Excluded IRFs (PPS-Excluded Rehab Units and Rehabilitation Hospitals) Packet 

The instructions and forms in this packet are designed to assist providers in submitting the required information for adding or for submission of annual self-attestation for Excluded IRF (Inpatient Rehabilitation Facilities) . The Hospital Bed Change Packet must be submitted with this packet.

  • IRF Instructional Letter
  • IRF Attestation Form
  • CMS 437A IRF Criteria Work Sheet
  • CMS 437B Rehabilitation Hospital Criteria Work Sheet
  • IRF Checklist