Inpatient Rehabilitation PPS

In a broad sense, rehabilitation services are measures taken to promote optimum attainable levels of physical, cognitive, emotional, psychological, social, and economic usefulness, and thereafter to maintain the individual at the maximal functional level.

The term is used to denote services provided in inpatient and outpatient settings, ranging from comprehensive coordinated medically based programs in specialized hospital settings to therapies offered in units of hospitals, nursing facilities, or ambulatory centers. Resources found on this site mainly focus on Medicare payment and related implementation issues.

Medicare’s Inpatient Rehabilitation Facility Prospective Payment System

On August 7, 2001, the Centers for Medicare & Medicaid Services (CMS) published a prospective payment system (PPS) for Medicare Inpatient Rehabilitation Facilities (IRF) as required by the Balanced Budget Act of 1997 (BBA). The payment system that became effective on January 1, 2002, significantly changed how inpatient medical rehabilitation hospitals and units are paid under Medicare. The payment system uses a streamlined patient assessment instrument (the IRF PAI), which incorporates functional independence and case mix measures. This site provides information and resources relative to the implementation, review, and operation of primarily hospital-based medical rehabilitation services.

Related Resources

Letter/Comment
Public
AHA's comments on the Centers for Medicare & Medicaid Services’ fiscal year (FY) 2022 proposed rule on the IRF prospective payment system (PPS).
Advisory
On April 7, the Centers for Medicare…
Special Bulletin
Public
The Centers for Medicare…
Letter/Comment
Public
AHA asks the CMS to withdraw its proposed IRF review choice demonstration.
Advancing Health Podcast
Public
Marie Cleary-Fishman, Vice President of Clinical Quality speaks with Amy Berman, Senior Program Officer at The John A. Hartford Foundation and Erin Emery-…
Advisory
Member
This advisory documents key findings from the inpatient rehabilitation facility prospective payment system for fiscal year 2021.