Form Cms-437a - Rehab Unit Criteria Worksheet (Page 8 of 9) in pdf

THE HOSPITAL REPRESENTATIVE WHO

TAG

REGULATION

GUIDANCE

YES

N/A

COMPLETES THIS ENTIRE FORM

A3517

(e) Have in effect a procedure to ensure that

• Review the hospital’s procedures or other

The representative will ensure the rehab unit has a

patients receive close medical supervision, as

alternative documents or records to verify the

procedure or other alternative documents or records

evidenced by at least 3 face-to-face visits per week

hospital has a procedure detailing close medical

verifying the hospital has a procedure detailing close

by a licensed physician with specialized training and

supervision for patients, including at least 3

medical supervision that includes the rehabilitation

experience in inpatient rehabilitation to access the

face-to-face visits per week.

physician making at least 3 face-to-face visits per

patient both medically and functionally, as well as

week.

• As part of the clincal record review, look for

to modify the courses of treatment as needed to

documentation supporting the physician visits.

maximize the patient’s capacity to benefit from the

rehabilitation process.

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(f) Furnish, through the use of qualified personnel,

• Review the licenses of all qualified personnel

The representative verifies that all qualified

rehabilitation nursing, physical therapy, and

that are required by the State to be licensed, to

personnel, that are required by the State to be

occupational therapy, plus as needed, speech-

verify the licenses are up-to-date.

licensed, have licenses that are up-to-date.

language pathology, social services, psychological

• Qualified personnel would include either

services (including neuropsychological service) and

personnel that are licensed in the State in which

orthotic and prosthetic services.

the 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.

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(g) Have a director of rehabilitation who —

• Verify the rehab unit has a director of

The representative will verify that the rehab unit has

rehabilitation by reviewing personnel logs or

a physician Director of Rehabilitation.

rosters and organization charts.

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(1) Provides services to the rehabilitation unit and to

• The 20 hours may be any combination of patient

The representative will verify that the physician

unit’s inpatients for at least 20 hours per week;

services and administration. Hours cannot be

is spending 20 hours per week providing a

substituted by a Physician Assistant or by any

combination of patient services and administration

other qualified professional. Verify the 20 hours

the rehab unit.

through review of personnel time cards/logs, etc.

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(2) Is a doctor of medicine or osteopathy;

• Review the physician’s license to verify the

The representative will review the physician’s license

physician is an MD or DO.

to ensure the physican is an MD or DO.

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(3) Is licensed under State law to practice medicine

• Ensure license is current and issued by the State. The representative will review the physician’s license

or surgery; and

is current.

Form CMS-437A (06/12)

Form Cms-437a - Rehab Unit Criteria Worksheet Page 8

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