CMS SOM App. A, Tag A-1132

Services must only be provided under the orders of a qualified and licensed

practitioner who is responsible for the care of the patient, acting within his or her

scope of practice under State law, and who is authorized by the hospital’s medical

staff to order the services in accordance with hospital policies and procedures and

State laws.

Interpretive Guidelines §482.56(b)

Rehabilitation services must be ordered by a qualified and licensed practitioner who is

responsible for the care of the patient. The practitioner must have medical staff

privileges to write orders for these services or, for outpatient services, if hospital policy

permits acceptance of orders from outside practitioners, the practitioner’s order must

meet the requirements at §482.54(c).

For practitioners who have medical staff privileges, such privileges must be granted in a

manner consistent with the State’s scope of practice law, as well as with hospital policies

and procedures governing rehabilitation services developed by the medical staff.

Practitioners who may be granted privileges to order rehabilitation services include

physicians, and may also, in accordance with hospital policy, include Nurse Practitioners,

Physicians’ Assistants, and Clinical Nurse Specialists as long as they meet the parameters

of this requirement. Although the following licensed professionals are also considered

“practitioners” in accordance with Section 1842(b)(18)(C) of the Social Security Act,

they generally would not be considered responsible for the care of the patient with regard

to rehabilitation services or qualified to order rehabilitation services: Certified registered

nurse anesthetist (Section 1861(bb)(2) of the Act); Certified nurse-midwife (Section

1861(gg)(2) of the Act); Clinical social worker (Section 1861(hh)(1) of the Act); Clinical

psychologist (for purposes of Section 1861(ii) of the Act and as defined at 42 CFR

410.71); or registered dietician or nutrition professional.

Survey Procedures §482.56(b)

• Review medical records of patients receiving rehabilitation services. Determine

who wrote the orders for the rehabilitation services. Determine if the practitioner

is responsible for the care of the patient and privileged to write orders for

rehabilitation services. Verify the practitioner meets hospital medical staff policy

criteria to order services as well as State law for ordering rehabilitation services.

Does the hospital permit acceptance of orders from outside practitioners who do not

practice at the hospital? If so, evaluate for compliance with §482.54(c).