CMS SOM App. W, Tag C-1036

or more providers or suppliers participating under Medicare to furnish other services

to its patients, including—]

(i) Services of doctors of medicine or osteopathy;

§485.635(c)(2) If the agreements or arrangements are not in writing, the CAH is

able to present evidence that patients referred by the CAH are being accepted and

treated.

Interpretive Guidelines §485.635(c)(1)(i) & §485.635(c)(2)

In accordance with §485.631(a)(1), the CAH is required to have at least one doctor of

medicine or osteopathy (MD or DO) on its staff who is responsible for the functions

described in §485.631(b). CAHs are free to have additional MDs or DOs on staff, part-

or full-time. MDs and DOs who have been credentialed and privileged to provide

services on-site at the CAH are part of the CAH’s professional healthcare staff, even if

they are not at the CAH full-time; they would not be considered to be providing services

under an arrangement and would not be covered by these regulatory provisions. These

regulations also do not apply to MDs and DOs who provide telemedicine services to the

CAH’s patients, even when they are provided under arrangement. (See §485.616(c) and

§485.635(c)(5) concerning telemedicine requirements.)

Under §485.635(c)(1)(i) & §485.635(c)(2), the CAH must have policies and procedures

for referring patients it discharges who need additional specialized MD or DO services

not available at the CAH. The policies and procedures must at a minimum identify the

services for which the CAH has referral arrangements or agreements, as well as the

information to be provided to referred patients. MDs and DOs to whom the CAH refers

its patients must participate in Medicare.

The CAH is not required to have referral arrangements in writing, but if it does not, then

it must be able to document that patients it has referred to an outside MD or DO have

been offered appointments and treatment.

Survey Procedures §485.635(c)(1)(i) & §485.635(c)(2)

• Verify that the CAH has arrangements with one or more MDs or DOs for referral

of discharged CAH patients who need medical services not available at the CAH.

• Are the referral arrangements in writing? If not, can the CAH document that

patients referred to an outside MD or DO have been offered appointments and

treatment?

• Does the CAH have policies and procedures addressing referral of discharged

patients? Are the CAH’s practitioners and staff who handle the discharge of

patients familiar with these policies and procedures?