Form Cms-437a - Rehab Unit Criteria Worksheet (Page 7 of 9) in pdf

THE HOSPITAL REPRESENTATIVE WHO

TAG

REGULATION

GUIDANCE

YES

N/A

COMPLETES THIS ENTIRE FORM

(4) Mergers. If an IRF hospital (or a

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• As with the change of ownership, the

The representative of the IRF unit that has

hospital with an IRF unit) merges with

owner of the merged hospital must accept

undergone a merger must ensure that the new

another hospital and the owner(s) of

assignment of the hospital’s (with the IRF unit)

owner(s) have accepted assignment of the

the merged hospital accept assignment

provider agreement to ensure uninterrupted

previous Medicare provider agreement. If the

of the IRF (or the hospital’s provider

reimbursement.

new owner(s) have not accepted the assignment,

agreement (or the provider agreement

the representative cannot request continued

• If the owner of the hospital to be merged

of the hospital with the IRF unit), then

participation as an IPPS-excluded unit.

doesn’t accept assignment of the previous

the IRF hospital or IRF unit retains its

owner(s) Medicare provider agreement, the new

excluded status and will continue to be

owner(s) will not be eligible for reimbursement

paid under the prospective payment

until the new owner(s) reapplies to the Medicare

system specified in § 412.1(a)(3) before

program to operate a new hospital and have

and after the merger, as long as the IRF

additionally been granted IRF status.

hospital or IRF unit continues to meet all

the requirements for payment under the

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

IRF prospective payment system. If the

new owner(s) reject assignment of the previous

owner(s) of the merged hospital do not

owner’s Medicare provider agreement. This also

accept assignment of the IRF hospital’s

applies to an acquisition that is followed by a

provider agreement (or the provider

merger.

agreement of the hospital with the IRF

unit), then the IRF hospital or IRF unit is

considered voluntarily terminated and

the owner(s) of the merged hospital

may reapply to the Medicare program to

operate a new IRF.

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(d) Have in effect a preadmission screening

• Review the hospital’s procedures, or other

The representative will ensure the hospital’s

procedure under which each prospective patient’s

alternative documents or records, to verify the

rehabilitation unit is using the preadmission

condition and medical history are reviewed to

hospital”s rehabilitation unit has a preadmission

screening procedure on all patients admitted to the

determine whether the patient is likely to benefit

screening procedure in place.

rehab unit.

significantly from an intensive inpatient hospital

• A review of the clinical records should indicate

program. This procedure must ensure that the

whether the IRF has such a screening procedure

preadmission screening is reviewed and approved

and whether it is using the screening procedure.

by a rehabilitation physician prior to the patient’s

admission to the IRF.

• The purpose of the preadmission screen is to

reduce the rate of hospital readmission by

ensuring that the patients that are accepted to

the IRF will benefit from intensive rehabilitation

services.

Form CMS-437A (06/12)

Form Cms-437a - Rehab Unit Criteria Worksheet Page 7

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