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) â 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) â 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 1,124 to 1,122. We estimate that changes to the IRF-PAI Version 4.0 will increase the amount of time required to complete the IRF-PAI by about 121 hours per year per IRF. Therefore, the overall burden hours increased from 97,418 to 704,747.
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.
CMS-10036 Supporting Statement A (August 1 2019)_.docx
Inpatient Rehabilitation Facility - Patient Assessment Instrument