the CAM in IRFs
The discharge item differs
from the admission
version of this item by
specifying the assessment
time period to be “within
the last 7 days”

(continued)
Page 11 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
14. Admission
Discharge

Proposed IRF-PAI Version 2.0

Item / Text
Affected
C1310
(footnote)

Proposed IRF-PAI Version 1.5
N/A – footnote associated with new
item

15. Admission
Discharge

Section D

New Section

16. Admission
Discharge

D0150

New Item

(Note: Proposed modifications to existing items are
presented in BLUE font)

Confusion Assessment Method. ©1988, 2003,
Hospital Elder Life Program. All rights reserved.
Adapted from: Inouye SK et al. Ann Intern Med.
1990; 113:941-8. Used with permission.
Section D - Mood

D0150. Patient Health Questionnaire 2 (PHQ2©)
Say to patient: "Over the last 2 weeks, have you
been bothered by any of the following
problems?"
If symptom is present, enter 1 (yes) in column 1,
Symptom Presence.
If yes in column 1, then ask the patient: "About
how often have you been bothered by this?"
Read and show the patient a card with the
symptom frequency choices. Indicate response
in column 2, Symptom Frequency.
1. Symptom Presence
0. No (enter 0 in column 2)
1. Yes (enter 0-3 in column 2)
9. No response (leave column 2 blank)

Rationale for
Change/Comments
Added footnote
associated with C1310
Added new section to
accommodate PHQ-2
items
Added PHQ-2 to assess for
symptoms of depression
and for consistency and
standardization with the
LTCH CARE Data Set
Public comments
supportive of using less
burdensome PHQ-2 rather
than PHQ-9; suggested
screening for depression
symptoms to ensure that
this important condition is
captured as early as
possible, increasing the
likelihood of being able to
prevent development of
severe depression.
(continued)

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

Page 12 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
No.

Item(s)
Affected

Item / Text
Affected

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5

(Note: Proposed modifications to existing items are
presented in BLUE font)

2. Symptom Frequency
0. Never or 1 day
1. 2-6 days (several days)
2. 7-11 days (half or more of the days)
3. 12-14 days (nearly every day)

Enter scores in boxes.
A. Little interest or pleasure in doing things?
17. Admission
Discharge

D0150
(footnote)

N/A –footnote associated with new
item

18. Admission
Discharge

Section E

New Section

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

B. Feeling down, depressed, or hopeless?

Copyright © Pfizer Inc. All rights reserved.
Reproduced with permission.
Section E – Behavioral Symptoms

Rationale for
Change/Comments
Technical expert panel
satisfied with the
reliability, validity, and
utility of the PHQ-2 as a
screener for depressive
symptoms

Added footnote
associated with D0150
item
Added new section to
accommodate new
behavioral symptoms
items
(continued)

Page 13 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
19. Admission
Discharge

Item / Text
Affected
E0200
E0200A
E0200B
E0200C

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
New Item

(Note: Proposed modifications to existing items are
presented in BLUE font)

E0200. Behavioral Symptom – Presence &
Frequency
Note presence of symptoms and their
frequency.

Enter Codes in Boxes
A. Physical behavioral symptoms directed
toward others (e.g., hitting, kicking, pushing,
scratching, grabbing, abusing others sexually).
B. Verbal behavioral symptoms directed toward
others (e.g., threatening others, screaming at
others, cursing at others).
C. Other behavioral symptoms not directed
toward others (e.g., physical symptoms such as
hitting or scratching self, pacing, rummaging,
public sexual acts, disrobing in public, throwing
or smearing food or bodily wastes, or
verbal/vocal symptoms like screaming,
disruptive sounds).
Coding:
0. Behavior not exhibited
1. Behavior of this type occurred 1 to 3 days
2. Behavior of this type occurred 4 to 6 days,
but less than daily
3. Behavior of this type occurred daily

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

Rationale for
Change/Comments
Added Behavioral
Symptoms to align with
Minimum Data Set and
LTCH CARE Data Set
Expert input suggested
that documenting the
occurrence of these
behaviors and their
frequency would be
useful
**Note. Given the 7-day
lookback, it is expected
that assessors will obtain
this information at
admission from providers
in previous setting, likely
through the IRF prescreen process. The
assessment time period
covers 4 days prior to
admission and the first 3
days of the patient’s IRF
stay.
(continued)

Page 14 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
20. Admission

Item / Text
Affected
GG110
GG0110A
GG0110B
GG0110C
GG0110D
GG0110E
GG0110Z

21. Admission

GG0130
Discharge
goal coding

22. Admission
Discharge

GG0130
Coding
options

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
GG0110. Prior Device Use. Indicate
devices and aids used by the patient
prior to the current illness,
exacerbation, or injury.
Check all that apply
A. Manual wheelchair
B. Motorized wheelchair or scooter
C. Mechanical lift
D. Walker
E. Orthotics/Prosthetics.
Z. None of the above
Code the patient's usual performance
at admission for each activity using
the 6-point scale. If activity was not
attempted at admission, code the
reason. Code the patient's discharge
goal(s) using the 6-point scale. Do not
use codes 07, 09, or 88 to code
discharge goal(s).
From 6-point scale
05. Setup or clean-up assistance –
Helper SETS UP or CLEANS UP; patient
completes activity. Helper assists only
prior or following the activity.

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

(Note: Proposed modifications to existing items are
presented in BLUE font)

GG0110. Prior Device Use. Indicate devices and
aids used by the patient prior to the current
illness, exacerbation, or injury.
Check all that apply
A. Manual wheelchair
B. Motorized wheelchair and/or scooter
C. Mechanical lift
D. Walker
E. Orthotics/Prosthetics
Z. None of the above

Rationale for
Change/Comments
Added “and/” for
clarification

Code the patient's usual performance at
admission for each activity using the 6-point
scale. If activity was not attempted at
admission, code the reason. Code the patient's
discharge goal(s) using the 6-point scale. Use of
codes 07, 09, 10, or 88 is permissible to code
discharge goal(s).

Added instructions
indicating that the activity
not attempted codes may
be used to code goal
items

From 6-point scale

Removed capitalization
for stylistic consistency
within the instrument

05. Setup or clean-up assistance – Helper sets
up or cleans up; patient completes activity.
Helper assists only prior or following the activity.

(continued)

Page 15 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
23. Admission
Discharge

24. Admission
Discharge

Item / Text
Affected
GG0130
Coding
options

GG0130

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
From 6-point scale
04. Supervision or touching
assistance - Helper provides VERBAL
CUES or TOUCHING/STEADYING
assistance as patient completes
activity. Assistance may be provided
throughout the activity or
intermittently.
If activity was not attempted, code
the reason:
07. Patient refused
09. Not applicable
88. Not attempted due to medical
condition or safety concerns

25. Admission
Discharge

GG0130A

A. Eating: The ability to use suitable
utensils to bring food to the mouth
and swallow food once the meal is
presented on a table/tray. Includes
modified food consistency.

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

(Note: Proposed modifications to existing items are
presented in BLUE font)

From 6-point scale

04. Supervision or touching assistance - Helper
provides verbal cues and/or touching/steadying
and/or contact guard assistance as patient
completes activity. Assistance may be provided
throughout the activity or intermittently.
If activity was not attempted, code the reason:
07. Patient refused
09. Not applicable – Not attempted and the
patient did not perform this activity prior to the
current illness, exacerbation, or injury.
10. Not attempted due to environmental
limitations (e.g., lack of equipment, weather
constraints)
88. Not attempted due to medical condition or
safety concerns
A. Eating: The ability to use suitable utensils to
bring food and/or liquid to the mouth and
swallow food and/or liquid once the meal is
placed before the patient.

Rationale for
Change/Comments
Added “contact guard”
and changed “or” to
“and/or” for clarification
Removed capitalization

Added definition of 09 for
clarification
Added new code to allow
reporting of
environmental limitations

Revised wording of the
item definition for
clarification
(continued)

Page 16 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
26. Admission
Discharge

Item / Text
Affected
GG0130B

27. Admission
Discharge

GG0130C

28. Admission
Discharge

GG0130E

29. Admission
Discharge

GG0130F

30. Admission
Discharge

GG0130H

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
B. Oral hygiene: The ability to use
suitable items to clean teeth.
[Dentures (if applicable): The ability to
remove and replace dentures from
and to the mouth, and manage
equipment for soaking and rinsing
them.]
C. Toileting hygiene: The ability to
maintain perineal hygiene, adjust
clothes before and after using the
toilet, commode, bedpan or urinal. If
managing an ostomy, include wiping
the opening but not managing
equipment.
E. Shower/bathe self: The ability to
bathe self in shower or tub, including
washing, rinsing, and drying self. Does
not include transferring in/out of
tub/shower.
F. Upper body dressing: The ability to
put on and remove shirt or pajama
top; includes buttoning, if applicable.
H. Putting on/taking off footwear:
The ability to put on and take off socks
and shoes or other footwear that is
appropriate for safe mobility.

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

(Note: Proposed modifications to existing items are
presented in BLUE font)

B. Oral hygiene: The ability to use suitable items
to clean teeth. Dentures (if applicable): The
ability to insert and remove dentures into and
from the mouth, and manage denture soaking
and rinsing with use of equipment.

Rationale for
Change/Comments
Revised wording of the
item definition for
clarification

C. Toileting hygiene: The ability to maintain
perineal hygiene, adjust clothes before and after
voiding or having a bowel movement. If
managing an ostomy, include wiping the
opening but not managing equipment.

Revised wording of the
item definition for
clarification

E. Shower/bathe self: The ability to bathe self,
including washing, rinsing, and drying self
(excludes washing of back and hair). Does not
include transferring in/out of tub/shower.

Revised wording of the
item definition for
clarification

F. Upper body dressing: The ability to dress and
undress above the waist; including fasteners, if
applicable.
H. Putting on/taking off footwear: The ability to
put on and take off socks and shoes or other
footwear that is appropriate for safe mobility;
including fasteners, if applicable.

Revised wording of the
item definition for
clarification
Revised wording of the
item definition for
clarification
(continued)

Page 17 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
31. Admission

Item / Text
Affected
GG0170
Discharge
goal coding

32. Admission
Discharge

GG0170
Coding
option

33. Admission
Discharge

GG0170
Coding
option

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
Code the patient's usual performance
at admission for each activity using
the 6-point scale. If activity was not
attempted at admission, code the
reason. Code the patient's discharge
goal(s) using the 6-point scale. Do not
use codes 07, 09, or 88 to code
discharge goal(s).
From 6-point scale

(Note: Proposed modifications to existing items are
presented in BLUE font)

Code the patient's usual performance at
admission for each activity using the 6-point
scale. If activity was not attempted at
admission, code the reason. Code the patient's
discharge goal(s) using the 6-point scale. Use of
codes 07, 09, 10, or 88 is permissible to code
discharge goal(s).
From 6-point scale

05. Setup or clean-up assistance –
Helper SETS UP or CLEANS UP; patient
completes activity. Helper assists only
prior or following the activity.
From 6-point scale

05. Setup or clean-up assistance – Helper sets
up or cleans up; patient completes activity.
Helper assists only prior or following the activity.

04. Supervision or touching
assistance - Helper provides VERBAL
CUES or TOUCHING/STEADYING
assistance as patient completes
activity. Assistance may be provided
throughout the activity or
intermittently.

04. Supervision or touching assistance - Helper
provides verbal cues and/or touching/steadying
and/or contact guard assistance as patient
completes activity. Assistance may be provided
throughout the activity or intermittently.

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

From 6-point scale

Rationale for
Change/Comments
Added instructions
indicating that the activity
not attempted codes may
be used to code goal
items

Removed capitalization

Added “contact guard”
and changed “or” to
“and/or” for clarification
Removed capitalization

(continued)

Page 18 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
34. Admission
Discharge

Item / Text
Affected
GG0170
Coding
option

35. Admission
Discharge

GG0170A

36. Admission
Discharge

GG0170C

37. Admission
Discharge

GG0170D

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
If activity was not attempted, code
the reason:
07. Patient refused
09. Not applicable
88. Not attempted due to medical
condition or safety concerns

A. Roll left and right: The ability to roll
from lying on back to left and right
side, and return to lying on back.
C. Lying to sitting on side of bed: The
ability to safely move from lying on
the back to sitting on the side of the
bed with feet flat on the floor, and
with no back support.
D. Sit to stand: The ability to safely
come to a standing position from
sitting in a chair or on the side of the
bed

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

(Note: Proposed modifications to existing items are
presented in BLUE font)

If activity was not attempted, code the reason:
07. Patient refused
09. Not applicable – Not attempted and the
patient did not perform this activity prior to the
current illness, exacerbation, or injury.
10. Not attempted due to environmental
limitations (e.g., lack of equipment, weather
constraints)
88. Not attempted due to medical condition or
safety concerns
A. Roll left and right: The ability to roll from
lying on back to left and right side, and return to
lying on back on the bed.
C. Lying to sitting on side of bed: The ability to
move from lying on the back to sitting on the
side of the bed with feet flat on the floor, and
with no back support.
D. Sit to stand: The ability to come to a standing
position from sitting in a chair, wheelchair, or on
the side of the bed.

Rationale for
Change/Comments
Added definition of 09 for
clarification.
Added new code to allow
reporting of
environmental limitations

Added “on the bed” for
clarification
Removed “safely.” The
coding instructions refer
to safe performance,
which applies to all selfcare and mobility items
Removed “safely.” The
coding instructions refer
to safe performance,
which applies to all selfcare and mobility items.
Added “wheelchair” for
clarification
(continued)

Page 19 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
38. Admission
Discharge

Item / Text
Affected
GG0170E

Proposed IRF-PAI Version 2.0

(Note: Proposed modifications to existing items are
presented in BLUE font)

Proposed IRF-PAI Version 1.5
E. Chair/bed-to-chair transfer: The
ability to safely transfer to and from a
bed to a chair (or wheelchair).

E. Chair/bed-to-chair transfer: The ability to
transfer to and from a bed to a chair (or
wheelchair).

39. Admission
Discharge

GG0170F

F. Toilet transfer: The ability to safely
get on and off a toilet or commode.

F. Toilet transfer: The ability to get on and off a
toilet or commode.

40. Admission

GG0170H1

Item deleted

41. Discharge

GG0170H3

H1. Does the patient walk?
0. No, and walking goal is not clinically
indicated -> Skip to GG0170Q1. Does
the patient use a wheelchair/scooter?
1. No, and walking goal is clinically
indicated -> Code the patient's
discharge goal(s) for items GG0170I, J,
K, L, M, N, O, and P. For admission
performance, skip to GG0170Q1. Does
the patient use a wheelchair/scooter?
2. Yes Continue to GG0170I. Walk 10
feet
H3. Does the patient walk?
0. No  Skip to GG0170Q3. Does the
patient use wheelchair/scooter?
2. Yes  Continue to GG0170I. Walk
10 feet

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

Item deleted

Rationale for
Change/Comments
Removed “safely.” The
coding instructions refer
to safe performance,
which applies to all selfcare and mobility items
Removed “safely.” The
coding instructions refer
to safe performance,
which applies to all selfcare and mobility items
The skip pattern is
associated with the item
Walk 10 feet

The skip pattern is
associated with the item
Walk 10 feet
(continued)

Page 20 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
42. Admission

Item / Text
Affected
GG0170I

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
I. Walk 10 feet: Once standing, the
ability to walk at least 10 feet in a
room, corridor or similar space.

43. Discharge

GG0170I

I. Walk 10 feet: Once standing, the
ability to walk at least 10 feet in a
room, corridor or similar space.

44. Admission
Discharge

GG0170L

45. Admission
Discharge
46. Admission

GG0170M

L. Walking 10 feet on uneven
surfaces: The ability to walk 10 feet on
uneven or sloping surfaces, such as
grass or gravel.
M. 1 step (curb): The ability to step
over a curb or up and down one step.
Q1. Does the patient use a
wheelchair/scooter?
0. No Skip to H0350. Bladder
Continence
1. Yes Continue to GG0170R. Wheel 50
feet with two turns

GG0170Q1

(Note: Proposed modifications to existing items are
presented in BLUE font)

I. Walk 10 feet: Once standing, the ability to
walk at least 10 feet in a room, corridor, or
similar space.
If admission performance is coded 07, 09, 10, or
88 --> Skip to GG0170M, 1 step (curb).
I. Walk 10 feet: Once standing, the ability to
walk at least 10 feet in a room, corridor, or
similar space.
If discharge performance is coded 07, 09, 10, or
88 --> Skip to GG0170M, 1 step (curb).
L. Walking 10 feet on uneven surfaces: The
ability to walk 10 feet on uneven or sloping
surfaces (indoor or outdoor), such as turf or
gravel.
M. 1 step (curb): The ability to go up and down a
curb and/or up and down one step
Q1. Does the patient use a wheelchair and/or
scooter?
0. No -> Skip to H0350, Bladder Continence
1. Yes -> Continue to GG0170R, Wheel 50 feet
with two turns

Rationale for
Change/Comments
Added skip pattern that
was previously associated
with GG0170H1
Added skip pattern that
was previously associated
with GG0170H3
Revised wording of the
item definition for
clarification
Added for clarification
Added for clarification

(continued)

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

Page 21 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
47. Discharge

Item / Text
Affected
GG0170Q3

48. Admission

GG0170RR1

49. Discharge

GG0170RR3

50. Admission

GG0170SS1

51. Discharge

GG0170SS3

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
Q3. Does the patient use a
wheelchair/scooter?
0. No -> Skip to J1800. Any Falls Since
Admission
1. Yes -> Continue to GG0170R. Wheel
50 feet with two turns
RR1. Indicate the type of
wheelchair/scooter used.
1. Manual
2. Motorized
RR3. Indicate the type of
wheelchair/scooter used.
1. Manual
2. Motorized
SS1. Indicate the type of
wheelchair/scooter used.
1. Manual
2. Motorized
SS3. Indicate the type of
wheelchair/scooter used.
1. Manual
2. Motorized

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

(Note: Proposed modifications to existing items are
presented in BLUE font)

Q3. Does the patient use a wheelchair and/or
scooter?
0. No -> Skip to J1800, Any Falls Since Admission
1. Yes -> Continue to GG0170R, Wheel 50 feet
with two turns
RR1. Indicate the type of wheelchair or scooter
used.
1. Manual
2. Motorized
RR3. Indicate the type of wheelchair or scooter
used.
1. Manual
2. Motorized
SS1. Indicate the type of wheelchair or scooter
used.
1. Manual
2. Motorized
SS3. Indicate the type of wheelchair or scooter
used.
1. Manual
2. Motorized

Rationale for
Change/Comments
Added for clarification

Added for clarification

Added for clarification

Added for clarification

Added for clarification

(continued)

Page 22 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
52. Discharge

Item / Text
Affected
J1800

53. Discharge

Section K

54. Admission

K0110
K0110A
K0110B
K0110C

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
J800. Any Falls Since Admission
Has the patient had any falls since
admission?
0. No  Skip to M0210. Unhealed
Pressure Ulcer(s)
1. Yes  Continue to J1900. Number
of Falls Since Admission
New Section
K0110. Swallowing/Nutritional Status
(3-day assessment period) Indicate
the patient's usual ability to swallow.
Check all that apply
A. Regular food -Solids and liquids
swallowed safely without
supervision or modified food or
liquid consistency.
B. Modified food
consistency/supervision -Patient
requires modified food or liquid
consistency and/or needs
supervision during eating for
safety.
C. Tube/parenteral feeding Tube/parenteral feeding used
wholly or partially as a means of
sustenance.

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

(Note: Proposed modifications to existing items are
presented in BLUE font)

J1800. Any Falls Since Admission
Has the patient had any falls since admission?
0. No  Skip to K0520, Nutritional Approaches
1. Yes  Continue to J1900. Number of Falls
Since Admission
Section K – Swallowing/Nutritional Status
N/A – delete K0110

Rationale for
Change/Comments
Modified skip pattern to
reflect addition of item
K0520 on discharge

Adding new section on
discharge to
accommodate item K0520
Item deleted and
replaced with K0520 for
purpose of alignment
with Minimum Data Set
and LTCH CARE Data Set

(continued)
Page 23 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
55. Admission

Item / Text
Affected
K0520
K0520A1
K0520B1
K0520C1
K0520D1
K0520Z1

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
New item

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

(Note: Proposed modifications to existing items are
presented in BLUE font)

K0520. Nutritional Approaches Check all of the
following nutritional approaches that were
performed during the first 3 days of admission.
1. Performed during the first 3 days of
admission.
↓ Check all that apply
A. Parenteral/IV feeding
B. Feeding tube - nasogastric or abdominal
(e.g., PEG)
C. Mechanically altered diet - require
change in texture of food or liquids (e.g.,
pureed food, thickened liquids)
D. Therapeutic diet (e.g., low salt, diabetic,
low cholesterol)
Z. None of the above

Rationale for
Change/Comments
Added to IRF-PAI to align
with Minimum Data Set
and LTCH CARE Data Set

(continued)

Page 24 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
56. Discharge

57. Admission
Discharge

Item / Text
Affected
K0520
K0520A2
K0520B2
K0520C2
K0520D2
K0520Z2

Section M
heading

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
New item

Report based on highest stage of
existing ulcer(s) at its worst; do not
"reverse" stage

(Note: Proposed modifications to existing items are
presented in BLUE font)

K0520. Nutritional Approaches Check all of the
following nutritional approaches that were
performed during the last 7 days.
2. Performed during the last 7 days.
↓ Check all that apply
A. Parenteral/IV feeding
B. Feeding tube - nasogastric or abdominal
(e.g., PEG)
C. Mechanically altered diet - require
change in texture of food or liquids (e.g.,
pureed food, thickened liquids)
D. Therapeutic diet (e.g., low salt, diabetic,
low cholesterol)
Z. None of the above
Report based on highest stage of existing
ulcers/injuries at their worst; do not "reverse"
stage

Rationale for
Change/Comments
Added to IRF-PAI to align
with Minimum Data Set
and LTCH CARE Data Set
A 7-day lookback period
provides more
information about
changes in the patient’s
status over the course of
rehabilitation, which can
be useful in care planning,
particularly in the context
of care transitions
Added the term “injury”
to be inclusive of updated
terminology supported by
the National Pressure
Ulcer Advisory Panel
(NPUAP)
Item wording aligns with
Minimum Data Set and
LTCH CARE Data Set
(continued)

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

Page 25 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
58. Admission

Item / Text
Affected
M0210

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
M0210. Unhealed Pressure Ulcer(s)
Does this patient have one or more
unhealed pressure ulcer(s) at Stage 1
or higher?
0. No -> Skip to O0100. Special
Treatments, Procedures, and
Programs
1. Yes -> Continue to M0300. Current
Number of Unhealed Pressure Ulcers
at Each Stage

(Note: Proposed modifications to existing items are
presented in BLUE font)

M0210. Unhealed Pressure Ulcers/Injuries
Does this patient have one or more unhealed
pressure ulcers/injuries?
0. No -> Skip to N2001, Drug Regimen Review
1. Yes -> Continue to M0300, Current Number of
Unhealed Pressure Ulcers/Injuries at Each Stage

Rationale for
Change/Comments
Deleted text to clarify
Added the term “injury”
to be inclusive of updated
terminology supported by
NPUAP
Modified skip pattern to
be consistent with
addition of new section
(N)
Item wording aligns with
Minimum Data Set and
LTCH CARE Data Set
(continued)

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

Page 26 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
59. Discharge

60. Admission
Discharge

Item / Text
Affected
M0210

M0300

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
M0210. Unhealed Pressure Ulcer(s)
Does this patient have one or more
unhealed pressure ulcer(s) at Stage 1
or higher?
0. No -> Skip to O0100. Special
Treatments, Procedures, and
Programs
1. Yes -> Continue to M0300. Current
Number of Unhealed Pressure Ulcers
at Each Stage

M0300. Current Number of Unhealed
Pressure Ulcers at Each Stage

(Note: Proposed modifications to existing items are
presented in BLUE font)

M0210. Unhealed Pressure Ulcers/Injuries
Does this patient have one or more unhealed
pressure ulcers/injuries?
0. No -> Skip to N2005, Medication Intervention
1. Yes -> Continue to M0300. Current Number of
Unhealed Pressure Ulcers/Injuries at Each Stage

Rationale for
Change/Comments
Deleted text to clarify
Added the term “injuries”
to be inclusive of updated
terminology supported by
NPUAP
Modified skip pattern to
be consistent with
addition of new section
(N)

M0300. Current Number of Unhealed Pressure
Ulcers/Injuries at Each Stage

Item wording aligns with
Minimum Data Set and
LTCH CARE Data Set
Added the term “injuries”
to be inclusive of updated
terminology supported by
NPUAP
Item wording aligns with
Minimum Data Set and
LTCH CARE Data Set
(continued)

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

Page 27 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
61. Admission
Discharge

Item / Text
Affected
M0300A

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
Number of Stage 1 pressure ulcers

(Note: Proposed modifications to existing items are
presented in BLUE font)

1. Number of Stage 1 pressure injuries

Rationale for
Change/Comments
Added the number one to
be consistent with other
items in the section
Replaced the term
“ulcers” with “injuries” as
the term “injuries”
indicates intact skin which
better aligns with criteria
for Stage 1

62. Discharge

M0300D1

63. Admission

M0300E
M0300E1

D1. Number of Stage 4 pressure
ulcers - If 0 -> Skip to M0300E.
Unstageable - Non-removable
dressing
E. Unstageable - Non-removable
dressing: Known but not stageable
due to non-removable dressing/device
1. Number of unstageable pressure
ulcers due to non-removable
dressing/device

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

D1. Number of Stage 4 pressure ulcers - If 0 ->
Skip to M0300E, Unstageable: Non-removable
dressing/device
E. Unstageable - Non-removable
dressing/device: Known but not stageable due
to non-removable dressing/device
1. Number of unstageable pressure
ulcers/injuries due to non-removable
dressing/device

Item wording aligns with
Minimum Data Set and
LTCH CARE Data Set
Added for clarification

Added the word “device”
for clarification
Item wording aligns with
Minimum Data Set and
LTCH CARE Data Set
(continued)

Page 28 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
64. Discharge

65. Admission

Item / Text
Affected
M0300E
M0300E1
M0300E2

M0300G
M0300G1

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
E. Unstageable - Non-removable
dressing: Known but not stageable
due to non-removable dressing/device
1. Number of unstageable pressure
ulcers due to non-removable
dressing/device  If 0 Skip to
M0300F. Unstageable, Slough and/or
eschar.
2. Number of these unstageable
pressure ulcers that were present
upon admission - enter how many
were noted at the time of admission
G. Unstageable - Deep tissue injury:
Suspected deep tissue injury in
evolution.
1. Number of unstageable pressure
ulcers with suspected deep tissue
injury in evolution

(Note: Proposed modifications to existing items are
presented in BLUE font)

E. Unstageable - Non-removable
dressing/device: Known but not stageable due
to non-removable dressing/device
1. Number of unstageable pressure
ulcers/injuries due to non-removable
dressing/device  If 0 Skip to M0300F,
Unstageable, Slough and/or eschar.
2. Number of these unstageable pressure
ulcers/injuries that were present upon
admission - enter how many were noted at the
time of admission
G. Unstageable - Deep tissue injury
1. Number of unstageable pressure injuries
presenting as deep tissue injury

Rationale for
Change/Comments
Added the term “injuries”
to be inclusive of updated
terminology supported by
NPUAP
Item wording aligns with
Minimum Data Set and
LTCH CARE Data Set

Removed the term
“suspected deep tissues
injury in evolution” and
added language to be
consistent with updated
NPUAP terminology
Item wording aligns with
Minimum Data Set and
LTCH CARE Data Set
(continued)

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

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Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
66. Discharge

67. Discharge

Item / Text
Affected
M0300G
M0300G1
M0300G2

M0800

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
G. Unstageable - Deep tissue injury:
Suspected deep tissue injury in
evolution.
1. Number of unstageable pressure
ulcers with suspected deep tissue
injury in evolution
If 0  Skip to M0800. Worsening in
Pressure Ulcers Status Since Admission
2. Number of these unstageable
pressure ulcers that were present
upon admission - enter how many
were noted at the time of admission.
M0800. Worsening in Pressure Ulcer
Status Since Admission
Indicate the number of current
pressure ulcers that were not present
or were at a lesser stage on
admission. If no current pressure ulcer
at a given stage, enter 0
A. Stage 2
B. Stage 3
C. Stage 4
D. Unstageable - Non-removable
dressing
E. Unstageable - Slough and/or
eschar
F. Unstageable - Deep tissue injury

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

(Note: Proposed modifications to existing items are
presented in BLUE font)

G. Unstageable - Deep tissue injury
1. Number of unstageable pressure injuries
presenting as deep tissue injury
If 0  Skip to N2005, Medication Intervention
2. Number of these unstageable pressure
injuries that were present upon admission enter how many were noted at the time of
admission.

Rationale for
Change/Comments
Removed the term
“suspected deep tissue
injury in evolution” and
replace with “deep tissue
injury” to be consistent
with updated NPUAP
terminology
Item wording aligns with
Minimum Data Set and
LTCH CARE Data Set

N/A – delete items

Deleted to reduce
provider burden
Alignment with Minimum
Data Set and LTCH CARE
Data Set

(continued)

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Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
68. Discharge

69. Admission
Discharge

Item / Text
Affected
M0900
M0900A
M0900B
M0900C
M0900D

Section N

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
M0900. Healed Pressure Ulcer(s)
Indicate the number of pressure
ulcers that were: (a) present on
Admission; and (b) have completely
closed (resurfaced with epithelium)
upon Discharge. If there are no healed
pressure ulcers noted at a given stage,
enter 0.
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
N/A – new section

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

(Note: Proposed modifications to existing items are
presented in BLUE font)

N/A – delete items

Section N. Medications

Rationale for
Change/Comments
Deleted to reduce
provider burden

New section added on
admission and discharge
to accommodate Drug
Regimen Review quality
measure items N2001,
N2003, and N2005
(continued)

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Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
70. Admission

71. Admission

Proposed IRF-PAI Version 2.0

Item / Text
Affected
N2001

Proposed IRF-PAI Version 1.5
New Item

N2003

New Item

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

(Note: Proposed modifications to existing items are
presented in BLUE font)

N2001. Drug Regimen Review
Did a complete drug regimen review identify
potential clinically significant medication
issues?
0. No - No issues found during review  Skip
to O0100, Special Treatments, Procedures,
and Programs
1. Yes - Issues found during review  Continue
to N2003, Medication Follow-up
9. NA - Patient is not taking any medications
Skip to O0100, Special Treatments,
Procedures, and Programs
N2003. Medication Follow-up
Did the facility contact a physician (or
physician-designee) by midnight of the next
calendar day and complete
prescribed/recommended actions in response
to the identified potential clinically significant
medication issues?
0. No
1. Yes

Rationale for
Change/Comments
New item added to collect
data for drug regimen
review quality measure

New item added to collect
data for drug regimen
review quality measure
Alignment with Minimum
Data Set and LTCH CARE
Data Set
(continued)

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Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
72. Discharge

73. Admission

Item / Text
Affected
N2005

O0100

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
New Item

O0100. Special Treatments,
Procedures, and Programs
↓ Check if treatment applies at
admission

(Note: Proposed modifications to existing items are
presented in BLUE font)

N2005. Medication Intervention
Did the facility contact and complete physician
(or physician-designee) prescribed/
recommended actions by midnight of the next
calendar day each time potential clinically
significant medication issues were identified
since the admission?
0. No
1. Yes
9. NA - There were no potential clinically
significant medication issues identified since
admission or patient is not taking any
medications
O0100. Special Treatments, Procedures, and
Programs Check all of the following treatments,
procedures, and programs that were performed
during the first 3 days of admission. For
chemotherapy and dialysis, check if it is part of
the patient’s treatment plan.
a. Performed during the first 3 days of
admission.
↓ Check all that apply.

Rationale for
Change/Comments
New item added to collect
data for drug regimen
review quality measure
Alignment with Minimum
Data Set and LTCH CARE
Data Set

The 3-day lookback
period was clarified for
internal consistency with
assessment time periods
in the IRF-PAI and to
document treatments,
procedures and programs
that were performed in
the first 3 days of the stay
Alignment with Minimum
Data Set and LTCH CARE
Data Set.
(continued)

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

Page 33 of 38

le 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0) (continued)
Item(s)
No.
Affected
74. Discharge

75. Admission
Discharge
(Note: ‘3’
denotes
admission
and ‘4’
denotes
discharge)

Item / Text
Affected
O0100

O0100

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
New Item

New Item

O0100A3
O0100A4
O0100A2a3
O0100A2a4
O0100A3a3
O0100A3a4
O0100A10a3
O0100A10a4

(Note: Proposed modifications to existing items are
presented in BLUE font)

O0100. Special Treatments, Procedures, and
Programs Check all of the following treatments,
procedures, and programs that were performed
during the last 14 days.
b. Performed during the last 14 days.
↓ Check all that apply.

A. Chemotherapy (if checked, please specify
below)
A2a. IV
A3a. Oral
A10a. Other

Rationale for
Change/Comments
The 14-day lookback
period was chosen to
achieve standardization
with Minimum Data Set
and the LTCH CARE Data
Set
A 14-day lookback period
provides useful
information for care
planning and risk
evaluation, especially in
the context of transfers of
care
New item added to align
with Minimum Data Set
and LTCH CARE Data Set
Public comment and
subject matter experts
support breaking the
parent item
“chemotherapy” into type
of chemotherapy to
distinguish patient
complexity/burden of
care
(continued)

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

Page 34 of 38

Item(s)
No.
Affected
76. Admission
Discharge
77. Admission
Discharge

Item / Text
Affected
O0100B3
O0100B4
O0100C3
O0100C4
O0100C2a3
O0100C2a4
O0100C3a3
O0100C3a4

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
New Item
New Item

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

(Note: Proposed modifications to existing items are
presented in BLUE font)

B. Radiation

C. Oxygen Therapy (if checked, please specify
below)
C2a. Continuous
C3a. Intermittent

Rationale for
Change/Comments
New item added to align
with Minimum Data Set
and LTCH CARE Data Set
New item added to align
with Minimum Data Set
and LTCH CARE Data Set
Public comment and
subject matter experts
support breaking the
parent item “oxygen
therapy” into continuous
or intermittent to
distinguish patient
complexity/burden of
care
(continued)

Page 35 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
78. Admission
Discharge

Item / Text
Affected
O0100D3
O0100D4
O0100D2a3
O0100D2a4
O0100D3a3
O0100D3a4

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
New Item

(Note: Proposed modifications to existing items are
presented in BLUE font)

D. Suctioning (if checked, please specify below)
D2a. Scheduled
D3a. As needed

79. Admission
Discharge

O0100E3
O0100E4

New Item

E. Tracheostomy Care

80. Admission
Discharge

O0100F3
O0100F4

New Item

F. Invasive Mechanical Ventilator

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

Rationale for
Change/Comments
New item added to align
with Minimum Data Set
and LTCH CARE Data Set
Public comment and
subject matter experts
support breaking the
parent item “suctioning”
into frequency of
suctioning to distinguish
patient
complexity/burden of
care
New item added to align
with Minimum Data Set
and LTCH CARE Data Set
Collecting information on
use of invasive
mechanical ventilation
support is important for
assessing cost and case
complexity in IRFs and
useful for care transfer
(continued)

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Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
81. Admission
Discharge

82. Admission
Discharge

83. Admission
Discharge
84. Admission
Discharge

Item / Text
Affected
O0100G3
O0100G4
O0100G2a3
O0100G2a4
O0100G3a3
O0100G3a4

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
New Item

(Note: Proposed modifications to existing items are
presented in BLUE font)

G. Non-invasive Mechanical Ventilator
(BiPAP/CPAP) (if checked, please specify below)
G2a. BiPAP
G3a. CPAP

O0100H3
O0100H4
O0100H3a3
O0100H3a4
O0100H4a3
O0100H4a4
O0100H10a3
O0100H10a4
O0100I3
O0100I4

New Item

New Item

I. Transfusions

O0100J3
O0100J4
O0100J2a3
O0100J2a4
O0100J3a3
O0100J3a4

New Item

J. Dialysis (if checked, please specify below)
J2a. Hemodialysis
J3a. Peritoneal dialysis

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

H. IV Medications (if checked, please specify
below)
H3a. Antibiotics
H4a. Anticoagulation
H10a. Other

Rationale for
Change/Comments
New item added to align
with Minimum Data Set
and LTCH CARE Data Set
In public comment, there
was support for breaking
the parent item into child
items: BiPAP and CPAP
New item added to align
with Minimum Data Set
and LTCH CARE Data Set
In public comment, there
was support for further
delineating types of IV
medications
New item added to align
with Minimum Data Set
and LTCH CARE Data Set
New item added to align
with Minimum Data Set
and LTCH CARE Data Set
In public comment, there
was support for breaking
out the parent item
“dialysis” into type of
dialysis
(continued)
Page 37 of 38

Table 2. Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018 (Changes from Version 1.5 to 2.0)
(continued)
Item(s)
No.
Affected
85. Admission

86. Admission
Discharge

87. Admission
Discharge

Item / Text
Affected
O0100N

O0100O3
O0100O4
O0100O2a3
O0100O2a4
O0100O3a3
O0100O3a4
O0100O4a3
O0100O4a4
O0100O10a3
O0100O10a4
O0100Z3
O0100Z4

Proposed IRF-PAI Version 2.0

Proposed IRF-PAI Version 1.5
O0100N. Total Parenteral Nutrition

New Item

New Item

Proposed IRF-PAI Version 2.0 Change Table – Effective October 1, 2018

(Note: Proposed modifications to existing items are
presented in BLUE font)

N/A – delete item

O. IV Access (if checked, please specify below)
O2a. Peripheral IV
O3a. Midline
O4a. Central line (e.g., PICC, tunneled, port)
O10a. Other

Z. None of the above

Rationale for
Change/Comments
Deleted to align with
Minimum Data Set and
LTCH CARE Data Set. Total
parental nutrition will be
assessed as part of new
item in Section K, K0520
New item added to align
with the Minimum Data
Set and LTCH CARE Data
Set
In public comment, there
was support for breaking
out the parent item into
types of IV access
New item added to align
with Minimum Data Set
and LTCH CARE Data Set

Page 38 of 38