Rural residents who are Medicare beneficiaries and need inpatient rehabilitation services may be able to receive services in their own community hospitals thanks to new instructions issued recently by the Centers for Medicare & Medicaid Services (CMS). The new CMS instructions, part of the Medicare Prescription Drug Improvement and Modernization Act of 2003, will allow critical access hospitals to set aside units of up to 10 beds each to be used exclusively for inpatient rehabilitation and psychiatric services.
The rehab and psychiatric units would be paid as if they were distinct parts of acute care hospitals and will have to meet the same standards as units in acute care hospitals. Medicare will reimburse for inpatient rehabilitation services in a critical care hospital-based rehab unit based on the 75% rule. Psychiatric services will be paid on a reasonable cost basis until a new prospective payment system for inpatient psychiatric services is introduced.
"We believe critical access hospitals have an important role to play in making it possible for patients to receive inpatient rehabilitation and psychiatric services in their communities," said Mark B. McClellan, MD, PhD, CMS administrator, in a statement released by CMS. "[This change] is especially important for elderly beneficiaries in rural areas, whose support network of family and friends might otherwise find it difficult to visit," he noted.
Critical access hospitals are limited-service hospitals located in rural areas that receive cost-based reimbursement. To be certified by Medicare as a critical access hospital, a facility must, among other requirements, be located in a county or equivalent unit of a local government in a rural area; be located more than a 35-mile drive from a hospital or another health care facility; or be certified by the state as being a necessary provider of health care services to residents in the area.