CMS SOM App. A, Tag A-1163

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 §482.57(b)(3)

Respiratory care 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 respiratory care services developed by the medical staff.

Practitioners who may be granted privileges to order respiratory care services include

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

Physicians’ Assistants, Clinical Nurse Specialists, Certified Registered Nurse

Anesthetists, and Certified Nurse Midwives 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

respiratory care services or qualified to order respiratory care services: Clinical social

worker (Section 1861(hh)(1) of the Act and as defined in 42 CFR 410.71); Clinical

psychologist (for purposes of Section 1861(ii) of the Act); or registered dietician or

nutrition professional.

Survey Procedures §482.57(b)(3)

• Review medical records of patients receiving respiratory care

services. Determine who wrote the orders for the respiratory care

services. Determine if the practitioner is responsible for the care of the patient

and privileged to write orders for respiratory care services. Verify the practitioner

meets hospital medical staff policy criteria to order services as well as State law

for ordering respiratory care 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).