Inpatient Rehabilitation Assessment Instrument and Data Set for PPS for Inpatient Rehabilitation Facilities (CMS-10036)

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.

The latest form for Inpatient Rehabilitation Assessment Instrument and Data Set for PPS for Inpatient Rehabilitation Facilities (CMS-10036) expires 2022-12-31 and can be found here.