CMS SOM App. A, Tag A-0068

§482.12(c)(4) A doctor of medicine or osteopathy is responsible for the care of each Medicare

patient with respect to any medical or psychiatric problem that--

(i) Is present on admission or develops during hospitalization; and

(ii) Is not specifically within the scope of practice of a doctor of dental surgery, dental

medicine, podiatric medicine, or optometry; a chiropractor; or clinical psychologist,

as that scope is--

(A) Defined by the medical staff;

(B) Permitted by State law; and

(C) Limited, under paragraph (c)(1)(v) of this section, with respect to chiropractors.

Interpretive Guidelines §482.12(c)(4)

CMS hospital regulations do permit licensed practitioners (i.e., doctors of dental surgery, dental

medicine, podiatric medicine, or optometry; chiropractors; or clinical psychologists), as allowed by the

State, to admit patients to a hospital. However, CMS does require that Medicare and Medicaid patients

who are admitted by a doctor of dental surgery, dental medicine, podiatric medicine, or optometry; a

chiropractor; or clinical psychologist be under the care of a MD/DO with respect to any medical or

psychiatric problem that is present on admission or develops during hospitalization that is outside the

scope of practice of the admitting practitioner. If a hospital allows a doctor of dental surgery, dental

medicine, podiatric medicine, or optometry, a chiropractor or a clinical psychologist to admit and care

for patients, as allowed by State law, the governing body and medical staff must establish policies and

bylaws to ensure that the requirements of 42 CFR §482 are met. As applicable, the patient’s medical

record must demonstrate MD/DO responsibility/care.

Survey Procedures §482.12(c)(4)

• Verify that an assigned doctor of medicine or osteopathy is responsible for and is monitoring the

care of each Medicare or Medicaid patient with respect to all medical or psychiatric problems

during the hospitalization.

• If non-MD/DOs admit patients, verify that every Medicare/Medicaid patient is being monitored

by an MD/DO who is responsible for any medical or psychiatric problem outside the scope of

practice of the admitting practitioners.