CMS Pub. 100-02, ch. 1, § 110.2.4

A primary distinction between the IRF environment and other rehabilitation settings is

the high level of physician supervision that accompanies the provision of intensive

rehabilitation therapy services. For this reason, the information in the patient’s IRF

medical record (especially the required documentation described in section 110.1) must

document a reasonable expectation that at the time of admission to the IRF the patient’s

medical management and rehabilitation needs require an inpatient stay and close

physician involvement. Close physician involvement in the patient’s care is

demonstrated by documented face-to-face visits from a rehabilitation physician at least 3

days per week throughout the patient’s IRF stay. Beginning with the second week of

admission to the IRF, a non-physician practitioner who is determined by the IRF to have

specialized training and experience in inpatient rehabilitation may conduct 1 of the 3

required face-to-face visits with the patient per week, provided that such duties are within

the non-physician practitioner’s scope of practice under applicable state law. In the first

week of the patient’s IRF stay, the rehabilitation physician is required to visit patients a

minimum of three times to ensure that the patient’s plan of care is fully established and

optimized to the patient’s care needs in the IRF. In the second, third, fourth weeks of the

stay, and beyond, CMS will continue to require Medicare fee-for-service beneficiaries in

IRFs to receive a minimum of three rehabilitation physician visits per week, but will

allow non-physician practitioners to independently conduct one of these three minimum

required visits per week.

The purpose of the face-to-face visits is to assess the patient both medically and

functionally (with an emphasis on the important interactions between the patient’s

medical and functional goals and progress), as well as to modify the course of treatment

as needed to maximize the patient’s capacity to benefit from the rehabilitation process.

Other physician specialties may treat and visit the patient, as needed, more often than 3

days per week. However, the requirement for IRF physician supervision is intended to

ensure that IRF patients receive more comprehensive assessments of their functional

goals and progress, in light of their medical conditions, by a rehabilitation physician who

is determined by the IRF to have specialized training and experience in inpatient

rehabilitation at least 3 times per week. The required rehabilitation physician and non-physician practitioner visits should generally be documented in the patient’s medical

record at the IRF per the requirements at 42 CFR § 482.24(4)(c)(vi).