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

THE HOSPITAL REPRESENTATIVE WHO

TAG

REGULATION

GUIDANCE

YES

N/A

COMPLETES THIS ENTIRE FORM

A3523

(4) Has had, after completing a 1 year hospital

• Review personnel and/or credentialing files to

The representative reviews the director of

internship, at least 2 years of training or experience

verify the physician’s training and experience

rehabilitation’s level of training and experience.

in the medical management of inpatients requiring

complies with the regulation.

rehabilitation services.

A3524

(h) Have a plan of treatment for each inpatient that

• Conduct a clinical record review to verify that

The representative verifies that the rehab unit has

is established, reviewed, and revised as needed by

each IRF patient has a plan of treatment and

patient plans of treatment.

a physician in consultation with other professional

that the plans are updated whenever there is a

personnel who provide services to the patient.

change in the patient’s condition.

• The plan of treatment should include the

patient’s medical prognosis and the anticipated

interventions, functional outcomes, and

discharge destination from the IRF stay.

• The anticipated interventions detailed in the

overall plan of care should include the expected

intensity (meaning number of hours per day),

frequency (meaning number of days per week),

and duration (meaning total number of days

during the IRF stay) of physical, occupational,

speech-language pathology, and prosthetic/

orthotic therapies required by the patient during

the IRF stay.

A3525

(i) Use a coordinated interdisciplinary team

• Review clinical records to determine whether the

The representative will determine whether

approach in the rehabilitation of each inpatient,

interdisciplinary team is meeting once a week to

interdiciplinary teams are meeting once weekly to

as documented by the periodic clinical entries

review patient progress toward goal attainment

review patient progress and that documentation is

made in the patient’s medical record to note the

and discharge planning.

in the medical records.

patient’s status in relationship to goal attainment

• Determine if the documentation complies with

and discharge plans and that team conferences

the regulatory requirements.

are held at least once per week to determine the

appropriateness of treatment.

According to the Paperwork Reduction of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0986. The time required to complete this

information collection is estimated to average 15 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the

time estimate(s) or suggestions for improving this form, please write to: CMS, Attn: PRA Reports Clearance Officer, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.

COMMENTS

Form CMS-437A (06/12)

Form Cms-437a - Rehab Unit Criteria Worksheet Page 9

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