Form Cms-671 - Ltc Facility Application For Medicare/medicaid Page 6
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6GENERAL INSTRUCTIONS AND DEFINITIONS
(use with CMS-671 Long Term Care Facility Application for Medicare and Medicaid)
Therapeutic Recreation Specialist - Person(s) who, in
Mental Health Services - Staff (excluding those included
accordance with State law, are licensed/registered and are
under therapeutic services) who provide programs of services
eligible for certification as a therapeutic recreation specialist
targeted to residents' mental, emotional, psychological, or
by a recognized accrediting body.
psychiatric well-being and which are intended to:
• Diagnose, describe, or evaluate a resident's mental or
Qualified Activities Professional - Person(s) who meet the
emotional status;
definition of activities professional at 483.15(f)(2)(i)(A) and
• Prevent deviations from mental or emotional well-being from
(B) or 483.15(f)(2)(ii) or (iii) or (iv) and who are providing an
developing; or
on-going program of activities designed to meet residents'
• Treat the resident according to a planned regimen to assist
interests and physical, mental or psychosocial needs. Do not
him/her in regaining, maintaining, or increasing emotional
include hours reported as Therapeutic Recreation Specialist,
abilities to function.
Occupational Therapist, OT Assistant, or other categories
Among the specific services included are psychotherapy and
listed above.
counseling, and administration and monitoring of psychotropic
medications targeted to a psychiatric diagnosis.
Other Activities Staff - Persons providing an on-going
program of activities designed to meet residents' needs and
Vocational Services - Evaluation and training aimed at
interests. Do not include volunteers or hours reported
assisting the resident to enter, re-enter, or maintain
elsewhere.
employment in the labor force, including training for jobs in
integrated settings (i.e., those which have both disabled and
Qualified Social Worker(s) - Person licensed to practice
nondisabled workers) as well as in special settings such as
social work in the State where the facility is located, or if
sheltered workshops.
licensure is not required, persons with a bachelor's degree in
social work, a bachelor's degree in a human services field
Clinical Laboratory Services - Entities that provide
including but not limited to sociology, special education,
laboratory services and are approved by Medicare as
rehabilitation counseling and psychology, and one year of
independent laboratories or hospitals.
supervised social work experience in a health care setting
working directly with elderly individuals.
Diagnostic X-ray Services - Radiology services, ordered by a
physician, for diagnosis of a disease or other medical
Other Social Services Staff - Person(s) other than the
condition.
qualified social worker who are involved in providing medical
social services to residents. Do not include volunteers.
Administration and Storage of Blood Services - Blood bank
and transfusion services.
Dentists - Persons licensed as dentists, according to State law
where the facility is located, to provide routine and
Housekeeping Services - Services, including those of the
emergency dental services.
maintenance department, necessary to maintain the
environment. Includes equipment kept in a clean, safe,
Podiatrists - Persons licensed/registered as podiatrists,
functioning and sanitary condition. Includes housekeeping
according to State law where the facility is located, to provide
services supervisor and facility engineer.
podiatric care.
Other - Record total hours worked for all personnel not
already recorded, (e.g., if a librarian works 10 hours and a
laundry worker works 10 hours, record 00020 in Column C).
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