This form is completed by the rehabilitation facility, not the patient

Accurate functional assessment at admission and discharge is critical for appropriate payment and quality measurement

The 60% rule applies — at least 60% of the facility's patients must have one of 13 qualifying conditions

Rehabilitationvery hardDoctor signature required

IRF-PAI (Inpatient Rehabilitation Facility Patient Assessment)

IRF-PAI · CMS

Assessment instrument determining Medicare Part A FFS payment for IRF stays. Must be in the patient's medical record, dated, timed, and authenticated.

Form Details

Total fields: 150
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Where to Submit This Form

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Submit electronically to CMS through the QIES ASAP system

https://www.cms.gov/medicare/quality/inpatient-rehabilitation-facility-patient-assessment-instrument

Submitted by the inpatient rehabilitation facility as part of the Medicare payment process.

Filing Deadline

Admission assessment: completed within 3 days of admission. Discharge assessment: completed by the date of discharge. Transmitted to CMS within 7 days of completion.

Required Attachments

📎 Completed IRF-PAI with all required data elements
📎 Physician evaluation and rehabilitation plan
📎 Functional status assessment using the Section GG items
📎 Medical history and comorbidities

Processing Time

Data is transmitted electronically and processed by CMS for payment determination through the IRF Prospective Payment System (PPS).

What Happens Next

CMS uses the IRF-PAI data to determine the Case-Mix Group (CMG) for payment and to monitor facility quality. Data is also used for quality reporting and outcome measures.

Tips for This Form

✓ This form is completed by the rehabilitation facility, not the patient
✓ Accurate functional assessment at admission and discharge is critical for appropriate payment and quality measurement
✓ The 60% rule applies — at least 60% of the facility's patients must have one of 13 qualifying conditions
✓ IRF-PAI data feeds into the IRF Compare tool at Medicare.gov, which patients can use to compare facilities

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Submitted to maintain IPPS-excluded status for inpatient rehabilitation facilities.

Inpatient Rehab Pre-Authorization

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Pre-certification for inpatient rehab admission. Must document patient can participate in 3 hours of therapy, 5 days per week (15 hours per week).

Outpatient PT/OT/ST Prior Authorization

Insurer/state-specific · Health insurance plans / State Medicaid

Prior authorization for outpatient physical therapy, occupational therapy, or speech therapy. Must specify frequency, duration, and medical necessity.

Concurrent Therapy Treatment Request / Recertification

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Request for continued therapy beyond initial authorization period. Must document progress toward goals and continued medical necessity.

Vocational Rehabilitation Application

State-specific (e.g., WA DSHS 11-022) · State Divisions of Vocational Rehabilitation

Application for VR services to help people with disabilities prepare for, find, and keep jobs. Eligibility based on disability that creates a barrier to employment.

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