Form Cms-437b - Rehab Hospital Criteria Worksheet Page 4
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6THE HOSPITAL REPRESENTATIVE WHO
TAG
REGULATION
GUIDANCE
YES
NO
N/A
COMPLETES THIS ENTIRE FORM
A3606
(4) Mergers. If an IRF hospital (or a hospital with an IRF
• As with the change of ownership, the owner
The representative of the IRF hospital that has undergone
unit) merges with another hospital and the owner(s)of the
of the merged hospital must accept assignment of
a merger, must ensure that the new owner(s) have
merged hospital accept assignment of the IRF hospital’s
the hospital with the existing provider agreement to
accepted assignment of the previous Medicare provider
provider agreement (or the provider agreement of the
ensure uninterrupted reimbursement.
agreement. If the new owner(s) have not accepted the
hospital with the IRF unit), then the IRF hospital or IRF
assignment, the representative cannot request continued
• If the owner of the hospital to be merged doesn’t
unit retains its excluded status and will continue to be
participation as an IPPS-excluded rehabilitation hospital.
accept assignment of the previous owner’s Medicare
paid under the prospective payment system specified
provider agreement, the new owner(s) would not be
in § 412,1(a)(3) before and after the merger, as long
eligible for reimbursement until the new owner(s)
as the IRF hospital or IRF unit continues to meet all of
reapplied to the Medicare program to operate a
the requirements for payment under the IRF prospective
new hospital and have additionally been granted IRF
payment system. If the owner(s) of the merged hospital
status,
do not accept assignment of the IRF hospital’s provider
agreement (or the provider agreement of the hospital
• IRF status is lost if a hospital is acquired and the new
with the IRF unit), then the IRF hospital or IRF unit is
owner(s) reject assignment of the previous owner’s
considered voluntarily terminated and the owner(s) of the
Medicare provider agreement. This also applies to an
merged hospital may reapply to the medicare program to
acquisition that is followed by a merger.
operate a new IRF.
A3607
(d) Have in effect a preadmission screening procedure
• Review the hospital’s procedures, or other alternative
The representative will ensure the hospital is using
under which each prospective patient’s condition and
documents or records, to verify the hospital has a
the preadmission screening procedure on all patients
medical history are reviewed to determine whether the
preadmission screening procedure in place.
admitted to the rehab hospital.
patient is likely to benefit significantly from an intensive
• A review of the clinical records should indicate
inpatient hospital program. This procedure must ensure
whether the IRF is using the screening procedure.
that the preadmission screening is reviewed and approved
by a rehabilitation physician prior to the patient’s
admission to the IRF,
A3608
(e) Have in effect a procedure to ensure that patients
• As part of the clinical record review, look for
The representative will ensure the rehabitation hospital
receive close medical supervision, as evidenced by at least
documentation supporting the physician visits.
has a procedure or other alternative documents or
3 face-to-face visits per week by a licensed physician
records verifying the hospital has a procedure detailing
• Review the hospital’s procedures or other alternative
with specialized training and experience in inpatient
close medical supervision that includes the rehabilitation
documents or records to verify the hospital has a
rehabilitation to assess the patient both medically and
physician making at least 3 face-to-face visits per week.
procedure detailing close medical supervision for
functionally, as well as to modify the course of treatment
patients.
as needed to maximize the patient’s capacity to benefit
from the rehabilitation process.
Form CMS-437B (06/12)
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