In response to concerns raised by APTA and other associations, the Centers for Medicare and Medicaid Services (CMS) revised interpretative guidelines (Transmittal 72) to eliminate the requirement that rehabilitation services furnished in outpatient hospital settings be ordered by a practitioner with medical staff privileges. The new guidance issued to the State Survey Agency Directors on February 17 is effective immediately and includes the following language:
Requirements for Ordering Hospital Outpatient Services: Outpatient services in hospitals may be ordered (and patients may be referred for hospital outpatient services) by a practitioner who is:
Previous Guidance Superseded: This guidance supersedes the guidance for ?482.56(b) (Tag A-1132) and ?482.57(b)(3) (Tag A-1163) found in SC-11-28 (May 13, 2011) and State Operations Manual (SOM) Transmittal #72 (November 18, 2011).
The hospital's medical staff policy for authorizing practitioners to refer patients for outpatient services must address how the hospital verifies that the referring practitioner who is responsible for the patient's care is appropriately licensed and acting within his/her scope of practice.
Resolving this issue has been a high priority for APTA and its members. APTA believes that this language is a significant improvement. The Survey and Certification Policy Memorandum in its entirety will be available on CMS's Web site next week.