AMRPA Access


What You Should Know About the 60% Rule Waiver‎

By AMRPA Headquarters posted 01-13-2021 09:22


What You Should Know About the 60% Rule Waiver‎

Lz4RDeKxSNqb5557vIcQ_temp-T.jpgBy Lisa Werner 

At the beginning of the COVID-19 public health emergency, the Centers for Medicare and Medicaid Services (CMS) enacted waivers that would enable smooth patient care transitions and alleviate capacity in acute care. One of these waivers was the 60% rule waiver for inpatient rehabilitation facilities (IRF). IRFs are allowed to admit patients and exclude them from their 60% rule calculation. The excerpt below is from the CMS website in the IRF Flexibilities Document updated on July 9, 2020.

        • Flexibility for Inpatient Rehabilitation Facilities Regarding the “60 Percent Rule”: CMS is waiving requirements to allow IRFs to exclude patients from the IRF freestanding 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. In addition, during the applicable waiver time period, we would also apply the exception to facilities not yet classified as IRFs, but that are attempting to obtain classification as an IRF.

If you are one of the providers who have taken advantage of the waiver, know that the request for data submission for 60% rule verification has not changed.  When your Medicare Administrative Contractor (MAC) reaches out to you, the request for data will look the same as other years. Thus, you will be asked to submit a list of all the patients that you treated during your compliance review period, which is a 12-month period that begins four months prior to the start of your cost report year. On the patient’s IRF-PAI, there is no place to document that a patient was admitted due to the public health emergency and is a waiver admission, so the presumptive review of your records will not exclude those patients from your calculation. If the admission of waiver patients brings your presumptive compliance percentage below 60%, you should expect to move on to another stage of review. At this point, medical charts will be requested. Your notation of Disaster Relief (DR) should be noted in the record, thus excluding your waiver patients from review. The MAC will then recalculate your percentage based on the remaining cases submitted. Subscribers of eRehabDataÒ have the ability to calculate their 60% rule compliance with or without waiver patients to ensure that they have an accurate picture of their compliance at any given time.

Be sure to follow your 60% compliance verification closely. Ensure that all waiver patients have a Disaster Relief notation in their record. Be a strong partner in your area by ensuring admission to those in need of inpatient rehabilitation services by taking advantage of the 60% waiver when necessary.