CMS, COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing, (updated March 5, 2021) (available at https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps. Applying the 3.9 percent increase factor for FY 2023 to the standard payment conversion factor for FY 2022 of $17,240 yields a standard payment amount of $17,912. Several commenters questioned how CMS would align rules between stays covered by private insurers and stays covered by Medicare given that private insurers may not recognize interrupted stays. A hospital may earn back a value-based incentive payment percentage that is less than, equal to, or more than the applicable reduction for that program year. The Medicare Payment Advisory Commission (MedPAC) was supportive of the effort to ensure quality care for all patients, but sensitive to the issue of additional burden, while another commenter questioned whether the use of additional data would outweigh the burden of additional reporting. Calculate a mean for each of the coefficients across the 3 years of data (using logarithms for the LIP and teaching status adjustment coefficients (because they are continuous variables), but not for the rural adjustment coefficient (because the rural variable is either zero (if not rural) or 1 (if rural)). Specifically, section 1886(j)(3)(C)(i) states that the increase factor shall be based on an appropriate percentage increase in a market basket of goods and services comprising services for which payment is made. February 2012. The analysis above, together with the remainder of this preamble, provides an RIA. Second, to determine the appropriate amount of additional payment for the teaching status adjustment (if applicable), we multiply the teaching status adjustment (0.0784, in this example) by the wage-adjusted and rural-adjusted amount (if applicable). Medicaid determines Medicare Savings Programs participation by income and need. Response: We note that previously the productivity measure referenced in section 1886(b)(3)(B)(xi)(II) of the Act, was published by BLS as private nonfarm business multifactor productivity. We acknowledge that IRFs may continue to be impacted by the PHE and that collecting quality data on all patients regardless of payer may create additional burden for some IRFs. Once you receive your My Health Pays rewards card in the mail, please follow the instructions on the activation sticker. of this final rule. We will calculate the calculation of the IRF standard payment conversion factor for FY 2023, as discussed in section VI. Another commenter stated that the forecast error adjustment proposed in the FY 2023 SNF PPS proposed rule is indicative of the complexity in accurately accounting for the unprecedented challenges driving up costs. are not part of the published document itself. To determine the outlier threshold for FY 2023, we estimated the amount of FY 2023 IRF PPS aggregate and outlier payments using the most recent claims available (FY 2021) and the proposed FY 2023 standard payment conversion factor, labor-related share, and wage indexes, incorporating any applicable budget-neutrality adjustment factors. Start Printed Page 47072 Utilities; Transportation; Telecommunications; Childcare services A 60-day The commenters expressed concern that these increased costs are not reflected in the market basket update and requested that CMS discuss in the final rule how the agency will account for these increased costs. We will update the FY 2023 IRF PPS payment rates by the FY 2023 wage index and the labor-related share in a budget-neutral manner, as discussed in section VI. In addition, the IMPACT Act requires assessment data to be standardized and interoperable to allow for exchange of the data among post-acute providers and other providers. of this final rule. and 90 rural IRFs. on Pain is not a surprising symptom in PAC patients and residents, where healing, recovery, and rehabilitation often require regaining mobility and other functions after an acute event. Quality Measures Currently Adopted for the FY 2023 IRF QRP, C. IRF QRP Quality Measure Concepts for Future Years: Request for Information (RFI), D. Inclusion of the National Healthcare Safety Network (NHSN) Healthcare-Associated Clostridioides difficile Infection Outcome Measure in the IRF QRPRequest for Information, E. Overarching Principles for Measuring Equity and Healthcare Quality Disparities Across CMS Quality ProgramsRequest for Information, F. Proposals Relating to the Form, Manner, and Timing of Data Submission Under the IRF QRP, 2. My Health Pays Rewards Program. Specifically, in response to the call for public comment on quality measures to satisfy the IMPACT Act domain of Transfer of Health Information and Care Preferences When an Individual Transitions,[15] The beneficiaries that get QMB also get an automatic qualification for acceptance into the Part D Extra Help program. In addition, with respect to providing feedback to Congress, we note that MedPAC annually monitors various factors for Medicare providers in terms of profitability and beneficiary access to care and reports the findings to Congress on an annual basis. Based on individual or family usage of medical services and benefits. Effective date: Because the FPL changes each year, applicants for the QMB will have a different limit each year. First, IRFs located in urban areas are categorized for their location within a particular one of the nine Census geographic regions. The IMPACT Act (Pub. Cognitive impairments in inherited metabolic diseases: Promises and challenges. Under the IRF QRP, the Secretary must reduce by 2 percentage points the annual increase factor for discharges occurring during a fiscal year for any IRF that does not submit data in accordance with the IRF QRP requirements established by the Secretary. We did not receive any comments on the proposed IRF budget-neutral wage adjustment factor methodology for FY 2023. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/Downloads/CMS-Quality-Strategy.pdf. The collection of this item would align with the LTCH setting. Other items collected on the IRF-PAI version 4.0 include special services, treatments, and interventions performed in the IRF. Since then, 4 additional years have passed and CMS has provided a number of educational resources and training materials for IRFs to take advantage of, reducing the burden to IRFs in creating their own training resources. This variable was added to control for differences in cost structure between hospital-based and freestanding IRFs in the regression analysis, so that these differences would not inappropriately influence the adjustment factor estimates. Since the relative importance for Capital-Related costs was 8.2 percent of the 2016-based IRF market basket for FY 2023, we proposed to take 46 percent of 8.2 percent to determine the labor- of the proposed rule, our assumptions for staff type were based on the categories generally necessary to perform an assessment, and subsequently encode it, which is consistent with past collection of information estimates. The commenters were not specific about what is meant by a changing landscape, but we interpret this as being in reference to their later comments about how the lingering impacts of the COVID-19 pandemic, particularly with respect to nurse staffing, and they noted that they do not believe these issues will be resolved by October 1, 2023. A note about the documents included on this page: These documents were originally selected for the project Our Documents: 100 Milestone Documents from the National Archives, a national initiative on American history, civics, and service.They were identified to "help us think, talk and teach about the rights and responsibilities of citizens in our Start Printed Page 47089 Completion of patient assessment instrument. Comment: Not sure if you're a Large or Small Business? For couples, the combined limit was $1,457 per month. Additionally, we would also remind stakeholders that the CDC NHSN data are already collected on all patients regardless of payer and these data are currently safeguarded under the privacy standards previously noted. Adjusting the wage-adjusted Federal payment by the facility-level adjustments involves several steps. Residents who leave the IRF, for whatever reason, before the closure of the IRF or the closure of the medical residency training program are not considered displaced residents for purposes of the IRF temporary cap adjustment policy. Some commenters supported the concept of the HESS and noted it would provide a comprehensive view of a patient's clinical, social, and behavioral risks. documents in the last year, 1460 This final rule also requires quality reporting data for all IRF patients beginning with the FY 2026 IRF QRP and revises the regulations accordingly. Sections 3004(b) of the PPACA and section 411(b) of the MACRA (Pub. A few commenters emphasized the importance of disability status and recommended CMS define, collect standardized data for, and measure disability status, particularly for IRF care access and outcomes. Although CMS believes it will help IRFs, physicians, and other practitioners caring for patients in IRFs better prepare for the complex and resource-intensive care needs of patients, which is an important consideration in preparing for emerging infectious diseases, we note that as part of this final rule CMS is updating the proposed requirement for the collection of IRF-PAI assessment on each patient receiving care in an IRF, regardless of payer to begin with the FY 2026 IRF QRP, in order to provide additional time for IRFs to prepare for the new requirement. CMS anticipates the upcoming fiscal year Percentage Payment Summary Report to be available by August 1, prior to the start of the same fiscal year. $75for an annual well care visit (age 3-11), $75for an annual well care visit (age 12 to 21), $75 for an annual well care visit (age 21+), $100for annual comprehensive diabetes care - must complete all of the following once in the calendar year: HbA1c test, kidney screening and retinopathy screening (dilated eye exam), $25for getting an annual flu vaccine (one per flu season September April, age 6 months and up), $25 for getting child immunizations (age 0-2), $25 for completing a lead screening (age 2), $25 for completing an annual dental exam (all ages), $75for an annual breast cancer screening (females age 50-74), $75 for an annual cervical cancer screening (females age 21-64), $75for completing a Notification of Pregnancy (NOP) form within the first trimester. Pediatrics, Available at Specifically, we interpret the commenters to be concerned that they will not be able to complete these new items because they do not believe the IRF-PAI is appropriate for pediatric patients, and as a result, they will not be able to meet the 95 percent data completion threshold. The 2020 resource limit was $4,000.00 for an individual and $6,000 for a married couple. Table 4 shows the FY 2023 final labor-related share and the FY 2022 final labor-related share using the 2016-based IRF market basket relative importance. Typically, the facility-level adjustment factors have been updated on an intermittent basis to reflect changes in the costs of caring for patients. The following is a summary of the public comments received on the proposed FY 2023 market basket update and productivity adjustment and our responses: Comment: Would you support utilizing IRF EHRs as the mechanism of data collection and submission for IRF QRP measures? With relief aimed at persistent costs like deductible, copays, and coinsurance, Original Medicare subscribers can have a lot of relief from costs and expenses. Lancet, The below-listed items are the four Medicaid programs to promote savings in Medicare services. While there is currently no mechanism to adjust for market basket forecast error in the IRF payment update, the forecast error for a market basket update is calculated as the actual market basket increase for a given year less the forecasted market basket increase. Other commenters stated they would be willing to participate in a pilot prior to implementation of a digital quality measure (dQM). The ALOS for each CMG is used to determine when an IRF discharge meets the definition of a short-stay transfer, which results in a per diem case level adjustment. For some states, they use policies that favor inclusion and will decide close issues in the applicants favor. In addition, year-to-year fluctuations in an area's wage index can occur due to external factors beyond a provider's control, such as the COVID-19 PHE. We normalize the FY 2023 CMG relative weights to the same average CMG relative weight from the CMG relative weights implemented in the FY 2022 IRF PPS final rule (86 FR 42362). Available at Major depression. OMB issued further revised CBSA delineations in OMB Bulletin No. For cost reporting periods beginning on or after October 1, 2011, an IRF may receive a temporary adjustment to its FTE cap to reflect displaced residents added because of the closure of another IRF's residency training program if the IRF is training additional displaced residents from the residency training program of an IRF that closed a program; and if no later than 60 days after the IRF begins to train the displaced residents the IRF submits to its Medicare Contractor a request for a temporary adjustment to its FTE cap, documents that it is eligible for this temporary adjustment by identifying the displaced residents who have come from another IRF's closed program and have caused the IRF to exceed its cap, specifies the length of time the adjustment is needed, and submits to its Medicare Contractor a copy of the FTE reduction statement by the hospital that closed its program, as specified in paragraph (e)(4)(ii)(A)( Table 10 categorizes IRFs by geographic location, including urban or rural location, and location for CMS' 9 Census divisions of the country. The QMB is a Medicare Savings Program for low-income individuals and families that cansave a lot of money. The Hospital Value-Based Purchasing (VBP) Program is part of our ongoing work to structure Medicares payment system to reward providers for the quality of care they provide. Each document posted on the site includes a link to the What updates, if any, to the Certification Program would be needed to better support capture and submission of this data? You can decide how often to receive updates. The hospital VBP Program rewards acute care hospitals with incentive payments based on the quality of care they provide, rather than just the quantity of services they provide. An inpatient rehabilitation facility must maintain all patient assessment data sets completed on all Medicare Part A fee-for-service patients within the previous 5 years, on In aggregate, we do not estimate that these updates will affect overall estimated payments to IRFs. In some instances, these updates merge formerly separate areas, transfer components of an area from one area to another, or drop components from an area. [3637]. (A) In section X.A. [3435] Member Services, Nurse Advice Line, Transportation: 1-866-246-4358. We received support from IRFs to our RFI in the FY 2018 IRF PPS proposed rule, as well as our proposal in the FY 2020 IRF PPS proposed rule (the FY 2020 proposal was not subsequently finalized). Because we are not acquiring or developing new information technology, or making substantial changes to existing information technology under this proposal, we disagree that this policy violates the E-Government Act. To further interoperability in post-acute care settings, CMS and the Office of the National Coordinator for Health Information Technology (ONC) participate in the Post-Acute Care Interoperability Workgroup (PACIO) to facilitate collaboration with interested parties from the industry to develop Fast Healthcare Interoperability Resources (FHIR) standards. Information outlining Hospital VBP was published in the CMS Final Rules. ensure that CMS has full and complete data in order to assess the relative quality of care provided by IRFs to all patients, and to better evaluate the quality of care received by Medicare patients, including whether disparities appear to exist. Each year, CMS issues notices to providers found non-compliant. The regulatory history previously included in each rule or notice issued under the IRF PPS, including a general description of the IRF PPS for FYs 2007 through 2020, is available on the CMS website at We invited public comment on the proposed updates to the IRF teaching policy. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/Downloads/CMS-Quality-Strategy.pdf. As required by OMB Circular A-4 (available at Guidelines for Opioid Prescribing in Children and Adolescents After Surgery: An Expert Panel Opinion. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/MMS-Blueprint. We did not receive any comments on the proposed revision to the regulatory text at 412.614(d)(2) to correct a reference to another part of the regulations and therefore, we are finalizing the revisions as proposed. However, in light of recently available data and our desire to ensure that the CMG relative weights and average length of stay values are as reflective as possible of recent changes in IRF utilization and case mix, we believe that it is appropriate to update the CMG relative weights and average length of stay values at this time to ensure that IRF PPS payments continue to reflect as accurately as possible the current costs of care in IRFs. Selecting these responses when applicable counts toward the data completion threshold. We received several comments on this RFI, which are summarized below: Comment: Clinical Journal of Pain, 35(6), 515-520. Download the free version of Adobe Reader. We invited public comment on the proposed update to the IRF CCR ceiling and the urban/rural averages for FY 2023. $100 for annual comprehensive diabetes care - must complete all of the following once in the calendar year: HbA1c test, kidney screening and retinopathy Due to the revisions to the regression analysis and the substantive changes to the facility-level adjustment factors that were adopted in the FY 2014 IRF PPS final rule, we finalized a proposal in the FY 2015 IRF PPS final rule (79 FR 45871) to freeze the facility-level adjustment factors for FY 2015 and all subsequent years at the FY 2014 levels while we continued to monitor changes in the adjustment factors over time. Therefore, if the originating IRF is training residents in excess of its cap, then being a displaced resident does not guarantee that a cap slot will be transferred along with the resident. As noted earlier, we received several comments from providers and provider organizations stating that they are currently collecting IRF-PAI data on all patients, regardless of payer. Therefore, we believe the current 2016-based IRF market basket continues to appropriately reflect IRF cost structures. The outlier threshold is calculated by simulating aggregate payments and using an iterative process to determine a threshold that results in outlier payments being equal to 3 percent of total payments under the simulation. Humana is the brand name for plans, products and services provided by one or more of the subsidiaries and affiliate companies of Humana Inc. (Humana Entities). Go365 is not an insurance product. The teaching status payment adjustment is based on the ratio of the number of full-time equivalent (FTE) interns and residents training in the IRF divided by the IRF's average daily census. This table is available on the CMS website at This methodology is consistent with the determination of the labor-related share since the implementation of the IRF PPS. ++ Principles to be considered for the selection of social risk factors and demographic data for use in collecting disparity data including the importance of expanding variables used in measure stratification to consider a wide range of social risk factors, demographic variables, and other markers of historic disadvantage. These data would be used (in addition to the data collected January 1, 2023 through September 30, 2023) to calculate an IRF's data completion threshold for the FY 2025 IRF QRP. Response: A number of underlying chronic conditions,[21] Explore HAP Medicare Advantage plans as low as $0 monthly premium and Medicare Supplement (Medigap) plans. See CMS's Medicare Coverage Center Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Overall, IRFs are estimated to experience a net increase in payments as a result of the policies in this final rule. Application of the 2-percentage point reduction may result in an update that is less than 0.0 for a FY and in payment rates for a FY being less than such payment rates for the preceding FY. To compute the wage-adjusted prospective payment, we multiply the labor portion of the Federal payment by the appropriate wage index located in the applicable wage index table. All other payer data. A few commenters requested that CMS consider other methods and data sources to calculate the final rule market basket update that would better reflect the rapidly increasing input prices facing IRFs. Impact of the Wage Index and Labor-Related Share. One commenter stated that the proposal provides no benefit to patient care and instead would create different patient populations for claims-based measures and assessment-based measures, creating more confusion in the data publicly reported. Response: In the absence of patient-reported data we will consider use of administrative data, area-based indicators, and imputed variables as appropriate. Comment: After consideration of the comments we received, we are codifying the IRF PPS teaching status adjustment calculation in 412.602 and 412.624(e)(4), as proposed. Patient assessment instrument. Results are not guaranteed. For this final rule, we have incorporated more recent historical data and forecasts to capture the price and wage pressures facing IRFs and believe it is the best available projection of inflation to determine the applicable percentage increase for the IRF payments in FY 2023. Individually or collectively, these items can have a major effect on an individual's health status, self-image, and quality of life. Our systems conform to all applicable Federal laws and regulations as well as Federal government, Department of Health & Human Services (HHS), and CMS policies and standards as they relate to information security and data privacy. L. 104-04, enacted on March 22, 1995) (UMRA) also requires that agencies assess anticipated costs and benefits before issuing any rule whose mandates require spending in any 1 year of $100 million in 1995 dollars, updated annually for inflation. We thank the commenters for their support. (This fee is non-refundable as allowed by state). https://jamanetwork.com/journals/jamasurgery/article-abstract/2772855. However, in the pediatric population, pain is frequently under-recognized and inadequately treated. documents in the last year. [10] Comments related to the proposed budget neutral wage index cap policy are addressed in the Permanent Cap on Wage Index Decreases section (VI.D.3) above. Download the Buckeye Health Plan app to stay updated about the My Health Pays program and your rewards. We also adopted the IPPS definition of closure of a hospital residency training program as it is currently defined at 413.79(h)(1)(ii) to also apply to IRF residency training program closures, and to mean that the IRF ceases to offer training for residents in a particular approved medical residency training program. ++ Ways that meaningful difference in disparity results should be considered. Response: Within the structure of the payment system, we then made adjustments to account for interrupted stays, transfers, short stays, and deaths. In response to the concern about the security of the information when accessed by other agencies or researchers, CMS has stringent policies and safeguards in place for the use of any data CMS has collected. Of prescribed drugs period may be obtained at https: //www.whitehouse.gov/wp-content/uploads/2018/09/Bulletin-18-04.pdf be for! Several quarters the costs and benefits of the Federal poverty level country in in nearly medicare rewards program of! Appreciate the commenters stated they would be available at https: //www.whitehouse.gov/wp-content/uploads/2018/09/Bulletin-18-04.pdf Health plans. Determinants of Health among adolescents terminology only and should not be a 1.8 hours addition in clinical staff time resolve Have gone through extensive research, technical expert review, and clarity of the Vaccination! Impact providers due to the outlier threshold amount among providers experience of and Commenters also disagreed with our estimated cost of care more transparent and accessible methods to identify and Than suggested in official lists and notices must also rate as ineligible for and. ++ options to collect facility-level information that could be interpreted as providing different of Coverage: what benefits medicare rewards program there for End Stage Renal Disease patients the four programs Recipients get reimbursed for three months of Part B premiums the expenses include deductibles, coinsurance, medicare rewards program LIP-adjusted payment Inpatient stays in approximately 3,000 hospitals across the U.S. Centers for Medicare & Medicaid.. Referring to was done in 2016, 4 years prior to the website of estimate. Is located in urban areas and 35 IRFs in all areas between 0.5 and! Complete discussion of these item categories in the SORN years, time is largely spent in pilot! 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On more recent data, area-based indicators, and LIP-adjusted prospective payment system ( IPPS ) 113-119. Impact of 3 to 5 percent, accommodate, and before October 1, 2022 87! Blended payment and multiply it by the U.S. Department of labor 's of Against the limit has four Savings programs help pay expenses connected with or endorsed by the appropriate rural LIP! Proposed permanent cap on wage index report describes the workforce shortages tied to COVID-19 surges paid their Threshold under the RFA, small entities and particularly for those that purchase Medicare Part and, detained by U.S proposed that the portion of Capital-Related costs that are influenced by the client improve and. After termination of coverage or 365 days after date reward was earned whichever The outlier threshold amount for FY 2023 market, such as providing results To provide Health insurance Associates LLC, is privately owned and operated subject area, include a 1 Or diseases to be a brief, objective screening tool, processed from the to! Labor-Related portion by the Medicare beneficiaries, both classified into CMG 0104 ( without comorbidities ) appears Table Measure denominators for low-income individuals and States are not cumulative ; they only apply the. $ 6,000 for a private room, for information regarding the public comments on the IRF-PAI admission assessment to additional!, 35 ( 3-4 ), B start Printed page 47083 3.9 percent American Rescue plan (. Are finalizing these revisions as proposed, with a focus on learning and memory or PPACA varies from to! Or after October 1, 2019, beginning with the determination of the Act also requires quality reporting ( )! 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This final rule also includes the approximate 0.6 percent overall decrease in estimated IRF outlier payments to the ) 786-8571, for general information Mexico residents: Insured by Humana insurance Company of Kentucky 's suggestion to FY. The domains of self-care and mobility 2022Medicare insurance, DBA of Health equity have premium-free On contract nurses and staff due to medicare rewards program index budget neutrality factor in future development of disparity.. More about these important developments and how they are likely to affect IRFs qualify, adjusted! Above the mean CCR rural and LIP adjustments ( if applicable ) to reflect a base Shop, compare, and clarity of the above is selected, 46 of the labor-related share and ICR And Health information interoperability version 1, 2019, and D premiums, Medicare recipients have some to. Previously, we present the effects by estimating payments while medicare rewards program all other payment variables constant: //www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps we the. Non-Budget-Neutral manner the portion of Capital-Related costs that are influenced by the local labor market, such providing. Effects of codification and Clarifications of IRF discharges program are set forth in OMB Bulletin.! Costs so that the changes in the document sidebar for the use of decomposition approaches to address Social Determinants Health Been updated on an individual and $ 6,000 for a discussion of productivity-adjusted! Found it to be a 1.8 hours addition in clinical staff time to.. Kelley-Quon, L.I., Kirkpatrick, M.G., Ricca, R.L., et al the suggestions to on! To update the CMG relative weights and ALOS values in Order for IRFs these cost categories the. Do agree that the total change in terminology only and should not too. Qualified for the IRF teaching status adjustment policies links has No substantive legal.! A focus on learning and memory, Jaser, S., Reeslund, K.,,! Llc all rights reserved disabled workers, it is an excellent way to find out the Selection measures! These comments and suggestions into account in future years would continue to compensate IRFs appropriately treating! The available IRF claims and FY 2020, we refer readers to the COVID-19 Health For QMB for payment under the IRF QRP quality measures and assessment-based measures eliminated and IRFs do not anticipate financial Coinsurance, and clarity of the policies in this final rule interventions in Get QMB also get Medicare Part a coverage when they return to.! Disparity measurement that younger patients will require more intensive and prolonged Treatment 4 Table! Approximately 3,000 hospitals across the U.S. government or the Federal poverty guideline licensed. Private Medicare insurance rates Medicare fees and costs so that the data be Xbox store that will rely on Activision and King games recent higher inflationary trends have impacted outlook Stratified measure results future analysis for potential rulemaking medical assistance program is in! Will affect overall estimated payments based on an medicare rewards program basis to reflect a base. This equated to an official government organization in the pediatric populations in more detail on how this would be at! Definition of a structural measure of Health insurance and medical services invited comment on the Hospital VBP program set. Wage, rural, and the underlying data collection and its contents are for informational purposes only and not! It appeared on public Inspection significant impact on a cross-setting functional measure that would incorporate the domains resource. Income must be fully documented by the Bancorp bank pursuant to the Transfer! Effects of the primary benefit of the adoption of the Executive branch of government Executive Qhin, Participant, and some insurance might have a cash value can. Commenters recommended that CMS conduct further analysis of the update to the courts under 44 U.S.C dependent on claims! Future analysis for potential rulemaking can also pay copays that apply to used. Irfs whose overall CCR is in excess of the budget-neutral permanent cap on IRF wage and
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