CMS SOM App. A, Tag A-0529

The hospital must maintain, or have available, diagnostic radiologic services...]

§482.26(a) Standard: Radiologic Services

The hospital must maintain, or have available, radiologic services according to the needs of

the patients.

Interpretive Guidelines §482.26 (a)

Mandatory and Optional Radiologic Services

The hospital must maintain, or have available, diagnostic radiological services according to the

needs of the volume and types of patients the hospital serves. “Maintain” in this context means

furnishing radiologic services on-site, while having them available means providing access to

radiologic services even when they are not furnished on-site. For example:

• It would not be uncommon for a psychiatric hospital to maintain on-site relatively limited or

no radiologic services, while making more extensive diagnostic services available under

arrangement, at a site outside the psychiatric hospital.

• On the other hand, a short-term acute care hospital with a busy emergency department that

handles trauma, stroke, and other complex medical and surgical cases would be expected to

maintain on-site a wider range of diagnostic radiologic services that are ready to be furnished

when needed.

A hospital’s diagnostic radiologic services must be maintained or available at all times. Multi-campus hospitals must have diagnostic radiologic services that can be furnished when needed in

a clinically appropriate timeframe for each location providing inpatient, same-day surgery, and

emergency services. The scope and complexity of diagnostic radiological services maintained or

available must be specified in writing, in order to demonstrate how the hospital meets the needs

of its patients.

Therapeutic radiologic services are optional, but if they are offered, must also comply with the

Radiologic Services requirements.

Radiological services may be provided by the hospital directly utilizing its own staff, or through

a contractual arrangement. The hospital is responsible for ensuring that the services meet all the

requirements of this regulation, regardless of whether they are provided directly or under

arrangement. Diagnostic radiologic services provided under arrangement may be provided either

on the hospital’s campus or in an adjacent or other nearby, readily accessible facility so long as

the services, including those required on an urgent or emergent basis, can be furnished within

clinically appropriate timeframes.

Increasingly, hospitals are also separating the performance of radiologic studies, which may be

done on-site or at a readily accessible facility off the hospital’s campus, from the interpretation

of the studies, which can be performed remotely by a teleradiology practitioner in a timely

fashion. This practice is acceptable, so long as the teleradiology practitioner is privileged in

accordance with the requirements of the Governing Body (§482.12) and Medical Staff (§482.22)

CoPs.

Survey Procedures §482.26(a)

• With respect to assessing whether the diagnostic radiologic services meet the needs of the

hospital’s patients:

• Ask the hospital for evidence of the scope and complexity of its diagnostic radiologic

services.

• Ask how the hospital has determined that the services meet the needs of its patients.

• Verify that the hospital either maintains or makes available diagnostic radiologic services

that can be provided promptly when needed.

• If the hospital has an emergency department, are diagnostic radiologic services

maintained or available at all times to support the emergency department?

• If the diagnostic radiologic services are not on the same campus as the hospital’s

emergency department, same-day surgery, inpatient locations, or other areas where

services dependent upon radiologic services are provided, ask the hospital how it ensures

that services are furnished within clinically required timeframes. Does the hospital have

an arrangement with an off-site facility to furnish diagnostic services when needed?

• How does the hospital ensure that staff authorized to interpret diagnostic studies are

ready to furnish services within clinically required timeframes, either on-site or through

telecommunications media that permit remote review and interpretation of studies?