Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: March 05, 2012

This page provides basic information about being certified as a Medicare and/or Medicaid Inpatient Rehabilitation Facility (IRF) and includes links to applicable laws, regulations, and compliance information. 

IRFs are free standing rehabilitation hospitals and rehabilitation units in acute care hospitals. They provide an intensive rehabilitation program and patients who are admitted must be able to tolerate three hours of intense rehabilitation services per day. CMS collects patient assessment data only on Medicare Part A fee-for service patients. 

These facilities are exempt from the Medicare Hospital PPS and are paid under the IRF Prospective Payment System (PPS) effective 1/1/2002. In order to be paid under the IRF PPS, they must submit the IRF-PAI (patient assessment instrument). The IRF-PAI is the third patient assessment instrument currently utilized by CMS (the other two are the MDS in nursing homes and OASIS in home health agencies).

Inpatient Rehabilitation

Survey protocols and Interpretive Guidelines are established to provide guidance to personnel conducting surveys. They serve to clarify and/or explain the intent of the regulations and all surveyors are required to use them in assessing compliance with Federal requirements. The purpose of the protocols and guidelines is to direct the surveyor’s attention to certain avenues for investigation in preparation for the survey, in conducting the survey, and in evaluation of the survey findings.

The Inpatient Rehabilitation Facility (IRF) survey is conducted in accordance with the appropriate protocols and substantive requirements in the statute and regulations to determine whether a citation of non-compliance is appropriate. Deficiencies are based on a violation of the statute or regulations, which, in turn, is to be based on observations of the IRF’s performance or practices. 

The Interpretive Guidelines include three parts:

• The first part contains the survey tag number. 
• The second part contains the wording of the regulation. 
• The third part contains guidance to surveyors, including additional survey procedures and probes.

HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the guidance@hhs.gov.

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.