What Is an Inpatient Rehabilitation Facility (IRF)?
What Medicare means by an inpatient rehabilitation facility, who qualifies, and how it differs from a nursing home or outpatient therapy.
After a stroke, a major injury or a joint replacement, a hospital discharge planner may suggest an "inpatient rehab" or "acute rehab." Medicare calls these inpatient rehabilitation facilities, or IRFs. They are hospitals, or distinct units within hospitals, that provide intensive rehabilitation under the supervision of a physician. This guide explains what an IRF is and how it differs from other places where people recover.
What an IRF provides
An IRF offers a coordinated program of several therapies, such as physical, occupational and speech-language therapy, along with rehabilitation nursing and regular physician oversight. Medicare's page on inpatient rehabilitation care describes what Medicare Part A may cover when a patient qualifies. The point of an IRF is an intensive, multidisciplinary program, which is different from a skilled nursing facility (SNF), where therapy is usually less intense.
Who typically qualifies
Medicare's coverage rules for IRF care are set out in the Medicare Benefit Policy Manual. In general, the patient must need and be able to take part in an intensive rehabilitation program, commonly described as about three hours of therapy a day at least five days a week. The patient must also need the services of more than one type of therapy, one of which must be physical or occupational therapy, and must need supervision by a rehabilitation physician. A patient who is too ill to take part, or who needs only one type of therapy, may be sent to a different setting. The treating physicians decide whether a patient meets the criteria, and the facility makes its own admission determination.
CMS also uses a list of qualifying conditions, such as stroke, spinal cord injury, brain injury, amputation, hip fracture and certain neurological conditions, to decide whether a facility is classified as an IRF. That list is about the facility's overall patient mix, not about whether any single patient is covered. See the federal classification rule for IRFs (42 CFR 412.29) for details.
IRF, SNF, LTCH and home health
- IRF: intensive rehabilitation, with a rehabilitation physician and several therapies, for patients who can take part.
- Skilled nursing facility (SNF): skilled nursing and therapy at a lower intensity, often for patients who need more time to recover or who cannot take part in intensive therapy.
- Long-term care hospital (LTCH): hospital-level care for patients with complex medical needs over an extended period. See our guide on LTCHs.
- Home health: skilled nursing or therapy at home for patients who are homebound and meet Medicare's rules.
- Outpatient therapy: therapy visits while living at home.
Freestanding hospitals and hospital units
An IRF can be a freestanding rehabilitation hospital or a unit inside a general hospital. Each has its own Medicare certification number (CCN) in the CMS file, and the listings on this site show it. A unit inside a hospital may share staff and services with the rest of the hospital; a freestanding hospital is usually set up around rehabilitation. Neither type is better by definition. Ask about therapy hours, staffing and what medical care is on site.
What to ask
- How many hours of therapy will the patient get each day, and how is that decided?
- Is a rehabilitation physician on site, and how often does the physician see patients?
- What conditions does the facility treat most often? Does it have experience with this patient's condition?
- How are family members involved in therapy and in planning discharge?
- What happens if the patient cannot keep up with the program?
- How will the facility confirm coverage with Medicare or a Medicare Advantage plan before admission?
Medicare Advantage
Medicare Advantage plans can require prior authorization for IRF stays, and their networks vary. If your parent has a Medicare Advantage plan, ask the plan and the facility whether the stay is authorized and in network before you accept a transfer. Medicare's guidance on health plans explains how plans differ.
Where this directory fits
The listings here come from the CMS Provider Data Catalog and show certification number, ownership, beds where CMS lists them and the date of Medicare certification. They are not ratings. For measures such as how often patients return to the community, use Medicare Care Compare. We do not rate or recommend any facility.
General information only, current as of the date above. The information on Inpatient Rehab & LTCH Index is not medical advice and does not replace a doctor, nurse, discharge planner or other qualified professional. Do not use it to make decisions about diagnosis or treatment. If you have a medical emergency, call 911. Rules and programs change; check the official sources linked in this guide.