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COVID-19: Vulnerable Populations
Q & A: Federal waivers for inpatient rehabilitation facilities

What federal waivers are available for inpatient rehabilitation facilities (IRFs)?

Federal legislative and regulatory action has included several important provisions affecting inpatient rehabilitation facilities. As the crisis continues and additional areas emerge, additional waivers may be forthcoming. 

CARES Act: On March 26, President Trump signed the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which includes measures of particular importance to the hospitals, including IRFs.  

  • Three-Hour Rule: The CARES Act waives requirement that IRF patients generally receive at least three hours of therapy a day.
  • CMS Blanket Waivers: On March 13, President Trump declared a national emergency, which allows flexibility in requirements for health care providers. The Centers for Medicare & Medicaid Services (CMS) announced several 1135 Medicare blanket waivers. Hospitals do not need to request an individual waiver to be relieved from compliance with these laws to the extent described in this list.
  • Housing Acute Care Patients in Excluded Distinct-Part Units: CMS is waiving requirements to allow acute care hospitals to house acute care inpatients in excluded distinct-part units, where the distinct part unit’s beds are appropriate for acute care inpatient. The Inpatient Prospective Payment System (IPPS) hospital should bill for the care and annotate the patient’s medical record to indicate the patient is an acute care inpatient being housed in the excluded unit because of capacity issues related to the disaster or emergency.
  • Care for Excluded Inpatient Rehabilitation Unit Patients in the Acute Care Unit of a Hospital:                                                                                           CMS is waiving requirements to allow acute care hospitals with excluded distinct-part inpatient rehabilitation units that, as a result of a disaster or emergency, need to relocate inpatients from the excluded distinct-part rehabilitation unit to an acute care bed and unit. 
  • 60% Rule Flexibility: CMS is waiving requirements to allow IRFs to exclude patients from the hospital’s or unit’s inpatient population for purposes of calculating the applicable thresholds associated with the requirements to receive payment as an IRF (commonly referred to as the “60 percent rule”) if an IRF admits a patient solely to respond to the emergency and the patient’s medical record properly identifies the patient as such.

Additional information is available here.     

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