Form Cms-437a - Rehab Unit Criteria Worksheet Page 4
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9THE HOSPITAL REPRESENTATIVE WHO
TAG
REGULATION
GUIDANCE
YES
NO
N/A
COMPLETES THIS ENTIRE FORM
A3507
(13) As part of the first day of the first cost reporting
• Prior to scheduling the survey, verify with the
period for which all other exclusion requirements
FI that the unit is operational: fully staffed and
are met, the unit is fully equipped and staffed and is
equipped.
capable of providing hospital inpatient rehabilitation
• It is not required that the unit has inpatients
care regardless of whether there are any inpatients
on the day of the survey, but must demonstrate
in the unit on that date.
capability of caring for patients.
A3508
(b) Changes in the size of excluded units. Except in
• Verify that the request the IRF is making to add
Representative to verify that if changes were made
the special cases noted at the end of this paragraph,
beds is the first and only request during the cost
to the unit, both CMS and the MAC/FI were notified
changes in the number of beds or square footage
report year.
prior to any change.
considered to be part of an excluded unit under this
• A decrease in the number of beds or square
section are allowed one time during a cost reporting
footage may occur at any time during the cost
period if the hospital notifies its Medicare contractor
report period. In both cases, the change must
and the CMS RO in writing of the planned change
remain in affect for the remainder of the cost
at least 30 days before the date of the change.
report period
The hospital must maintain the information needed
to accurately determine costs that are attributable to
• No changes can be made without notifying both
the excluded unit. A change in bed size or a change
CMS RO and the FI/MAC at least 30 days prior
in square footage may occur at any time during a
to the change.
cost reporting period and must remain in effect for
the rest of that cost reporting period. Changes in
bed size or square footage may be made at any time
if these changes are made necessary by relocation
of a unit to permit construction or renovation
necessary for compliance with changes in Federal,
State, or local law affecting the physical facility or
because of catastrophic events such as fires, floods,
earthquakes, or tornadoes.
§ 412.29 Classification criteria
for payment under the inpatient
rehabilitation facility prospective
payment systems. To be excluded from the
prospective payment systems described in
§ 412.1(a)(1) and to be paid under the prospective
payment system specified in § 412.(1)(a)(3), an
inpatient rehabilitation hospital or an inpatient
rehabilitation unit of a hospital (otherwise referred
to as an IRF) must meet the following requirements:
A3509
(a) Have (or be part of a hospital that has) a
• The SA will check these provisions with the RO
Representative to ensure the hospital has a
provider agreement under part 489 of this chapter
prior to the survey.
Medicare provider agreement.
to participate as a hospital.
Form CMS-437A (06/12)
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