Form Cms-437b - Rehab Hospital Criteria Worksheet (Page 3 of 6) in pdf

THE HOSPITAL REPRESENTATIVE WHO

TAG

REGULATION

GUIDANCE

YES

N/A

COMPLETES THIS ENTIRE FORM

A3604

(1) New IRFs beds. Any IRF beds that are added to an

• If the rehabilitation hospital added beds, the surveyor

The representative completes this form (Form CMS 437B)

existing IRF must meet all applicable State Certificate

or CMS will verify that the hospital had approval

as well as a signed attestation statement attesting

of Need and State licensure laws. New IRF beds may be

(certificate of need or State license ) before adding

that the rehab patients it intends to serve meets the

added one time at any point during a cost reporting

beds, if such approval is required.

requirements outlined in § 412.29(b)(2).

period and will be considered new for the rest of that

• The surveyor must verify that the hospital received

cost report period. A full 12-month cost report period

written CMS RO approval before adding any new

must elapse between the delicensing or decertification

beds.

of IRF beds in an IRF hospital or IRF unit and the addition

of new IRF hospital or IRF unit. Before an IRF can add

• The surveyor will verify that the hospital didn’t have

new beds, it must receive written approval from the

more than one increase in beds during a single cost

appropriate CMS RO, so that the CMS RO can verify that

reporting period.

a full 12-month cost eporting period has elapsed since

the IRF has had beds delicensed or decertified, New IRF

• Surveyors must verify that if the rehabilitation hospital

beds are ncluded in the compliance review calculations

decreased beds, it didn’t thereafter add beds unless a

under paragraph (b) of this section from the time that

full 12 month cost reporting period had elapsed.

they are added to the IRF.

A3605

(3) Change of ownership or leasing. An IRF

• IRF status is lost if a hospital is acquired and the new

The representative of the IRF hospital that has undergone

hospital or IRF unit that undergoes a change

owners reject assignment of the previous owner’s

a change of ownership, must ensure that the new

of ownership or leasing, as defined in § 489, 18 of this

Medicare provider assignment

owner(s) have accepted assignment of the previous

chapter, retains its excluded status and will continue to be

Medicare provider agreement. If the new owner(s) have

• Only entire hospitals may be sold or leased, IRF

paid under the prospective payment system specified in §

not accepted the assignment, the representative cannot

units may not be sold or leased,

412,1(a)(3) before and after the change of ownership or

request continued participation as an IPPS-excluded rehab

leasing, if the new owner(s) of the IRF accept assignment

hospital.

of the previous owner’s Medicare provider agreement,

and the IRF continues to meet all of the requirements

for payment under the IRF prospective payment system.

If the new owner(s) do not accept assignment of the

previous owner’s Medicare provider agreement, the IRF

is considered to be voluntarily terminated, and the new

owner(s) may re-apply to participate in the Medicare

program. If the IRF does not continue to meet all of the

requirements for payment under the IRF prospective

payment system, then the IRF loses its excluded status

and is paid according to the prospective payment systems

described in §412,(a)(1),

Form CMS-437B (06/12)

Form Cms-437b - Rehab Hospital Criteria Worksheet Page 3

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