CMS to begin implementing criteria for 75% Rule

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There's some good news for providers: The Centers for Medicare & Medicaid Services said it plans to begin implementing the classification criteria used to determine eligibility standards under Medicare's inpatient rehabilitation payment rule, also known as the 75% Rule.

The June 21 notice lifts the January suspension of enforcement of criteria of the rule. It follows the Government Accountability Office's report that did not recommend CMS delay implementation of the revised criteria. The report also found that Medicare could save more money treating therapy patients at skilled nursing facilities rather than inpatient rehabilitation facilities (IRFs).

Skilled nursing providers praise the rule because it sends more patients their way. They also say it could save taxpayers as much as $370 million a year. Only 6% of IRFs in fiscal year 2003 met the 75% threshold, according to the GAO.

The rule, which was adopted in May 2004, expands the number of qualifying medical conditions for IRFs from 10 to 13. Conditions include: stroke, spinal cord injury, major multiple traumas and three kinds of arthritis. It also provides a four-year transition period during which the required percentage of patients with a qualifying condition increases gradually from 50% to 75%.

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