AHA Comment Letter on CMS' Proposed Inpatient Rehab Facility PPS for FY 2024

The Honorable Chiquita Brooks-LaSure
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS–1781–P
P.O. Box 8016
Baltimore, MD 21244–8016

Re: Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2024 and Updates to the IRF Quality Reporting Program; 88 Fed. Reg. 20,950 (April 7, 2023).

Dear Administrator Brooks-LaSure:

On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, including approximately 900 inpatient rehabilitation facilities (IRF), and our clinician partners — more than 270,000 affiliated physicians, two million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the American Hospital Association (AHA) appreciates the opportunity to address the fiscal year (FY) 2024 IRF prospective payment system (PPS) proposed rule.

As CMS is aware, IRFs played a critical role during the COVID-19 public health emergency (PHE) by providing additional hospital capacity to communities struggling to meet demand, as well as by rehabilitating COVID-19 patients who are encountering serious deficits. In meeting this challenge, IRFs have utilized their unique capabilities as hospital-level providers who also specialize in caring for patients with challenging post-acute care needs, such as stroke, spinal cord and brain injury, amputation, cancer, and other complex conditions and comorbidities.

That said, we wish to impress upon CMS that the COVID-19 PHE’s end does not mean that hospitals’ operations are returning to “pre-COVID-19” status. IRFs, along with their counterparts throughout the entire continuum of care, continue to face a myriad of challenges in meeting the needs of their patients. For this reason, AHA appreciates that CMS has not proposed any major changes to the payment or coverage dynamics of IRF PPS. This predictability will allow IRFs to continue to adapt to the “new normal,” and therefore maximize their ability to provide the best care possible to their communities. Still, AHA does have concerns that CMS’ historical approach to annual payment updates may not be well-suited to capture the extraordinary challenges facing hospitals due to the effects of inflation and labor shortages. As such, we urge the agency to consider deviating from its usual update to properly calibrate the IRF PPS with present-day costs and operations.

In addition, the AHA has concerns about certain proposals related to the IRF Quality Reporting Program (IRF QRP). While we appreciate CMS’ goals to continue monitoring incidence of COVID-19 in post-acute care settings, we are unsure whether the two measures proposed in this rule will be operational for IRFs as currently specified. In addition, the proposed Discharge Function Score measure lacks clarity, especially as a purported “cross-setting” measure. We urge CMS to consider our recommendations on updates to the IRF QRP to ensure that it is focused on high-priority areas and measures that are based upon reliable clinical evidence.

View the detailed letter below.