9 AUGUST - 20233-hour rule). Additional requirements by CMS to be classified as an IRF/U includes that 60% (known as the 60% rule) of all patients admitted must have a diagnosis or co-morbidity that falls within 13 diagnostic categories. In contrast, skilled nursing facilities do not have a requirement for the intensity of therapy or requirements to have certain diagnoses for admission. During the PHE, IRF/U's were granted waivers that allowed flexibility for patient admissions. Many managed care providers removed the prior authorization process for admission to IRF/U's. This process has typically delayed admissions to IRF/U's from acute care hospitals. The elimination of this process allowed acute care hospitals to admit patients to IRF/U's without delays. This assisted the acute care hospitals in managing patient surges brought on by the PHE. There were three Federal waivers that assisted IRF/U's in facilitating admissions. These included the relaxation of the 60% rule, the allowance of acute care and rehab patients to be commingled in IRF/U's, and the relaxation of the 3-hour rule. The first two waivers allowed acute care hospitals to move acute care patients to the IRF/U's and accept patients that did not fall within the 60% rule. The relaxation of the 3-hour rule allowed therapists to base the amount of therapy a patient receives in an IRF/U on patient need and not on a required amount of time.The waivers granted for IRF/U's created the need for these facilities to adapt their admission practices and assess their ability to care for medically acute care patients. Those facilities that were able to make these adjustments had an increase in admissions and were seen as a value-add service in providing capacity for acute care hospitals during patient surges. While many IRF/U's admitted patients who were still deemed as having an acute care need the percent of admitted patients to IRF/U's who were discharged to the community did not decrease. This suggests that IRF/U's are capable of caring for patients earlier in their recovery process with a positive outcome of a discharge back to the community. As we learn from the PHE, we should reassess the placement of patients within the post-acute care continuum. IRF/U's have demonstrated their ability to care for patients with increasingly complex medical needs and have demonstrated their value in the post-acute care continuum. Many factors have contributed to this shift in referral patterns including the fear among patients to discharge to a skilled nursing facility
< Page 8 | Page 10 >