Hospital Conditions of Participation for Rehabilitation Services

NOTE:  for those hospitals that have their OP therapy departments certified as CORFs or Rehab Agencies, these Conditions DO NOT apply, as the CORF or RA Conditions apply. On November 18, 2011 CMS issued Transmittal 72 to the State Operations Manual (SOM) clarifying the Hospital Conditions of Participation with respect to rehabilitation services (42 CFR 481.56(b).  the bottom line is that all patients referred to outpatient therapy at the hospital’s outpatient department MUST have a referral from a physician, nurse practitioner, physician assistant or clinical nurse specialist who has been granted privileges.  This applies to all referrals, not just Medicare.  The effective date is November 18, 2011.  The standard also applies to hospitals that use an accreditation organization who has been granted deemed status. The statement below that reflects a Change in the Condition is exactly as it appears in the transmittal: A-1132 (Rev.72, Issued: 11-18-11, Effective: 11-18-11, Implementation: 11-18-11) §482.56(b) Standard: Delivery of Services Services must only be provided under the orders of a qualified and licensed practitioner who is responsible for the care of the patient, acting within his or her scope of practice under State law, and who is authorized by the hospital’s medical staff to order the services in accordance with hospital policies and procedures and State laws. The Interpretive Guidelines for 482.56(b) have been significantly changed as follows: Interpretive Guidelines §482.56(b) Rehabilitation services must be ordered by a qualified and licensed practitioner who is responsible for the care of the patient. The practitioner must have medical staff privileges to write orders for these services. Privileges must be granted in a manner consistent with the State’s scope of practice law, as well as with hospital policies and procedures governing rehabilitation services developed by the medical staff and approved by the governing body. Practitioners who may be granted privileges to order rehabilitation services include physicians, and may also, in accordance with hospital policy, be extended to Nurse Practitioners, Physicians’ Assistants, and Clinical Nurse Specialists as long as they meet the parameters of this requirement. Although the following licensed professionals are also considered “practitioners” in accordance with Section 1842(b)(18)(C) of the Social Security Act, they generally would not be considered responsible for the care of the patient or qualified to order rehabilitation services: Certified registered nurse anesthetist (Section 1861(bb)(2) of the Act); Certified nurse-midwife (Section 1861(gg)(2) of the Act); Clinical social worker (Section 1861(hh)(1) of the Act); Clinical psychologist (for purposes of Section 1861(ii) of the Act and as defined at 42 CFR 410.71); or registered dietician or nutrition professional. The Survey Procedures to evaluate compliance with 482.56(b) have been significantly changed as follows: Survey Procedures §482.56(b) • Review the medical staff policies and procedures for rehabilitation services privileging. Do they identify the types of eligible practitioners and their qualification criteria? • Review medical records of patients receiving rehabilitation services. Determine who wrote the orders for the rehabilitation services. Determine if the practitioner is responsible for the care of the patient and privileged to write orders for rehabilitation services. Verify the practitioner meets hospital medical staff policies and procedures as well as State law for ordering rehabilitation services. Transmittal 72 is linked here for reference: https://www.cms.gov/transmittals/downloads/R72SOM.pdf The DIRECT ACCESS for Physical Therapy Issue This is the text from the 2010 final rule for reference: (which APTA felt provided interpretation for direct access): If the hospital provides rehabilitation, physical therapy, occupational therapy, audiology, or speech pathology services, the services must be organized and staffed to ensure the health and safety of patients. (a) Standard: Organization and staffing. The organization of the service must be appropriate to the scope of the services offered. (1) The director of the services must have the necessary knowledge, experience, and capabilities to properly supervise and administer the services. (2) Physical therapy, occupational therapy, speech-language pathology or audiology services, if provided, must be provided by qualified physical therapists, physical therapist assistants, occupational therapists, occupational therapy assistants, speech-language pathologists, or audiologists as defined in part 484 of this chapter. (b) Standard: Delivery of services. Services must only be provided under the orders of a qualified and licensed practitioner who is responsible for the care of the patient, acting within his or her scope of practice under State law, and who is authorized by the hospital's medical staff to order the services in accordance with hospital policies and procedures and State laws. (1) All rehabilitation services orders must be documented in the patient's medical record in accordance with the requirements at § 482.24. (2) The provision of care and the personnel qualifications must be in accordance with national acceptable standards of practice and must also meet the requirements of § 409.17 of this chapter. REFERENCE:[51 FR 22042, June 17, 1986, as amended at 72 FR 66406, Nov. 27, 2007; 75 FR 50418, Aug. 16, 2010]