Inpatient rehabilitation services: regulatory changes.

Inpatient rehabilitation facilities (IRFs) operate in a changing environment. First was the transition from the reimbursement system of the 1980s and 1990s to our current Prospective Payment System. Along with that came the challenges of educating and re-educating staff and patients about achieving optimal outcomes within prescribed periods of time. Now the paradigm is shifting once again. This time the shift is more clinical rather than fiscal. Although the following discussion specifically applies to patients with Medicare coverage, the new guidelines set the standard within the industry for all patients. In 2009, the Centers for Medicare and Medicaid Services (CMS) rescinded HCFA Ruling 85-2, “Medicare Criteria for Coverage of Inpatient Hospital Rehabilitation Services,” 50 FR 31040 (July 31, 1985) as corrected at 50 FR 32643 (August 13, 1985). Some regulations remain unchanged. Patients can be considered acute rehabilitation candidates if they can be expected to make significant functional gains in a reasonable time. REFERENCES 1. http://www.cdc.gov/injury/wisqars/. 2. Finkelstein EA, Corso PS, Miller TR. The Incidence and Economic Burden of Injuries in the United States.?USA: Oxford University Press; 2006. 3. Hansen TS, Engberg AW, Larsen K. Functional oral intake and time to reach unrestricted dieting for patients with traumatic brain injury. Arch Phys Med Rehabil 2008;89:1556-62. 4. Shalev AY, Freedman S, et al. Prospective study of posttraumatic stress disorder and depression following trauma. Am J Psychiatry 1998;155:630-7. 5. Gregg SC, Harrington DT, Adams CA Jr. The evolution of the Rhode Island trauma system: where do we stand? Med Health RI 2009 May;92:172-4.