What is the '60% rule' in the Inpatient Rehabilitation Facility (IRF) PPS?

• A. At least 60% of IRF patients must have specified conditions for the IRF PPS classification.
• B. IRF PPS classification is based on the length of stay alone.
• C. IRF must maintain a patient-to-staff ratio of 60%.
• D. At least 60% of IRF patients must have specified conditions for the IRF PPS classification.

Answer: (D)

In this context, the 60% rule means that for a facility to be paid under the IRF PPS, at least 60% of its admitted patients must have one of a defined set of qualifying diagnoses, such as stroke, spinal cord injury, brain injury, congenital deformity, amputation, major trauma, burns, or other similar conditions. This threshold ensures reimbursement aligns with the specialized, intensive rehab services IRFs are designed to provide. If the patient mix doesn’t meet the 60% requirement, those cases aren’t paid under the IRF PPS, and different Medicare payment arrangements apply. The rule isn’t about length of stay or staffing ratios.