Final rule on inpatient rehabilitation facilities reflects APA's comments

The rule requires the provision of psychological services as needed and does not limit these services to neuropsychologists only

by Legal and Regulatory Affairs Staff

August 27, 2009 — The Centers for Medicare and Medicaid Services (CMS) released on July 31 a final rule on inpatient rehabilitation facilities (IRFs) that reflects the American Psychological Association (APA) Practice Directorate's comments on the rule as proposed by CMS.

Specifically, as APA urged a month earlier in a letter to CMS, the final rule requires the provision of psychological services as needed and does not limit the delivery of these services to neuropsychologists only.

The newly revised rule governs payment rates and polices for Medicare's payment system for IRFs. In addition to updating rates, the rule clarifies the requirements for inpatient admissions and post-admission procedures.

The regulations in effect before the recent revision provided that in order for a facility to qualify as an IRF for Medicare payment purposes, it must, among other things, furnish certain services like physical and occupational therapy plus, as needed, social services or psychological services.

This wording in effect equated social services with psychological services and allowed inpatient rehabilitation facilities to provide social services in lieu of psychological services.

The new final rule requires IRFs to provide both psychological services and social services as needed.

Further, the proposed rule would have specified services provided by neuropsychologists, instead of psychologists. In doing so, the language may have precluded the services of rehabilitation psychologists, health psychologists and other psychologists who, along with neuropsychologists, regularly work in rehab facilities.

Instead, the final rule speaks broadly to the delivery of psychological services and requires IRFs to:

"Ensure that the patients receive close medical supervision and furnish, through the use of qualified personnel, rehabilitation nursing, physical therapy, and occupational therapy, plus, as needed, speech-language pathology, social services, psychological services (including neuropsychological services), and orthotic and prosthetic services."

This provision takes effect on January 1, 2010. The complete rule is available at the GPO website.

The APA Practice Directorate consulted with representatives of APA Division 22 (Rehabilitation) and 40 (Clinical Neuropsychology) in developing its June 29 comment letter to CMS about the proposed rule (PDF, 172 KB).