On July 20, 2021, the Centers for Medicare and Medicaid Services (CMS) issued the fiscal year (FY) 2022 inpatient rehabilitation facility prospective payment system (IRF PPS) final rule. This final rule updates the Medicare payment policies and rates for IRFs, as well as the policies under the IRF Quality Reporting Program (QRP). CMS also finalizes a Medicare Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) payment provision adopted in an interim final rule with comment period (IFC) issued on May 11, 2018, as well as a provision that was included in a DMEPOS proposed rule published in the Federal Register on November 4, 2020. Other key provisions included in this final rule include:

Updates to IRF Payment Rates:

CMS updates the IRF PPS payment rates by 1.9 percent based on the IRF specific market basket estimate of 2.6 percent, less a 0.7 percentage point productivity adjustment. In addition, the final rule contains an adjustment to the outlier threshold to maintain outlier payments at 3 percent of total payments. This adjustment will result in a 0.4 percentage point decrease in outlier payments.

IRF QRP Final Rule Updates:

The IRF QRP is a pay-for-reporting program. IRFs that do not meet reporting requirements are subject to a two-percentage point reduction in their annual increase factor. CMS is adopting one measure and finalizing its proposal to update the specifications for another measure. In addition, CMS is finalizing its proposal to modify the number of quarters used for public reporting of IRF quality measures due to the public health emergency and sought comments for two Requests for Information (RFI).

Closing the Health Equity Gap – RFI:

CMS is working to make health care quality more transparent to consumers and providers, enabling them to make better choices as well as promoting provider accountability around health equity. CMS’s ongoing commitment to closing the health equity gap in IRFs has been demonstrated by the adoption of standardized patient assessment data elements, which include several social determinants of health (SDOH) that were finalized in the FY 2020 IRF PPS final rule for the IRF QRP (84 FR 39149 through 39161).

CMS sought feedback in this RFI on ways to attain health equity for all patients through policy solutions and has indicated that they would take all comments received into consideration as they continue to address and develop policies on this topic. The provision of stratified measure results will allow IRFs to understand how they are performing with respect to certain patient risk groups and to support these providers in their efforts to ensure equity.

COVID-19 Vaccination Coverage Among Healthcare Personnel (HCP) Measure:

In the ongoing efforts to address the COVID-19 public health emergency (PHE), CMS is finalizing the adoption of the COVID-19 Vaccination Coverage among HCP Measure. This measure is designed to help assess whether IRFs are taking steps to limit the spread of COVID-19 among their HCP, reduce the risk of transmission within their facilities, and help sustain the ability of IRFs to continue serving their communities through the PHE and beyond. Public reporting of the COVID-19 Vaccination Coverage among HCP measure will begin with the September 2022 Care Compare refresh or as soon as technically feasible based on data collected for Q4 2021 (October 1, 2021 through December 31, 2021).

Transfer of Health (TOH) Information to the Patient-Post Acute Care (PAC) Quality Measure:

CMS is finalizing updates to the denominator for the TOH Information to the PAC quality measure. Currently, the measure denominators for both the TOH Information to the Patient-PAC and to the Provider-PAC quality measures include patients discharged home under the care of an organized home health service organization or hospice. In order to avoid counting these patients in both TOH measures, CMS is removing this location from the definition of the denominator for the TOH Information to the Patient-PAC measure.

Public Reporting of Quality Measures with Fewer than Standard Numbers of Quarters Due to COVID-19 PHE Exemptions:

In March 2020, and in response to the COVID-19 PHE, CMS granted an exception to the IRF QRP requirements for calendar year Q1 2020 (January 1, 2020–March 31, 2020) and Q2 2020 (April 1, 2020–June 30, 2020). CMS also stated that any IRF QRP data that might be significantly impacted in terms of measure reportability and reliability by these exceptions would not be publicly reported for Q1 and Q2 of 2020 due to the absence of useable data these exceptions created. CMS is finalizing its proposal to update the number of quarters used for public reporting to account for this exception.

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Policy Issues:
Exclusion from Fee Schedule Adjustments for Accessories (Including Seating Systems) and Seat and Back Cushions Furnished in Connection with Group 3 or Higher Complex Rehabilitative Power Wheelchairs and Complex Rehabilitative Manual Wheelchairs

CMS is finalizing an exclusion from fee schedule adjustments based on information from the DMEPOS Competitive Bidding Program (CBP) for wheelchair accessories (including seating systems) and seat and back cushions furnished in connection with group 3 or higher complex rehabilitative power wheelchairs. CMS is also extending this fee schedule adjustment exclusion to wheelchair accessories (including seating systems) and seat and back cushions furnished in connection with complex rehabilitative manual wheelchairs. Additionally, CMS is modifying the regulatory definition of “item” under the DMEPOS CBP at 42 CFR 414.402 to exclude complex rehabilitative manual wheelchairs and certain other manual wheelchairs and related accessories when furnished in connection with these wheelchairs from the DMEPOS CBP, as required by section 106(a) of the 2020 Further Consolidated Appropriations Act.

All of the provisions contained in this final rule will be reviewed and discussed in greater detail at the upcoming RCPA Outpatient Rehabilitation Committee and Medical Rehabilitation Committee meetings.