Inpatient Rehabilitation Facility (IRF)

Key facts

Medicare criteria

42 CFR 412.29 (facility) and 412.622 (patient coverage)

Medicare payment

IRF Prospective Payment System, since January 2002

Patient mix rule

At least 60 percent of patients with one of 13 listed conditions

Patient assessment

IRF Patient Assessment Instrument (IRF-PAI)

Payment groups

Case-mix groups (CMGs)

What is an inpatient rehabilitation facility?

IRFs treat patients who need, and can tolerate, an intensive rehabilitation program under close physician supervision. Compared with a skilled nursing facility, an IRF provides more therapy per day, more frequent physician involvement and hospital-level nursing.

An IRF can be a freestanding rehabilitation hospital or a distinct-part unit inside an acute care hospital. Both are excluded from the Inpatient Prospective Payment System and paid under their own Medicare system, with rates based on case-mix groups built from functional status, age and comorbidities.

Who qualifies for IRF care

Medicare sets requirements at both the facility level and the patient level:

• Facility: at least 60 percent of patients must have one or more of 13 listed conditions, including stroke, spinal cord injury, brain injury, amputation, major multiple trauma, hip fracture, burns and certain neurological, arthritis and joint replacement conditions.
• Therapy need: the patient must require active and ongoing therapy in more than one discipline, one of which is physical or occupational therapy.
• Intensity: the patient must be expected to participate in and benefit from an intensive program, generally at least three hours of therapy a day at least five days a week, or at least 15 hours over seven consecutive days.
• Supervision: a rehabilitation physician must conduct face-to-face visits at least three days a week.

Why IRF data matters

IRFs compete with skilled nursing facilities for post-acute patients:

• Stroke, orthopedic and neurology programs choose between IRF and SNF discharge, so mapping IRF capacity shows where the higher-intensity option exists.
• IRF admissions draw frequent Medicare medical review, so documentation of therapy need and intensity is a compliance priority.
• Therapy equipment suppliers and makers of drugs for spasticity and post-stroke care use IRF locations for targeting.
• Because many IRFs are units inside acute care hospitals, capacity counts should separate freestanding hospitals from units to avoid double counting beds.