Form Cms-437b - Rehab Hospital Criteria Worksheet Page 5
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6THE HOSPITAL REPRESENTATIVE WHO
TAG
REGULATION
GUIDANCE
YES
NO
N/A
COMPLETES THIS ENTIRE FORM
A3609
(f) Furnish, through the use of qualified personnel,
• Review the licenses of all qualified personnel, that
The representative verifies that all qualified personnel,
rehabilitation nursing, physical therapy, and occupational
are required by the State to be licensed, to verify the
that are required by the State to be licensed, have
therapy; plus, as needed, speech-language pathology,
licenses are up-to-date.
licenses that are up-to-date.
social services, psychological services (including
• Qualified personnel would include either personnel
neuropsychological services), and orthotic and prosthetic
that are licensed in the State in which the services
services.
are provided or those personnel that are recognized
under reciprocity by the State in which the services
are provided.
• Determine if the hospital has and follows a procedure
to evaluate and document that personnel are
qualified and that those personnel maintain their
qualifications.
A3610
(g) Have a director of rehabilitation who-
Verifies the rehab hospital has a director
The representative will verify that the rehab hospital has a
of rehabilitation by reviewing by reviewing personnel logs
physician Director of Rehabilitation.
or rosters and organization charts.
A3611
(1) Provides services to the IRF hospital and its inpatients
• The hospital will define the term “full-time” as it
The representative will verify that the physician is full
on a full-time basis.
applies to all of its employees,
time providing a combination of patient services and
administration.
• The full time hours may be any combination of
patient services and administration.
• A director of rehabilitation hours cannot be
substituted by a Physician Assistant,
• Verify the full time hours through review of personnel
time cards/logs, etc.”
A3612
(2) Is a doctor of medicine or osteopathy;
Review the physician’s license to verify the physician is an
The representative will review the physician’s license to
MD or DO.
ensure the physician is a MD or DO.
A3613
(3) Is licensed under State law to practice medicine or
Surveyor will verify the physician has a current license
The representative verifies the physician’s license is
surgery;
issued by the State, as appropriate.
current.
A3614
(4) Has had, after completing a 1-year hospital
Review personnel and/or credentialing files to
The representative reviews the director of rehabilitation’s
internship, at least 2 years of training or experience in the
verify the physician’s training and experience complies
level of training and experience.
medical management of inpatients requiring rehabilitation
with the regulation.
services.
Form CMS-437B (06/12)
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