Clarification for Interdisciplinary Team Meetings for Inpatient Rehabilitation Facility Services

An Inpatient Rehabilitation Facility (IRF) stay will only be considered reasonable and necessary if, at the time of admission to the IRF, the documentation in the patient’s IRF medical record indicates a reasonable expectation that the complexity of the patient’s nursing, medical management and rehabilitation needs requires an inpatient stay and an interdisciplinary team approach to the delivery of rehabilitation care. 

Per 42 CFR 412.622(a)(5)(ii), the interdisciplinary team meeting (IDT) occur at least once per week throughout the duration of the patient's stay to implement appropriate treatment services; review the patient's progress toward stated rehabilitation goals; identify any problems that could impede progress towards those goals; and, where necessary, reassess previously established goals in light of impediments, revise the treatment plan in light of new goals, and monitor continued progress toward those goals.

The Centers for Medicare & Medicaid Services (CMS) now allows IRFs to conduct a patient’s initial IDT meeting by day eight of the patient’s stay under specific conditions.

Key Points

• Same-Day Admissions and IDT Meetings
  If a patient is admitted to the IRF on the same day the facility holds its regularly scheduled IDT meeting, CMS expects that the patient will be included in that day’s discussion.
   
• Post-Meeting Admissions
  If a patient is admitted after the IDT meeting has occurred on that day, it is acceptable for the patient’s first IDT discussion to take place during the next scheduled weekly meeting, even if that falls on day eight of the patient’s stay.
  
  Example
  If the IRF holds its IDT meetings every Wednesday at 2 p.m., and a patient is admitted on Wednesday at 5 p.m., the patient’s first IDT meeting may occur the following Wednesday at 2 p.m. on the eighth day of their stay.
   
• Documentation Requirement
  IRFs must clearly document in the patient’s medical record the specific reason for conducting the initial IDT meeting on day eight. This justification must align with CMS guidelines.
   
• Compliance Deadline
  Under no circumstances may the initial IDT meeting occur later than day eight of the patient’s stay.