Federal Register #CMS1845P

Proposed Updates to Medicare IRF Payment System and Quality Reporting for FY 2027

This opportunity concerns proposed updates to the Medicare Inpatient Rehabilitation Facility (IRF) payment system and quality reporting for Federal Fiscal Year 2027: - Government Buyer: - Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS) - OEMs and Vendors: - No specific OEMs or vendors are named; the notice is focused on policy and payment system updates, not direct procurement of goods or services - Products/Services Requested: - Updates to the IRF Prospective Payment System (PPS), including: - 2.4% market basket update with a 0.8% productivity adjustment - Revised case-mix group (CMG) relative weights - Updated wage index and outlier thresholds - Phaseout of rural wage adjustment - Policy changes for IRFs: - Therapy treatments must begin within 36 hours of admission - Documentation of current functional status in preadmission screening - Initial interdisciplinary team meeting required by day 4 of admission - IRF Quality Reporting Program (QRP) updates: - Revised data submission deadlines starting FY 2029 (by the 15th day of the second month after each calendar quarter) - Solicitation of public comments on alternative wage index data sources, therapy timing, and functional status documentation - Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program changes: - Increase in bid surety bond for Remote Item Delivery (RID) from $50,000 to $100,000 - Unique or Notable Requirements: - Focus on policy and payment methodology changes rather than procurement of specific products - Emphasis on timely therapy initiation, functional status documentation, and team coordination in IRFs - Higher bid surety bond requirement for DMEPOS RID to ensure bidder commitment and program integrity - Places of Performance and Delivery: - Centers for Medicare & Medicaid Services offices in Baltimore, MD - Fort Stewart, Hinesville, GA (federal facility) - Spencer County, IN; Harrison County, IN; North Dakota (additional locations referenced) - No specific product part numbers or purchase quantities are listed

Description

This proposed rule updates the prospective payment rates for inpatient rehabilitation facilities (IRFs) for fiscal year 2027, including classification and weighting factors, methodologies, and data used in computing the rates. It continues the phaseout of the rural adjustment and proposes requirements such as therapy treatments beginning within 36 hours of admission, documentation of functional status on preadmission screening, and timing of the initial interdisciplinary team meeting. The rule also updates the IRF Quality Reporting Program and includes changes to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program. Public comments are solicited on wage index data sources and potential future payment reforms.

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