CMS SOM App. W, Tag C-1024

(1) General

(i) The CAH provides those diagnostic and therapeutic services and

supplies that are commonly furnished in a physician’s office or at another

entry point into the health care delivery system, such as a low intensity

hospital outpatient department or emergency department. These CAH

services include medical history, physical examination, specimen

collection, assessment of health status, and treatment for a variety of

medical conditions.

Interpretive Guidelines §485.635(b)(1)(i)

This regulation addresses the minimum level of outpatient services (with the exception of

emergency services – see §485.635(b)(4)) which a CAH must provide. Such services

must be provided on-site at the CAH, but may be provided either by CAH staff or under

an arrangement or contract. At a minimum, the CAH must provide those diagnostic and

therapeutic services and supplies which are typically found in an ambulatory healthcare

setting where patients first come into contact with the healthcare delivery system. The

services required to be provided must, at a minimum, reflect the scope and complexity of

services provided in a physician’s office or in a hospital outpatient or emergency

department that furnishes low intensity (i.e., less complex) services. Such services

include, but are not limited to: taking a patient’s medical history; conducting a physical

examination of the patient; specimen collection, assessment of health status, and

treatment for a variety of medical conditions. The extent of the CAH’s outpatient

services is expected to be sufficient to meet the needs of the patients it services for basic

ambulatory care services. Further, the CAH’s outpatient services must be integrated with

its inpatient services.

For those outpatient services that fall only within the scope of practice of a physician or

non-physician practitioner, in order to demonstrate compliance, a CAH physician or non-physician practitioner must be available to treat patients at the CAH when such outpatient

services are provided. This requirement does not mean the CAH must have a practitioner

physically present in the CAH 24 hours per day, seven days per week. See the discussion

of required emergency services at §485.618(d) concerning required response times for a

physician or non-physician practitioner to come to the CAH to provide medical care.

Survey Procedures §485.635(b)(1)(i)

• Does the CAH provide on-site outpatient services that are typical of those

provided in a physician office or low intensity hospital outpatient or emergency

department, including medical history, physical examination, specimen collection,

assessment of health status, and treatment for a variety of medical conditions?

• Determine that the outpatient services are integrated with the appropriate CAH

inpatient services in accordance with the needs of the patient care provided.

• Verify that the types and number of qualified personnel are appropriate for the

scope and complexity of the outpatient services offered. Review personnel files

or contracts to verify current licensure, certifications and training of staff

consistent with applicable State laws.

• Verify that equipment, staff and facilities are adequate to provide the outpatient

services and are in accordance with acceptable standards of practice.