On May 6, 2009, CMS published its proposed IRF PPS update for FY 2010. For FY 2010, CMS proposes to apply a 2.4% market basket increase, which is estimated to increase payments under IRF-PPS by $140 million. The rule also would increase the outlier threshold amount, resulting in an additional $10 million increase in aggregate IRF-PPS payments. In addition to updating the payment methodology, including adjustments to the relative weights, market basket and outlier threshold, CMS is proposing the most dramatic changes to the IRF-PPS since it adopted changes to the IRF “75 percent rule” criteria for cost reporting periods beginning on or after July 1, 2004 . Specifically, the rule would impose extensive preadmission screening requirements, increase the responsibilities of physicians, require additional face-to-face encounters with patients, mandate that physicians and nurses have specialized training in rehabilitation, revise the post admission evaluation process, and require IRFs to create and maintain additional documents in the patient medical record, in addition to other obligations. Companion changes to IRF-PPS policy are included in proposed revisions to Section 110 of the Medicare Benefit Policy Manual. Comments on the proposed rule are due June 29, 2009, and comments on the proposed revisions to the Medicare Benefit Policy Manual are due June 30, 2009.