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CMS to implement rehabilitation criteria

Credentialing Resource Center Connection, June 30, 2005

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On June 21, the Centers for Medicare & Medicaid Services (CMS) announced that it will begin to implement the revised classification criteria used to determine inpatient hospital rehabilitation payment it adopted in a May 7, 2004 ruling. In January 2005, the rule was suspended by CMS after Congress ordered a review by the Government Accountability Office.

The rule provides for a four-year transition period during which the required percentage of patients with a qualifying condition (the "compliance threshold") increases gradually from 50 percent to 75 percent. The rule also expands the number of qualifying medical conditions for inpatient hospital facilities from 10 to 13. They include stroke, spinal cord injury, congenital deformity, amputation, major multiple traumas, fracture of the femur, brain injury, three types of arthritis, neurological disorder, burns, and certain joint replacements.

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