Inpatient Rehabilitation PPS

August 27, 2024

At A Glance

The Centers for Medicare & Medicaid Services (CMS) July 31 issued its fiscal year (FY) 2025 final rule for the inpatient rehabilitation facility (IRF) prospective payment system (PPS). This rule updates IRF payments and modifies the IRF Quality Reporting Program (QRP) measures and reporting requirements.

Key Highlights

The final rule:

Updates payment rates by a net 3.0%, relative to FY 2024. This includes a market basket update of 3.5%, less a productivity cut of 0.5%.
Increases the high-cost outlier threshold, which will result in an additional 0.2% decrease in overall payments.
Updates the wage index using the most recent Office of Management and Budget (OMB) statistical area delineations based on the 2020 Decennial Census.
Adopts and modifies patient assessment items addressing social determinants of health (SDOH).