CMS halts 75% Rule at 60% level, disappointing nursing homes

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CMS halts 75% Rule at 60% level, disappointing nursing homes
CMS halts 75% Rule at 60% level, disappointing nursing homes
The Centers for Medicare & Medicaid Services released a regulation Friday that reduces the 75% Rule pertaining to inpatient rehabilitation facilities (IRFs) to 60%.

Under the rule, which was published in the Federal Register, at least 60% of an IRF's patient population must have one of 13 qualifying conditions to receive higher Medicare payments. Nursing homes, which compete with IRFs for patients, have been lobbying for the rule to reach the 75% level. CMS projects that Medicare payments to IRFs under this final rule will be approximately $5.6 billion in fiscal year 2009, a decrease of $40 million from fiscal year 2008.

Meanwhile, CMS at its Open Door Forum late last week provided updates regarding other initiatives: Participation space is still available for the Post Acute Care (PAC) Payment Reform Demonstration, which involves post-acute healthcare facilities, such as long-term care, the agency said. Also, CMS is in the process of finalizing MDS 3.0, the system that helps generates billing related to Medicaid and Medicare costs. It also said a crosswalk from MDS 2.0 to MDS 3.0 will be published soon.

Facilities wishing to participate in the demonstration should go to https://register.rti.org/pacdemo/contact.cfm.
A final RAND report on MDS 3.0 is available at http://www.cms.hhs.gov/NursingHomeQualityInits/Downloads/MDS30FinalReport.pdf.