Admission Criteria

Reasonable and Necessary Care

1. Patient must demonstrate an inability to function independently as demonstrated by a requirement for minimal to moderate assistance in one or more of the areas listed below and must demonstrate potential for significant improvement as measured against his/her condition prior to rehabilitation:

• Activities of daily living
  • Feeding
  • Bathing
  • Dressing
• Mobility
  • Transfers
  • Ambulation
  • Stair Climbing
  • Wheelchair Mobility
• Cognitive or Communication Abilities (accompanied by at least one element of ADL or Mobility loss)
  • Aphasia with major receptive and/or expressive components
  • Cognitive dysfunction (e.g., attention span, confusion, memory, intelligence)
  • Perceptual motor dysfunction area (e.g., spatial orientation, visual motor, depth and distance perception)

OR
Patient must have significant functional loss due to somatic dysfunction including:

• Spasticity
• Incoordination
• Paresis
• Bowel and bladder dysfunction
• Gait disturbance
• Dysarthria or
• Dyskinesia

2. And, patient must meet one of the following criteria:

• Has had no previous comprehensive rehabilitation effort or, previous rehabilitative efforts for the same condition showed little or no improvement, but because of an intervening circumstance, rehabilitation is now considered reasonable
• Previously has been unable to attain rehabilitation goals that are currently considered attainable because of techniques or technology not previously available to the patient. This may include previous trial of outpatient therapy with unsatisfactory response
• Has lost previous level of attained functional independence due to complications or illness and re-obtainment of functional independence currently is feasible
• The patient is medically stable, but has complications that require special care to achieve rehabilitation goals
• There has been some documented objective evidence of a significant change in the patient’s function requiring a planned evaluation or re-evaluation of rehabilitation goals or attainment of goals

3. And, patient must meet all of the following criteria:

• The patient requires the active and ongoing intervention of multiple therapy disciplines, one of which must be physical or occupational therapy.
• The patient must require and actively participate in at least 3 hours of therapy per day at least 5 days per week.
• In certain well-documented cases, this intensive rehabilitation therapy program might instead consist of at least 15 hours of intensive rehabilitation therapy within a 7 consecutive day period, beginning with the date of admission to the IRF.
  • The patient can reasonably be expected to make measurable improvement (that will be of practical value to improve the patient’s functional capacity or adaptation to impairments) as a result of the rehabilitation treatment.
• The patient must require medical supervision by a rehabilitation physician at least three days per week throughout the stay in order to assess the patient both medically and functionally and to modify the course of rehabilitation treatment as needed to maximize the patient’s capacity to benefit from rehab.
• The patient must require and receive and intensive and coordinated interdisciplinary approach to providing rehab.

Other Factors

• Patient must have appropriate and approved benefits for inpatient rehabilitation services. Patients without funding may be considered on an individual basis, based on hospital policies on the provision of charity care
• Patient with known or suspected suicidal intent, mental illness or chemical addition will not be admitted until the psychological status is appropriate for participation in a comprehensive medical rehabilitation program
• When patients require rehabilitation for conditions that are not included in the approved Medicare diagnostic categories, patients will be considered for admission as long as the inpatient rehabilitation facility is able to maintain compliance with the established percentages for the current qualifying period.

Have questions? Call 606.783.6653 to speak with our intake specialist.