Cover: Case Mix Certification Rule for Inpatient Rehabilitation Facilities

Case Mix Certification Rule for Inpatient Rehabilitation Facilities

Published 2003

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.

This report is part of the RAND draft series. The unrestricted draft was a product of RAND from 1993 to 2003 that represented preliminary or prepublication versions of other more formal RAND products for distribution to appropriate external audiences. The draft could be considered similar to an academic discussion paper. Although unrestricted drafts had been approved for circulation, they were not usually formally edited or peer reviewed.

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