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irf pai

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The Centers for Medicare and Medicaid Services (CMS) has published the draft inpatient rehabilitation facility patient assessment instrument (IRF-PAI) version 4.4. This version of the IRF-PAI becomes effective on October 1, 2026.

This draft version has the following modifications from the current IRF-PAI Version 4.2:

  • IRF-PAI Item 8. Gender – has been moved to IRF-PAI Item A0810. Sex.
  • IRF-PAI Item 14. Admission Class – has been removed.
  • Transportation Item A1250 – has been modified into Transportation Item A1255 with new item verbiage and response options and is only to be collected at admission. Transportation item A1250 has been removed from the discharge assessment.
  • Item O0350. Patient’s COVID-19 vaccination is up to date – has been removed from the discharge assessment.

As finalized in the fiscal year (FY) 2026 Final Rule, draft version 4.4 also removes the Section R Social Needs items. The four items removed were social determinants of health (SDoH) data elements related to living situation, food, and utilities, which were previously scheduled to be implemented October 1, 2026.

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The Centers for Medicare and Medicaid Services (CMS) published and released a summary report from a recent inpatient rehabilitation facility (IRF) listening session that focused on revising the transmission schedule for the inpatient rehabilitation facility Patient Assessment Instrument (IRF-PAI).

The summary highlights the discussion about potential changes to the IRF-PAI transmission schedule for unplanned discharges as well as changes in payer source, providing the rationale for this discussion, and questions posed during the listening session. The listening session also discussed opportunities to improve the assessment and data collection for pediatric patients.

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In order to avoid a potential 2 percent decrease in the annual payment update for fiscal year (FY) 2025 (October 2024 – September 2025), inpatient rehabilitation facilities (IRF) are reminded that they must submit complete data in calendar year (CY) 2023 for all quality measures that are a part of the IRF Quality Reporting Program (QRP).

IRF Patient Assessment Instrument (IRF-PAI) assessment data and data submitted via the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) for July 1 – September 30 (Q3) of calendar year 2023 must be submitted no later than 11:59 pm on February 15, 2024.

The Centers for Medicare and Medicaid Services (CMS) contractor Swingtech sends informational messages to IRFs that are not meeting Annual Increase Factor (AIF) thresholds on a quarterly basis ahead of each submission deadline. These messages were sent late last week. IRFs are encouraged to check to see if any members of their QRP team received a message from the email address “[email protected].” If members need to add or change the email addresses to which these messages are sent, please email QRP Help and be sure to include your facility name and CCN along with any requested email updates. Any IRFs who receive a Swingtech email message are encouraged to identify and review the measures stated as missing data for Q3 2023 ASAP, and resolve any data issues by the February 15 deadline.

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RCPA has been in communication with the American Medical Rehabilitation Providers Association (AMRPA), who has been working with the Centers for Medicare and Medicaid Services (CMS) to ensure inpatient rehabilitation facilities (IRFs) do not face inappropriate non-compliance penalties related to the IRF Patient Assessment Instrument (PAI) version 4.0 that is set to go into effect tomorrow (October 1, 2022). One particular concern is new items in version 4.0 do not include a “skip logic” to account for unplanned discharges that classify as incomplete stays. This oversight could lead to many IRFs not meeting the 95 percent data completion threshold for the Inpatient Rehabilitation Facility Quality Reporting Program (IRF QRP).

Yesterday, CMS released a statement on the issue along with a Question & Answer (Q&A) document. CMS also noted that the agency will determine if a permanent fix is necessary and will release any related guidance or data specifications in the coming weeks.

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The Centers for Medicare and Medicaid Services (CMS) has issued a quarterly (consolidated from June 2020 to September 2022) inpatient rehabilitation facility patient assessment instrument (IRF-PAI) Question and Answer (Q&A) document in light of the release of the IRF-PAI 4.0. This document focuses on questions submitted to the IRF Quality Reporting Program (QRP) Help Desk related to the IRF-PAI version 4.0 and consolidates guidance from prior releases.

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The Centers for Medicare and Medicaid Services (CMS) recently issued updates associated with the inpatient rehabilitation facility (IRF) provider preview reports and the IRF Patient Assessment Instrument (PAI).

CMS has released the updated IRF Provider Preview Reports, which contain provider performance scores for quality measures and contain IRF-PAI data submitted by IRFs from Quarter 1 (Q1) 2021 through Quarter 4 (Q4) 2021, as well as CDC Clostridium Difficile (CDI) and Catheter-Associated Urinary Tract Infections (CAUTI) measures from Quarter 4 (Q4) 2020 through Quarter 3 (Q3) 2021, and Q4 2018 through Q1 2019 of the Healthcare Personnel (HCP) Influenza measure. The new HCP COVID-19 Vaccination Coverage measure will also be publicly reported on Care Compare in the September 2022 release and will reflect Q4 2021 data. Unlike prior September Care Compare refreshes, CMS will not be preforming the annual update to IRF claims-based measures, due to CMS only resuming the reporting of claims-based measures during the June 2022 refresh.

Providers have until July 15, 2022, to review their performance data. Providers can request CMS review their data during the preview period if they believe the scores are inaccurate. The final reports will be published on Care Compare and Provider Data Catalog during the September 2022 refresh of the website. Additional information is on the CMS IRF Quality Reporting Program (QRP) public reporting website.

CMS also published the IRF-PAI Quarterly Questions & Answers (Q&A) document that provides clarification to existing guidelines.

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The Centers for Medicare and Medicaid Services (CMS) identified an error in the patient counts for each inpatient rehabilitation facility patient assessment instrument (IRF-PAI) measure in the March 2022 provider preview reports (which were originally issued on April 13, 2022) related to the June 2022 refresh of IRF quality data on CMS Care Compare. CMS has updated the report to apply the COVID-19 reporting exceptions to only exclude stays that occurred in Quarter 1 (Q1) and Quarter 2 (Q2) of 2020. The March 2022 provider preview reports are currently available for review until May 27, 2022. Questions about the reports should be sent by email.

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The Centers for Medicare and Medicaid Services (CMS) has announced a virtual training program for both inpatient rehabilitation facilities (IRFs) and Long-Term Care Hospitals (LTCHs). The virtual IRF training program will review the updated guidance for the Inpatient Rehabilitation Facility – Patient Assessment Instrument (IRF-PAI) 4.0 and the LTCH Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS) 5.0 for providers in the IRF and LTCH settings. This training is part of a comprehensive strategy to ensure IRF and LTCH providers have access to the education necessary to understand and comply with changes in reporting requirements associated with the IRF and LTCH Quality Reporting Programs (QRPs) that go into effect on October 1, 2022. A major focus of this training will be on the cross-setting implementation of the standardized patient assessment data elements being introduced in 2022 to ensure more consistent reporting and evaluation across post-acute care settings.

The training program consists of two parts:

  • Part 1: Beginning May 9, 2022: Access will be provided to recorded training session videos that deliver foundational knowledge necessary to understanding the new items and guidance. These videos are intended to be reviewed in advance of the live event.
  • Part 2: June 15–16, 2022: Live, virtual workshop sessions will provide coding practice on the items covered in the Part 1 videos. These live sessions will take place each day from 1:00 pm – 5:00 pm.

To participate in the training program, registration is required. If you have questions about accessing resources or feedback regarding the trainings, please email the PAC Training Mailbox. Content-related questions should be submitted to the LTCH QRP Help Desk and IRF QRP Help Desk

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