CMS SOM App. W, Tag C-1052

Physical therapy, occupational therapy, and speech-language therapy pathology

services furnished at the CAH, if provided, are provided by staff qualified under

State law, and consistent with the requirements for therapy services in §409.17 of

this subpart.

Interpretive Guidelines §485.635(e)

Rehabilitation services are optional CAH services. If a CAH provides any rehabilitative

services to its patients, either directly or under arrangement or agreement, either inpatient

or outpatient, the services must be provided by staff qualified under State law, and

consistent with the requirements for therapy services in §409.17. Rehabilitation services

services can be initiated only upon the order of a practitioner responsible for the care of

the patient. Physical therapy, occupational therapy, or speech-language pathology must

be furnished in accordance with the regulation at 42 CFR 409.17, which specifies the

following rehabilitation services plan of care requirements:

• Establishment of the plan: “The plan must be established before treatment begins by

one of the following: (1) A physician; (2) A nurse practitioner, a clinical nurse

specialist or a physician assistant; (3) The physical therapist furnishing the physical

therapy services; (4) A speech-language pathologist furnishing the speech-language

pathology services; (5) An occupational therapist furnishing the occupational therapy

services.”

• Content of the plan: “The plan: (1) Prescribes the type, amount, frequency, and

duration of the physical therapy, occupational therapy, or speech-language pathology

services to be furnished to the individual; and (2) Indicates the diagnosis and

anticipated goals.”

• Changes in the plan: “Any changes in the plan are implemented in accordance with

the provider’s policies and procedures.”

Also in accordance with 42 CFR 409.17, rehabilitation services must be provided by

qualified physical therapists, physical therapy assistants, occupational therapists,

occupational therapy assistants, and/or speech-language pathologists who meet the

personnel qualifications defined in 42 CFR 484.4. CAHs must have policies and

procedures consistent with State law.

Rehabilitation services must be provided according to national standards of practice as

established by professional organizations such as, but not limited to, the American

Physical Therapy Association, the American Occupational Therapy Association, and the

American Speech-Language-Hearing Association.

Survey Procedures §485.635(e)

If the CAH provides rehabilitation services:

• Review clinical records of patients who received rehabilitation services.

Determine whether the required care plan was developed and implemented.

• Review employee personnel files to verify the rehabilitation service providers

(i.e., physical therapists, physical therapy assistants, occupational therapists,

occupational therapy assistants, and/or speech-language pathologists) have the

necessary education, experience, training, and documented competencies to

provide rehabilitation services.

• Ask the CAH what national standards of rehabilitation practice provide the basis

for its rehabilitation services. Is there supporting documentation?