IRF-PAI Change Table

Change Table: Proposed IRF-PAI Version 3.0– Effective October 1, 2019 (FY 2020) – Changes from Version 2.0 to 3.0

3.

Item(s)
Affected
Admission
Discharge
Admission
Discharge
Admission

4.

Admission

5.

Admission
Discharge
Admission
Discharge

No.
1.
2.

6.

Item/Text
Affected
N/A

Final IRF-PAI v2.0
Effective October 1, 2018 (FY 2019)
Version 2.0

Proposed IRF-PAI v3.0
Effective October 1, 2019 (FY 2020)
Version 3.0

Rationale for
Change/Comments
Updated version number

Footer

Final IRF-PAI Version 2.0 - Effective
October 1, 2018
Identification Information*

Proposed IRF-PAI Version 3.0 - Effective
October 1, 2019
Identification Information

Updated footer

Payer Information*

Payer Information

Medical Information*

Medical Information

Impairment Group

Impairment Group*

* The FIM data set, measurement scale
and impairment codes incorporated or
referenced herein are the property of U B
Foundation Activities, Inc. ©1993, 2001 U
B Foundation Activities, Inc. The FIM mark
is owned by UBFA, Inc.
Function Modifiers:
Bladder Level of Assistance

* The impairment codes incorporated or
referenced herein are the property of U B
Foundation Activities, Inc. ©1993, 2001 U B
Foundation Activities, Inc.

Function Modifiers:
Bladder Frequency of Accidents

DELETED

Section
heading
Section
heading
Section
heading
21

7.

Admission
Discharge

Footnote

8.

Admission
Discharge

29

9.

Admission
Discharge

30

Proposed IRF-PAI Version 3.0 Change Table – Effective October 1, 2019 (FY2020)

DELETED

Removed asterisk that is
no longer needed
Removed asterisk that is
no longer needed
Removed asterisk that is
no longer needed
Added asterisk to indicate
presence of the footnote
associated with this item
Revised footnote to
reflect the proposed
removal of the FIM data
set and measurement
scale.
Proposed revisions to the
IRF prospective payment
system (PPS) would no
longer require the FIM
items or their associated
function modifiers.
Proposed revisions to the
IRF PPS would no longer
require the FIM items or
their associated function
modifiers.
(continued)

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Change Table: Proposed IRF-PAI Version 3.0– Effective October 1, 2019 (FY 2020) – Changes from Version 2.0 to 3.0
Item(s)
Affected
Admission
Discharge

Item/Text
Affected
31

Final IRF-PAI v2.0
Effective October 1, 2018 (FY 2019)
Function Modifiers:
Bowel Level of Assistance

Proposed IRF-PAI v3.0
Effective October 1, 2019 (FY 2020)
DELETED

11.

Admission
Discharge

32

Function Modifiers:
Bowel Frequency of Accidents

DELETED

12.

Admission
Discharge

33

Function Modifiers:
Tub Transfer

DELETED

13.

Admission
Discharge

34

Function Modifiers:
Shower Transfer

DELETED

14.

Admission
Discharge

35

Function Modifiers:
Distance Walked

DELETED

15.

Admission
Discharge

36

Function Modifiers:
Distance Traveled in Wheelchair

DELETED

No.
10.

Proposed IRF-PAI Version 3.0 Change Table – Effective October 1, 2019 (FY2020)

Rationale for
Change/Comments
Proposed revisions to the
IRF PPS would no longer
require the FIM items or
their associated function
modifiers.
Proposed revisions to the
IRF PPS would no longer
require the FIM items or
their associated function
modifiers.
Proposed revisions to the
IRF PPS would no longer
require the FIM items or
their associated function
modifiers.
Proposed revisions to the
IRF PPS would no longer
require the FIM items or
their associated function
modifiers.
Proposed revisions to the
IRF PPS would no longer
require the FIM items or
their associated function
modifiers.
Proposed revisions to the
IRF PPS would no longer
require the FIM items or
their associated function
modifiers.
(continued)

Page 2 of 4

Change Table: Proposed IRF-PAI Version 3.0– Effective October 1, 2019 (FY 2020) – Changes from Version 2.0 to 3.0
Item(s)
Affected
Admission
Discharge

Item/Text
Affected
37

Final IRF-PAI v2.0
Effective October 1, 2018 (FY 2019)
Function Modifiers:
Walk

Proposed IRF-PAI v3.0
Effective October 1, 2019 (FY 2020)
DELETED

17.

Admission
Discharge

38

Function Modifiers:
Wheelchair

DELETED

18.

Admission
Discharge

39

FIM Instrument

DELETED

19.

Discharge

Discharge Information*

Discharge Information

20.

Discharge

Section
heading
Section O

Special Treatments, Procedures, and
Programs

DELETED

No.
16.

Proposed IRF-PAI Version 3.0 Change Table – Effective October 1, 2019 (FY2020)

Rationale for
Change/Comments
Proposed revisions to the
IRF PPS would no longer
require the FIM items or
their associated function
modifiers.
Proposed revisions to the
IRF PPS would no longer
require the FIM items or
their associated function
modifiers.
Proposed revisions to the
IRF PPS would no longer
require the FIM items or
their associated function
modifiers.
Removed asterisk that is
no longer needed
Section removed on
discharge due to removal
of item O0250, Influenza
Vaccine
(continued)

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Change Table: Proposed IRF-PAI Version 3.0– Effective October 1, 2019 (FY 2020) – Changes from Version 2.0 to 3.0
No.
21.

22.

Item(s)
Affected
Discharge

Item/Text
Affected
O0250A
O0250B
O0250C

Admission
Discharge

Z0400A

Final IRF-PAI v2.0
Effective October 1, 2018 (FY 2019)
Influenza Vaccine
A. Did the patient receive the influenza
vaccine in this facility for this year's
influenza vaccination season?
0. No Skip to O0250C, If influenza
vaccine not received, state reason
1. Yes Continue to O0250B, Date
influenza vaccine received
B. Date influenza vaccine received
Complete date and skip to Z0400A,
Signature of Persons Completing the
Assessment
MM – DD - YYYY
C. If influenza vaccine not received,
state reason:
1. Patient not in this facility during
this year's influenza vaccination
season
2. Received outside of this facility
3. Not eligible - medical
contraindication
4. Offered and declined
5. Not offered
6. Inability to obtain influenza
vaccine due to a declared
shortage
9. None of the above
Signature of Persons Completing the
Assessment*

Proposed IRF-PAI Version 3.0 Change Table – Effective October 1, 2019 (FY2020)

Proposed IRF-PAI v3.0
Effective October 1, 2019 (FY 2020)
DELETED

Rationale for
Change/Comments
The quality measure,
Percent of Residents or
Patients Who Were
Assessed and
Appropriately Given the
Seasonal Influenza
Vaccination (NQF #0680),
is proposed to be
removed from the IRF
Quality Reporting
Program, thus these
influenza vaccination
items would no longer be
required.

Signature of Persons Completing the
Assessment

Removed asterisk that is
no longer needed

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