Change Table for Proposed IRF QRP New and Modified Items

Change Table for Proposed IRF QRP New and Modified Items – Effective Date: October 1, 2020
#
1.
2.

Admission/
Item / Text
Discharge
Affected
All
N/A
Admission
9

3.

Admission

15A

IRF-PAI Version 3.0

Version 3.0
9. Race/Ethnicity (Check all that apply)
American Indian or Alaska Native A.
Asian B.
Black or African American C.
Hispanic or Latino D.
Native Hawaiian or Other Pacific Islander E.
White F.
15A. Admit From
(01-Home (private home/apt., board/care,
assisted living, group home, transitional
living); 02-Short-term General Hospital; 03 Skilled Nursing Facility (SNF); 04 Intermediate care; 06 -Home under care of
organized home health service
organization; 50 -Hospice (home);51 Hospice (institutional facility); 61 -Swing
bed; 62 -Another Inpatient Rehabilitation
Facility; 63 -Long-Term Care Hospital
(LTCH);64 -Medicaid Nursing Facility; 65 Inpatient Psychiatric Facility; 66 -Critical
Access Hospital; 99 -Not Listed)

IRF-PAI Version 4.0 (Note: Modifications to
Rationale for
existing items highlighted in yellow)
Change / Comments
Version 4.0
Updated version number.
Deleted
Item 9. Race/Ethnicity is
deleted and replaced with
items A1005. Ethnicity and
A1010. Race.

15A. Admit From
Revised for PAC alignment.
(01. Home (e.g. private home/apt.,
board/care, assisted living, group home,
transitional living, other residential care
arrangements); 02. Short-term General
Hospital; 03. Skilled Nursing Facility (SNF);
04: Intermediate care; 06. Home under care
of organized home health service
organization; 50. Hospice (home); 51.
Hospice (medical facility); 61. Swing Bed; 62.
Another Inpatient Rehabilitation Facility; 63.
Long-Term Care Hospital (LTCH); 64.
Medicaid Nursing Facility; 65. Inpatient
Psychiatric Facility; 66. Critical Access
Hospital (CAH); 99. Not Listed

Page 1 of 24

Change Table for Proposed IRF QRP New and Modified Items – Effective Date: October 1, 2020 (continued)
#
4.

Admission/
Item / Text
Discharge
Affected
Discharge
44D

IRF-PAI Version 3.0
44D. Patient’s discharge destination/living
setting, using codes below: (answer only if
44C = 1; if 44C = 0, skip to item 46)
(01- Home (private home/apt., board/care,
assisted living, group home, transitional
living); 02- Short-term General Hospital;
03 - Skilled Nursing Facility (SNF); 04 Intermediate care; 06 - Home under care of
organized home health service
organization; 50 - Hospice (home); 51 Hospice (institutional facility); 61 - Swing
bed; 62 - Another Inpatient Rehabilitation
Facility; 63 - Long-Term Care Hospital
(LTCH); 64 - Medicaid Nursing Facility; 65 Inpatient Psychiatric Facility; 66 - Critical
Access Hospital; 99 - Not Listed)

5.

Admission

Section

N/A – new section

6.

Admission

A1005

N/A – new item

IRF-PAI Version 4.0 (Note: Modifications to
Rationale for
existing items highlighted in yellow)
Change / Comments
44D. Patient’s discharge destination/living Revised for Transfer of Health
setting, using codes below: (answer only if
Information measure
44C = 1; if 44C = 0, skip to item 46)
calculation and PAC alignment.
(01. Home (e.g. private home/apt.,
board/care, assisted living, group home,
transitional living, other residential care
arrangements); 02. Short-term General
Hospital; 03. Skilled Nursing Facility (SNF);
04: Intermediate care; 06. Home under care
of organized home health service
organization; 50. Hospice (home); 51.
Hospice (medical facility); 61. Swing Bed; 62.
Another Inpatient Rehabilitation Facility; 63.
Long-Term Care Hospital (LTCH); 64.
Medicaid Nursing Facility; 65. Inpatient
Psychiatric Facility; 66. Critical Access
Hospital (CAH); 99. Not Listed
Section A. Administrative Information
Adding new section to
accommodate new items.
A1005. Ethnicity
Item 9. Race/Ethnicity is
Are you Hispanic, Latino/a, or Spanish
deleted and replaced with
origin?
A1005. Ethnicity. Proposed as
Check all that apply
SPADE in the FY 2020 IRF PPS
A. No, not of Hispanic, Latino/a, or
proposed rule. Aligns with
Spanish origin
2011 HHS race and ethnicity
B. Yes, Mexican, Mexican American,
data standards for person-level
Chicano/a
data collection, while
C. Yes, Puerto Rican
maintaining the 1997 OMB
D. Yes, Cuban
minimum data standards for
E. Yes, Another Hispanic, Latino, or
race and ethnicity.
Spanish origin
X. Patient unable to respond
Page 2 of 24

Change Table for Proposed IRF QRP New and Modified Items – Effective Date: October 1, 2020 (continued)
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7.

8.

Admission/
Item / Text
Discharge
Affected
Admission
A1010

Admission,
Discharge

A1110
A1110A
A1110B

IRF-PAI Version 3.0
N/A – new item

N/A – new item

IRF-PAI Version 4.0 (Note: Modifications to
existing items highlighted in yellow)
A1010. Race
What is your race?
Check all that apply
A. White
B. Black or African American
C. American Indian or Alaska Native
D. Asian Indian
E. Chinese
F. Filipino
G. Japanese
H. Korean
I. Vietnamese
J. Other Asian
K. Native Hawaiian
L. Guamanian or Chamorro
M. Samoan
N. Other Pacific Islander
X. Patient unable to respond
A1110. Language
A. What is your preferred language?

Rationale for
Change / Comments
Item 9. Race/Ethnicity is
deleted and replaced with
A1010. Race. Proposed as
SPADE in the FY 2020 IRF PPS
proposed rule. Aligns with
2011 HHS race and ethnicity
data standards for person-level
data collection, while
maintaining the 1997 OMB
minimum data standards for
race and ethnicity.

Proposed as SPADE in the FY
2020 IRF PPS proposed rule.

B. Do you need or want an interpreter to
communicate with a doctor or health care
staff?
0. No
1. Yes
9. Unable to determine

Page 3 of 24

Change Table for Proposed IRF QRP New and Modified Items – Effective Date: October 1, 2020 (continued)
#
9.

Admission/
Item / Text
Discharge
Affected
Admission,
A1250
Discharge

10. Discharge

A2121

IRF-PAI Version 3.0
N/A – new item

N/A – new item

IRF-PAI Version 4.0 (Note: Modifications to
existing items highlighted in yellow)
A1250. Transportation
Has lack of transportation kept you from
medical appointments, meetings, work, or
from getting things needed for daily living?
Check all that apply
A. Yes, it has kept me from medical
appointments or from getting my
medications
B. Yes, it has kept me from non-medical
meetings, appointments, work, or
from getting things that I need
C. No
D. Patient unable to respond
A2121. Provision of Current Reconciled
Medication List to Subsequent Provider at
Discharge
At the time of discharge to another provider,
did your facility provide the patient’s current
reconciled medication list to the subsequent
provider?
0. No – Current reconciled medication list
not provided to the subsequent
provider
1. Yes – Current reconciled medication
list provided to the subsequent
provider

Rationale for
Change / Comments
Proposed as SPADE in the FY
2020 IRF PPS proposed rule.
Consistent with Healthy People
2020 priority to address
patients' social determinants of
health.

New data element added for
the Transfer of Health
Information quality measures.

Page 4 of 24

Change Table for Proposed IRF QRP New and Modified Items – Effective Date: October 1, 2020 (continued)
Admission/
Item / Text
#
Discharge
Affected
11. Discharge
A2122

IRF-PAI Version 3.0
N/A – new item

12. Discharge

N/A – new item

A2123A1
A2123A2
A2123B1
A2123B2
A2123C1
A2123C2
A2123D1
A2123D2
A2123E1
A2123E2

IRF-PAI Version 4.0 (Note: Modifications to
existing items highlighted in yellow)
A2122. Provision of Current Reconciled
Medication List to Patient at Discharge
At the time of discharge, did your facility
provide the patient’s current reconciled
medication list to the patient, family and/or
caregiver?
0. No – Current reconciled medication list
not provided to the patient, family
and/or caregiver
1. Yes – Current reconciled medication
list provided to the patient, family
and/or caregiver
A2123. Route of Current Reconciled
Medication List Transmission
Indicate the route(s) of transmission of the
current reconciled medication list to the
subsequent provider and/or
patient/family/caregiver.

Rationale for
Change / Comments
New data element added for
the Transfer of Health
Information quality measures.

New data element added for
the Transfer of Health
Information quality measures.

1. To subsequent provider
2. To patient/family/caregiver
Check all that apply
A. Electronic Health Record
B. Health Information Exchange
Organization
C. Verbal (e.g., in-person, telephone,
video conferencing)
D. Paper-based (e.g., fax, copies, printouts)
E. Other Methods (e.g., texting, email, CDs)

Page 5 of 24

Change Table for Proposed IRF QRP New and Modified Items – Effective Date: October 1, 2020 (continued)
Admission/
Item / Text
#
Discharge
Affected
13. Admission
B0200

IRF-PAI Version 3.0
N/A – new item

14. Admission

N/A – new item

B1000

IRF-PAI Version 4.0 (Note: Modifications to
existing items highlighted in yellow)
B0200. Hearing
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
B1000. Vision
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
Added to assess Hearing in
Section B – Speech, Hearing,
and Vision. MDS currently
assesses this but it is missing
from previous versions of IRFPAI. National Beta Test data
supports cross-setting
reliability and feasibility.

Added to assess Vision in
Section B – Speech, Hearing,
and Vision. MDS currently
assesses this but it is missing
from previous versions of IRFPAI. National Beta Test data
supports cross-setting
reliability and feasibility.

Page 6 of 24

Change Table for Proposed IRF QRP New and Modified Items – Effective Date: October 1, 2020 (continued)
Admission/
Item / Text
#
Discharge
Affected
15. Admission,
B1300
Discharge

IRF-PAI Version 3.0
N/A – new item

16. Discharge

N/A – new item

C0100

IRF-PAI Version 4.0 (Note: Modifications to
existing items highlighted in yellow)
B1300. Health Literacy
How often do you need to have someone
help you when you read instructions,
pamphlets, or other written material from
your doctor or pharmacy?
0. Never
1. Rarely
2. Sometimes
3. Often
4. Always
9. Patient unable to respond
C0100. Should Brief Interview for Mental
Status (C0200-C0500) be Conducted? (3day assessment period)
Attempt to conduct interview with all
patients.
0. No (patient is rarely/never understood)
Skip to XXXX
1. Yes Continue to C0200, Repetition of
Three Words

Rationale for
Change / Comments
Proposed as SPADE in the FY
2020 IRF PPS proposed rule.
Recommended for inclusion in
Medicare data by HHS and the
National Academies of
Sciences, Engineering and
Medicine (NASEM).

Added BIMS to Cognitive
Patterns section on discharge
of the IRF-PAI to assess mental
status. Most public comments
supportive of including BIMS.
TEP supported use of BIMS.
Testing supports use of MDS
version of BIMS. National Beta
Test data supports crosssetting reliability and
feasibility.

Page 7 of 24

Change Table for Proposed IRF QRP New and Modified Items – Effective Date: October 1, 2020 (continued)
Admission/
Item / Text
#
Discharge
Affected
17. Discharge
C0200

IRF-PAI Version 3.0
N/A – new item

IRF-PAI Version 4.0 (Note: Modifications to
Rationale for
existing items highlighted in yellow)
Change / Comments
C0200. Repetition of Three Words
Added BIMS to Cognitive
Patterns section on discharge
Ask patient: “I am going to say three words of the IRF-PAI to assess mental
for you to remember. Please repeat the
status. Most public comments
words after I have said all three. The words supportive of including BIMS.
are: sock, blue and bed. Now tell me the
TEP supported use of BIMS.
three words.”
Testing supports use of MDS
version of BIMS. National Beta
Number of words repeated after first
Test data supports crossattempt
setting reliability and
3. Three
feasibility.
2. Two
1. One
0. None
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.

Page 8 of 24

Change Table for Proposed IRF QRP New and Modified Items – Effective Date: October 1, 2020 (continued)
Admission/
Item / Text
#
Discharge
Affected
18. Discharge
C0300
C0300A
C0300B
C0300C

IRF-PAI Version 3.0
N/A – new item

IRF-PAI Version 4.0 (Note: Modifications to
Rationale for
existing items highlighted in yellow)
Change / Comments
C0300. Temporal Orientation (orientation
Added BIMS to Cognitive
to year, month, and day)
Patterns section on discharge
of the IRF-PAI to assess mental
Ask patient: “Please tell me what year it is
status. Most public comments
right now.”
supportive of including BIMS.
A. Able to report correct year
TEP supported use of BIMS.
3. Correct
Testing supports use of MDS
2. Missed by 1 year
version of BIMS. National Beta
1. Missed by 2 - 5 years
Test data supports cross0. Missed by > 5 years or no answer
setting reliability and
feasibility.
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
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

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Change Table for Proposed IRF QRP New and Modified Items – Effective Date: October 1, 2020 (continued)
Admission/
Item / Text
#
Discharge
Affected
19. Discharge
C0400
C0400A
C0400B
C0400C

IRF-PAI Version 3.0
N/A – new item

IRF-PAI Version 4.0 (Note: Modifications to
Rationale for
existing items highlighted in yellow)
Change / Comments
C0400. Recall
Added BIMS to Cognitive
Patterns section on discharge
Ask patient: “Let's go back to an earlier
of the IRF-PAI to assess mental
question. What were those three words that status. Most public comments
I asked you to repeat?” If unable to
supportive of including BIMS.
remember a word, give cue (something to
TEP supported use of BIMS.
wear; a color; a piece of furniture) for that
Testing supports use of MDS
word.
version of BIMS. National Beta
Test data supports crossA. Able to recall “sock”
setting reliability and
2. Yes, no cue required
feasibility.
1. Yes, after cueing ("something to
wear")
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. Able to recall “bed”
2. Yes, no cue required
1. Yes, after cueing ("a piece of
furniture")
0. No - could not recall

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Change Table for Proposed IRF QRP New and Modified Items – Effective Date: October 1, 2020 (continued)
Admission/
Item / Text
#
Discharge
Affected
20. Discharge
C0500

IRF-PAI Version 3.0
N/A – new item

21. Admission

N/A – new item

C1310A
C1310B
C1310C
C1310D

IRF-PAI Version 4.0 (Note: Modifications to
Rationale for
existing items highlighted in yellow)
Change / Comments
C0500. BIMS Summary Score
Added BIMS to Cognitive
Patterns section on discharge
Add scores for questions C0200-C0400 and of the IRF-PAI to assess mental
fill in total score (00-15)
status. Most public comments
Enter 99 if the patient was unable to
supportive of including BIMS.
complete the interview
TEP supported use of BIMS.
Testing supports use of MDS
version of BIMS. National Beta
Test data supports crosssetting reliability and
feasibility.
C1310. Signs and Symptoms of Delirium
TEP supportive of CAM use
(from CAM©)
across settings. National Beta
Code after completing Brief Interview for
Test data supports crossMental Status or Staff Assessment and
setting reliability and feasibility
reviewing medical record.
of CAM.
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
Page 11 of 24

Change Table for Proposed IRF QRP New and Modified Items – Effective Date: October 1, 2020 (continued)
#

Admission/
Discharge

22. Discharge

Item / Text
Affected

C1310A
C1310B
C1310C
C1310D

IRF-PAI Version 3.0

N/A – new item

IRF-PAI Version 4.0 (Note: Modifications to
existing items highlighted in yellow)
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)
C1310. Signs and Symptoms of Delirium
(from CAM©)
Code after completing Brief Interview for
Mental Status and reviewing medical record.
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

TEP supportive of CAM use
across settings. National Beta
Test data supports crosssetting reliability and feasibility
of CAM.

Page 12 of 24

Change Table for Proposed IRF QRP New and Modified Items – Effective Date: October 1, 2020 (continued)
#

Admission/
Discharge

Item / Text
Affected

IRF-PAI Version 3.0

IRF-PAI Version 4.0 (Note: Modifications to
existing items highlighted in yellow)
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

Rationale for
Change / Comments

Coding:
0. Behavior not present
1. Behavior continuously present,
does not fluctuate
2. Behavior present, fluctuates
(comes and goes, changes in
severity)

Page 13 of 24

Change Table for Proposed IRF QRP New and Modified Items – Effective Date: October 1, 2020 (continued)
Admission/
Item / Text
#
Discharge
Affected
23. Admission,
CAM ©
Discharge
Footnote

24. Admission,
Discharge

D0150
D0150A1
D0150A2
D0150B1
D0150B2
D0150C1
D0150C2
D0150D1
D0150D2
D0150E1
D0150E2
D0150F1
D0150F2
D0150G1
D0150G2
D0150H1
D0150H2
D0150I1
D0150I2

IRF-PAI Version 3.0
Adapted with permission from: Inouye SK
et al, Clarifying confusion: The Confusion
Assessment Method. A new method for
detection of delirium. Annals of Internal
Medicine. 1990; 113: 941-948. Confusion
Assessment Method: Training Manual and
Coding Guide, Copyright 2003, Hospital
Elder Life Program, LLC. Not to be
reproduced without permission.
N/A – new item

IRF-PAI Version 4.0 (Note: Modifications to
Rationale for
existing items highlighted in yellow)
Change / Comments
Confusion Assessment Method. ©1988,
TEP supportive of CAM use.
2003, Hospital Elder Life Program. All rights
reserved. Adopted from: Inouye SK et al. Ann
Intern Med. 1990; 113:941-8. Used with
permission.

D0150. Patient Mood Interview (PHQ-2 to
9)
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.

Adding PHQ-2 to 9 to IRF-PAI.
Stakeholder and expert input,
including public comments and
the TEP, supportive of using
PHQ-2 as gateway to full PHQ9 depression screening. This
approach reduces burden
while ensuring that patients
with some depressive
symptoms are screening with
full PHQ-9. Results of the
National Beta Test support the
PHQ-2 to 9 as feasible and
reliable across PAC settings.

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).

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Change Table for Proposed IRF QRP New and Modified Items – Effective Date: October 1, 2020 (continued)
#

Admission/
Discharge

Item / Text
Affected

IRF-PAI Version 3.0

IRF-PAI Version 4.0 (Note: Modifications to
existing items highlighted in yellow)
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)

Rationale for
Change / Comments

Enter scores in boxes.
A. Little interest or pleasure in doing
things
B. Feeling down, depressed, or hopeless
If either D0150A2 or D0150B2 is coded 2
or 3, CONTINUE asking the questions
below. If not, END the PHQ interview and
SKIP to next section.
C. Trouble falling or staying asleep, or
sleeping too much
D. Feeling tired or having little energy
E. Poor appetite or overeating
F. Feeling bad about yourself – or that
you are a failure or have let yourself
or your family down
G. Trouble concentrating on things, such
as reading the newspaper or watching
television
H. Moving or speaking so slowly that
other people could have noticed. Or
the opposite – being so fidgety or
restless that you have been moving
around a lot more than usual
I. Thoughts that you would be better off
dead, or of hurting yourself in some
way

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Change Table for Proposed IRF QRP New and Modified Items – Effective Date: October 1, 2020 (continued)
Admission/
Item / Text
#
Discharge
Affected
25. Admission,
D0160
Discharge

IRF-PAI Version 3.0
N/A – new item

26. Admission,
Discharge

D0700

N/A – new item

27. Admission,
Discharge

J0510

N/A – new item

IRF-PAI Version 4.0 (Note: Modifications to
Rationale for
existing items highlighted in yellow)
Change / Comments
D0160. Total Severity Score
Adding PHQ-2 to 9 to IRF- PAI.
Add scores for all frequency responses in
Column 2, Symptom Frequency.
Total score must be between 00 and 27.
Enter 99 if unable to complete interview
(i.e., Symptom Frequency is blank for 3 or
more required items).
D0700. Social Isolation
How often do you feel lonely or isolated
from those around you?
0. Never
1. Rarely
2. Sometimes
3. Often
4. Always
9. Patient unable to respond
J0510. Pain Effect on Sleep

Proposed as SPADE in the FY
2020 IRF PPS proposed rule.
Recommended for inclusion in
Medicare data by HHS and the
NASEM.

TEP comments and National
Beta Test data supports crossAsk patient: “Over the past 5 days, how
setting reliability and
much of the time has pain made it hard for feasibility.
you to sleep at night?”
0. Does not apply – I have not had any
pain or hurting in the past 5 days
Skip to XXXX
1. Rarely or not at all
2. Occasionally
3. Frequently
4. Almost Constantly
9. Unable to answer

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Change Table for Proposed IRF QRP New and Modified Items – Effective Date: October 1, 2020 (continued)
Admission/
Item / Text
#
Discharge
Affected
28. Admission,
J0520
Discharge

29. Admission,
Discharge

J0530

IRF-PAI Version 3.0
N/A – new item

N/A – new item

IRF-PAI Version 4.0 (Note: Modifications to
Rationale for
existing items highlighted in yellow)
Change / Comments
J0520. Pain Interference with Therapy
TEP comments and National
Activities
Beta Test data supports crosssetting reliability and
Ask patient: “Over the past 5 days, how
feasibility.
often have you limited your participation in
rehabilitation therapy sessions due to
pain?”
0. Does not apply – I have not received
rehabilitation therapy in the past 5
days
1. Rarely or not at all
2. Occasionally
3. Frequently
4. Almost Constantly
9. Unable to answer
J0530. Pain Interference with Day-to-Day
Activities
Ask patient: “Over the past 5 days, how
often have you limited your day-to-day
activities (excluding rehabilitation therapy
sessions) because of pain?”

TEP comments and National
Beta Test data supports crosssetting reliability and
feasibility.

1. Rarely or not at all
2. Occasionally
3. Frequently
4. Almost Constantly
9. Unable to answer

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Change Table for Proposed IRF QRP New and Modified Items – Effective Date: October 1, 2020 (continued)
Admission/
Item / Text
#
Discharge
Affected
30. Admission
K0110
K0110A
K0110B
K0110C

31. Admission

K0520
K0520A
K0520B
K0520C
K0520D
K0520Z

IRF-PAI Version 3.0
K0110. Swallowing/Nutritional Status (3day assessment period)
Indicate the patient's usual ability to
swallow.

IRF-PAI Version 4.0 (Note: Modifications to
Rationale for
existing items highlighted in yellow)
Change / Comments
Deleted
Replaced with item K0520.
Nutritional Approaches to align
with MDS’ assessment of
nutritional status.

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.
N/A – new item
K0520. Nutritional Approaches
Check all of the following nutritional
approaches that apply on admission.
Check all that apply
A. Parenteral/IV feeding
B. Feeding tube (e.g., nasogastric or
abdominal (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

Included to align with MDS’
assessment of nutritional
status. Item K0520 will mirror
the MDS.

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Change Table for Proposed IRF QRP New and Modified Items – Effective Date: October 1, 2020 (continued)
Admission/
Item / Text
#
Discharge
Affected
32. Discharge
K0520
K0520A1
K0520A2
K0520B1
K0520B2
K0520C1
K0520C2
K0520D1
K0520D2
K0520Z1
K0520Z2

IRF-PAI Version 3.0
N/A – new item

IRF-PAI Version 4.0 (Note: Modifications to
Rationale for
existing items highlighted in yellow)
Change / Comments
K0520. Nutritional Approaches
Included to align with MDS’
assessment of nutritional
1. Last 7 days
status. Item K0520 will mirror
Check all of the nutritional approaches the MDS.
that were received in the last 7 days
2. At discharge
Check all of the nutritional approaches
that were being received at discharge
Check all that apply
A. Parenteral/IV feeding
B. Feeding tube (e.g., nasogastric or
abdominal (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

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Change Table for Proposed IRF QRP New and Modified Items – Effective Date: October 1, 2020 (continued)
Admission/
Item / Text
#
Discharge
Affected
33. Admission
N0415
N0415A1
N0415A2
N0415E1
N0415E2
N0415F1
N0415F2
N0415H1
N0415H2
N0415I1
N0415I2
N0415J1
N0415J2

IRF-PAI Version 3.0
N/A – new item

IRF-PAI Version 4.0 (Note: Modifications to
existing items highlighted in yellow)
N0415. High-Risk Drug Classes: Use and
Indication
1. Is taking
Check if the patient is taking any
medications in the following drug
classes
2. Indication noted
If Column 1 is checked, check if there is
an indication noted for all medications
in the drug class

Rationale for
Change / Comments
TEP comments and National
Beta Test data supports crosssetting reliability and
feasibility.

Check all that apply
A. Antipsychotic
E. Anticoagulant
F. Antibiotic
H. Opioid
I. Antiplatelet
J. Hypoglycemic (including insulin)

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Change Table for Proposed IRF QRP New and Modified Items – Effective Date: October 1, 2020 (continued)
Admission/
Item / Text
#
Discharge
Affected
34. Discharge
N0420A1
N0420A2
N0420E1
N0420E2
N0420F1
N0420F2
N0420H1
N0420H2
N0420I1
N0420I2
N0420J1
N0420J2

35. Admission

O0100N
O0110

IRF-PAI Version 3.0
N/A – new item

O0100. Special Treatments, Procedures,
and Programs
Check if treatment applies at admission
O0100N. Total Parenteral Nutrition

36. Discharge

O0110

N/A – new item

IRF-PAI Version 4.0 (Note: Modifications to
existing items highlighted in yellow)
N0420. High-Risk Drug Classes: Use and
Indication
1. Is taking
Check if the patient is taking any
medications in the following drug
classes
2. Indication noted
If Column 1 is checked, check if there is
an indication noted for all medications
in the drug class
Check all that apply
A. Antipsychotic
E. Anticoagulant
F. Antibiotic
H. Opioid
I. Antiplatelet
J. Hypoglycemic (including insulin)
O0110. Special Treatments, Procedures,
and Programs
Check all of the following treatments,
procedures, and programs that apply on
admission.
Check all that apply
O0110. Special Treatments, Procedures,
and Programs
Check all of the following treatments,
procedures, and programs that apply at
discharge.

Rationale for
Change / Comments
TEP comments and National
Beta Test data supports crosssetting reliability and
feasibility.

TEP comments and National
Beta Test data supports crosssetting reliability and
feasibility.

TEP comments and National
Beta Test data supports crosssetting reliability and
feasibility.

Check all that apply

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Change Table for Proposed IRF QRP New and Modified Items – Effective Date: October 1, 2020 (continued)
Admission/
#
Discharge
37. Admission,
Discharge;
note: “a” is
used for item
numbering
for
admission
while “b” is
used for item
numbering
for discharge

Item / Text
Affected
O0110A1a
O0110A2a
O0110A3a
O0110A10a
O0110B1a
O0110A1b
O0110A2b
O0110A3b
O0110A10b
O0110B1b

IRF-PAI Version 3.0
N/A – new item

IRF-PAI Version 4.0 (Note: Modifications to
Rationale for
existing items highlighted in yellow)
Change / Comments
Cancer Treatments
Included to align with the MDS,
and public comment and
A1. Chemotherapy
subject matter experts support
A2. IV
breaking the parent item
A3. Oral
“chemotherapy” into type of
A10. Other
chemotherapy to distinguish
patient complexity/burden of
B1. Radiation
care.

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Change Table for Proposed IRF QRP New and Modified Items – Effective Date: October 1, 2020 (continued)
Admission/
#
Discharge
38. Admission,
Discharge;
note: “a” is
used for item
numbering
for
admission
while “b” is
used for item
numbering
for discharge

Item / Text
Affected
O0110C1a
O0110C2a
O0110C3a
O0110C4a
O0110D1a
O0110D2a
O0110D3a
O0110E1a
O0110F1a
O0110G1a
O0110G2a
O0110G3a
O0110C1b
O0110C2b
O0110C3b
O0110C4b
O0110D1b
O0110D2b
O0110D3b
O0110E1b
O0110F1b
O0110G1b
O0110G2b
O0110G3b

IRF-PAI Version 3.0
N/A – new item

IRF-PAI Version 4.0 (Note: Modifications to
Rationale for
existing items highlighted in yellow)
Change / Comments
Respiratory Therapies
Included to align with the MDS,
and public comment and
C1. Oxygen Therapy
subject matter experts
C2. Continuous
support: breaking the parent
C3. Intermittent
item “oxygen therapy” into
C4. High-concentration
continuous vs. intermittent to
distinguish patient
D1. Suctioning
complexity/burden of care;
D2. Scheduled
breaking the parent item
D3. As needed
“suctioning” into frequency of
suctioning to distinguish
E1. Tracheostomy Care
patient complexity/burden of
care. In public comment, there
F1. Invasive Mechanical Ventilator
was support for breaking the
(ventilator or respirator)
parent item into 2 response
options (BiPAP and CPAP).
G1. Non-invasive Mechanical Ventilator
G2. BiPAP
G3. CPAP

Page 23 of 24

Change Table for Proposed IRF QRP New and Modified Items – Effective Date: October 1, 2020 (continued)
Admission/
#
Discharge
39. Admission,
Discharge;
note: “a” is
used for item
numbering
for
admission
while “b” is
used for item
numbering
for discharge

Item / Text
Affected
O0110AH1a
O0110AH2a
O0110H3a
O0110H4a
O0110H10a
O0110I1a
O0110J1a
O0110J2a
O0110J3a
O0110O1a
O0110O2a
O0110O3a
O0110O4a
O0110Z1a
O0110H1b
O0110H2b
O0110H3b
O0110H4b
O0110H10b
O0110I1b
O0110J1b
O0110J2b
O0110J3b
O0110O1b
O0110O2b
O0110O3b
O0110O4b
O0110Z1b

IRF-PAI Version 3.0
N/A – new item

IRF-PAI Version 4.0 (Note: Modifications to
Rationale for
existing items highlighted in yellow)
Change / Comments
Other
In public comment, there was
support for: further delineating
H1. IV Medications
types of IV medications (and
H2. Vasoactive medications
the new vasoactive medication
H3. Antibiotics
item, O0110H2, is included in
H4. Anticoagulation
the LTCH ventilator liberation
H10. Other
quality measures); breaking
out the dialysis parent item
I1. Transfusions
into type of dialysis; breaking
out the IV access parent item
J1. Dialysis
(which appears on the MDS)
J2. Hemodialysis
into types of IV access.
J3. Peritoneal dialysis
O1. IV Access
O2. Peripheral IV
O3. Midline
O4. Central line (e.g., PICC,
tunneled, port)
None of the Above
Z1. None of the above

Page 24 of 24