Case Mix Certification Rule for Inpatient Rehabilitation Facilities

by Grace M. Carter, Orla Hayden, Susan M. Paddock, Barbara O. Wynn

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To be classified as an inpatient rehabilitation facility (IRF), a hospital or unit must show that during its most recent 12-month cost reporting period, it served an inpatient population of whom at least 75 percent required intensive rehabilitation services for one of ten specified conditions. For the sake of brevity we denote this rule as the “75% rule.” The purpose of this 75% rule is to ensure that IRFs are primarily involved in providing intensive rehabilitation services. In early 2002, Medicare and Medicaid Services (CMS) instituted a comprehensive review of this policy with the intent of understanding whether potential policy or administrative changes are needed. This report provides a description of case mix at IRFs as input to that review.

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