Medicare Program: Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2027 and Updates to the IRF Quality Reporting Program
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This proposed rule updates payment rates and case-mix groups for Inpatient Rehabilitation Facilities (IRFs) for FY 2027 (discharges from October 1, 2026 to September 30, 2027). It continues the third year of phasing out the rural adjustment that began in FY 2025. The rule proposes requiring all therapy treatments and evaluations to begin within 36 hours of midnight on the day of admission. It also requires documentation of a patient's current functional status in the preadmission screening and mandates that the initial Interdisciplinary Team meeting occur by the 4th day of admission. Additionally, it solicits comments on alternative wage index data sources, potential payment reform using elements of the SNF PDPM model, and updates to the IRF Quality Reporting Program data submission deadlines starting in FY 2029. Changes to the DMEPOS Competitive Bidding Program are also included.
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Key Changes
- Updates IRF prospective payment rates and CMG weighting factors for FY 2027 using FY 2025 claims and FY 2024 cost report data
- Continues third year of 3-year phaseout of the rural adjustment that began in FY 2025
- Proposes 36-hour rule: all therapy treatments/evaluations must begin within 36 hours from midnight on day of admission (§412.622(a)(3)(ii))
+ 3 more changes with Pro
Obligations
What this law requires
All therapy treatments and therapy evaluations must begin within 36 hours from midnight on the day of admission (revising 42 CFR 412.622(a)(3)(ii))
Document a patient's current functional status in the preadmission screening (revising 42 CFR 412.622(a)(4)(i)(B))
Conduct the initial Interdisciplinary Team meeting by the 4th day of admission (revising 42 CFR 412.622(a)(5))
Apply the continued third-year phaseout of the rural adjustment to payment calculations for discharges occurring on or after October 1, 2026 through September 30, 2027
Submit IRF Quality Reporting Program data by revised submission deadlines beginning with FY 2029