We are requesting approval for
revisions to the Inpatient Rehabilitation Facility Patient
Assessment Instrument (IRF-PAI). This is the assessment instrument
that Inpatient Rehabilitation Facilities (IRFs) are required to
submit in order for CMS to administer the payment rate methodolgy
under the IRF PPS described in 42 CFR 412 Subpart P. The burden
associated with this requirement is the staff time required to
complete and encode the data from the IRF-PAI. The burden
associated with transmitting the IRF-PAI is not being included in
this revision, since the requirement for IRFs to transmit the data
is unaffected by the proposed revision to the assessment
instrument. We are proposing the following revisions to the
IRF-PAI: Updates Associated with IRF-PAI Version 1.3 (Effective
October 1, 2015) We are proposing to add an item (24A) to the IRF
PAI to record arthritis conditions as part of our continued
monitoring of the IRF benefit. We are also proposing to add items
(O0401 and O0402) to the IRF PAI to record how much and what mode
of therapy (i.e., individual, group, co-treatment) patients receive
in each therapy discipline (i.e., physical therapy, occupational
therapy, and speech-language pathology) as part of our continued
monitoring and oversight of the IRF benefit, as well as to inform
the necessity of any future policy making. Updates Associated with
IRF-PAI Version 1.4 (Effective October 1, 2016) – Exempt from PRA
In the IRF PPS Final Rule FY 2016 , several quality measures were
finalized for the IRF QRP which require modification to the IRF-PAI
Version 1.4, effective October 1, 2016. We note that the burden
associated with the these measures is exempt from the PRA under the
IMPACT Act of 2014 but have provided it on the supporting
statement. Updates Associated with IRF-PAI Version 1.5 (Effective
October 1, 2017) We are proposing to remove an item (27) from the
IRF PAI. This item is no longer needed, as new quality items have
been added to Section K. Updates Associated with IRF-PAI Version
2.0 (Effective October 1, 2018) – Exempt from PRA In the FY 2017
IRF PPS final rule, we adopted 1 assessment-based measure to meet
the requirements of the IMPACT Act. The Drug Regimen Review
Conducted With Follow-Up for Identified Issues- Post Acute Care
(PAC) Inpatient Rehabilitation Facility (IRF) Quality Reporting
Program (QRP) measure was adopted for the FY 2020 and subsequent
payment determinations. In the FY 2018 IRF PPS proposed rule, we
proposed to adopt 1 measure and remove 2 measures. The proposed
measure for adoption is Changes in Skin Integrity Post-Acute Care:
Pressure Ulcer/Injury. The proposed measures for removal are
Percent of Residents or Patients with Pressure Ulcers That Are New
or Worsened (Short Stay) (NQF #0678) and the All-Cause Unplanned
Readmission Measure for 30 Days Post Discharge from Inpatient
Rehabilitation Facilities (NQF #2502). We also proposed adding
standardized patient assessment data, including 23 items on
admission and 24 items on discharge. Section 1886(j)(7)(F)(iii) of
the Act requires that for fiscal years 2019 and each subsequent
year, IRFs report standardized patient assessment data required
under section 1899B9b)(1) of the Act, using the standard instrument
in a time, form, and manner specified by the Secretary.
PL:
Pub.L. 111 - 148 3004 Name of Law: Quality Reporting for
Long-Term Care Hospitals, etc.
PL:
Pub.L. 105 - 1 4421 Name of Law: Prospective Payment for
Inpatient Rehab Hospital Services
US Code:
42 USC 1395ww(jX2)(d) Name of Law: Prospective Payment for
Inpatient Rehab Services
Since the Information
Collection Requirements (ICR) approval, the number of IRFs has
decreased from 1,137 to 1,126. We estimate that changes to the
IRF-PAI Version 3.0 will decrease the amount of time required to
complete the IRF-PAI by about 178 hours per year per IRF.
Therefore, the overall burden hours not exempt from PRA decreased
from 227,151 to 97,418.
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.
Form CMS-10036 Inpatient Rehabilitation Facility - Patient Assessment Instrument
CMS-10036 IRF-PAI Supporting Statement A FINAL.docx
Inpatient Rehabilitation Facility - Patient Assessment Instrument