CMS SOM App. A, Tag A-1695

Doctors of medicine or

osteopathy and other appropriate professional personnel must be available to

provide necessary medical and surgical diagnostic and treatment services. If

medical and surgical diagnostic services and treatment are not available within the

institution, the institution must have an agreement with an outside source of these

services to ensure that they are immediately available or a satisfactory agreement

must be established for transferring patients to a general hospital that participates

in the Medicare program.

Interpretive Guidelines §482.62(c)

All psychiatric hospitals must have the ability to address medical and surgical conditions

of psychiatric patients. The hospital must have MDs or DOs and other appropriate

professional personnel available to provide diagnostic and treatment services to address

comorbidities and concurrent medical and surgical conditions. The hospital is required

to provide care and treatment of necessary medical conditions in addition to psychiatric

care.

It is not uncommon for psychiatric patients to experience minor injuries or illnesses

during hospitalization. The hospital must have qualified professionals who can assess

and provide initial, stabilizing treatment for any minor injuries or illnesses.

All psychiatric hospitals, like other Medicare participating hospitals, must have the

ability to address emergencies that occur on the hospital’s campus, as required by

§482.12(f). The hospital must have qualified personnel and equipment to address such

emergencies.

If the medical or emergency condition of a patient exceeds the hospital capabilities, the

hospital must provide an appropriate transfer of the patient to a hospital that can provide

the services needed. See §482.12(f)(2), Tag A-0093, interpretive guidelines for referral

when appropriate.

Survey Procedures §482.62(c)

• Interview staff to determine how the hospital meets the medical/surgical/diagnostic

needs of its patients.

• Interview patients who have required medical/surgical/diagnostic needs to

determine adequacy and quality of treatment.

• Review the medical, surgical, and diagnostic services provided by the hospital

during the interview with the clinical director. If the medical and surgical

services are provided by outside sources or another hospital, discuss the contract

or agreement with the clinical director to determine the kind and extent of

services provided.

• Ask the clinical director for copies of the agreements to verify the hospital has

agreements in place.

• Review medical records to verify if medical, surgical and diagnostic services are

provided timely and appropriately.

• Interview hospital staff at various locations. Ask them to describe how they

respond to emergencies and minor injuries or illnesses.

• For medical and surgical diagnostic and treatment services that are beyond the

capabilities of the hospital, verify the hospital has an agreement with an outside

source of these services to ensure they are immediately available or with a local

Medicare participating hospital for transferring patients.