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Medicare: More Specific Criteria Needed to Classify Inpatient Rehabilitation Facilities

GAO-05-825T Published: Jun 16, 2005. Publicly Released: Jun 16, 2005.
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Highlights

Medicare classifies inpatient rehabilitation facilities (IRF) using the "75 percent rule." If a facility can show that during a 12-month period at least 75 percent of its patients required intensive rehabilitation for 1 of 13 listed conditions, it may be classified as an IRF and paid at a higher rate than for less intensive rehabilitation in other settings. Because this difference can be substantial, it is important to classify IRFs correctly. GAO was asked to discuss issues relating to the classification of IRFs, and in April 2005 it issued a report, Medicare: More Specific Criteria Needed to Classify Inpatient Rehabilitation Facilities (GAO-05-366). For that report, GAO analyzed data on all Medicare patients (the majority of patients in IRFs) admitted to IRFs in fiscal year 2003, spoke to IRF medical directors, and had the Institute of Medicine (IOM) convene a meeting of experts to evaluate the use of a list of conditions in the 75 percent rule. This testimony is based on the April 2005 report.

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Data collectionEligibility criteriaEligibility determinationsHealth care facilitiesHealth statisticsMedical services ratesMedicarePolicy evaluationEvaluation criteriaInpatient care services