Conditions of Participation
for Clinics, Rehabilitation Agencies and Public Health Agencies as Providers of Outpatient
Physical Therapy and Speech Language Pathology Services: Plan of Care and Physician
Involvement - INFORMATION
PDF Version
of OQA 00-032 (PDF, 5 KB)
Outpatient Rehabilitation Facilities: Introduction | Contacts | Publications
Date: April 5, 2000 DSL-BQA-00-032
To: Outpatient Rehabilitation Facilities OPT/SP 03
From: Susan Schroeder, Director, Bureau of Quality Assurance
This is to inform you that effective January 1, 2000, as a result of a revision to the
Code of Federal Regulations at 42 CFR 485.711(b), nurse practitioners, clinical nurse
specialists and physician assistants are able to review plans of care and results of
treatment at least every 30 days for Medicare patients. Formerly, only physicians could
review the plans of care and results of treatment for Medicare patients. Definitions of
these personnel have been added to Part 485.705.
The changes noted above are located in the Federal Register/Vol.63, No. 211. The
Federal Register and Code of Federal Regulations may be accessed electronically through
the following website:
http://www.access.gpo.gov/su_docs/aces/aces140.html
(exit DHFS) [address updated]
The revised code language is included on the following pages of this memo with the
changes underlined.
Questions may be addressed to Helen Brewster, Bureau of Quality Assurance, Health
Services Section, (608)
243-2089.
42CFR485 .705 PART 485--CONDITIONS OF PARTICIPATION:
SPECIALIZED PROVIDERS--Table of Contents Subpart H--Conditions of Participation for
Clinics, Rehabilitation Agencies, and Public Health Agencies as Providers of Outpatient
Physical Therapy and Speech-Language Pathology Services Sec. 485.705
Personnel qualifications. (a) General qualification requirements. Except as specified in
paragraphs (b) and (c) of this section, all personnel who are involved in the furnishing
of outpatient physical therapy, occupational therapy, and speech-language pathology
services directly by or under arrangements with an organization must be legally authorized
(licensed or, if applicable, certified or registered) to practice by the State in which
they perform the functions or actions, and must act only within the scope of their State
license or State certification or registration. (b) Exception for Federally defined
qualifications. The following Federally defined qualifications must be met: (1) For a
physician, the qualifications and conditions as defined in section 1861(r) of the Act and
the requirements in part 484 of this chapter. (2) For a speech-language pathologist, the
qualifications specified in section 1861(11)(1) of the Act and the requirements in part
484 of this chapter. (c) Exceptions when no State Licensing laws or State certification or
registration requirements exist. If no State licensing laws or State certification or
registration requirements exist for the profession, the following requirements must be
met-- (1) An administrator is a person who has a bachelor's degree and: (i) Has experience
or specialized training in the administration of health institutions or agencies; or (ii)
Is qualified and has experience in one of the professional health disciplines. (2) An
occupational therapist must meet the requirements in part 484 of this chapter. (3) An
occupational therapy assistant must meet the requirements in part 484 of this chapter. (4)
A physical therapist must meet the requirements in part 484 of this chapter. (5) A
physical therapist assistant must meet the requirements in part 484 of this chapter. (6) A
social worker must meet the requirements in part 484 of this chapter. (7) A vocational
specialist is a person who has a baccalaureate degree and-- (i) Two years experience in
vocational counseling in a rehabilitation setting such as a sheltered workshop, State
employment service agency, etc.; or (ii) At least 18 semester hours in vocational
rehabilitation, educational or vocational guidance, psychology, social work, special
education or personnel administration, and 1 year of experience in vocational counseling
in a rehabilitation setting; or (iii) A master's degree in vocational counseling. (8)
After
December 31, 1999, a nurse practitioner is a person who must: (i) Possess a master's
degree in nursing; (ii) Be a registered professional nurse who is authorized by the State
in which the services are furnished, to practice as a nurse practitioner in accordance
with State law; and, (iii) Be certified as a nurse practitioner by the American Nurses
Credentialing Center. (9) A clinical nurse specialist is a person who must: (i) Be a
registered nurse who is currently licensed to practice in the State where he or she
practices and be authorized to perform the services of a clinical nurse specialist in
accordance with State law; (ii) Have a master's degree in a defined clinical area of
nursing from an accredited educational institution; and, (iii) Be certified as a clinical
nurse specialist by the American Nurses Credentialing Center. (10) A physician assistant
is a person who: (i) Has graduated from a physician assistant educational program that is
accredited by the Commission on Accreditation of Allied Health Education Programs; or (ii)
Has passed the national certification examination that is administered by the National
Commission on Certification of Physician Assistants; and (iii) Is licensed by the State to
practice as a physician assistant.
42CFR485 .711 PART 485--CONDITIONS OF PARTICIPATION:
SPECIALIZED PROVIDERS--Table of Contents Subpart H--Conditions of Participation for
Clinics, Rehabilitation Agencies, and Public Health Agencies as Providers of Outpatient
Physical Therapy and Speech-Language Pathology Services Sec. 485.711
Condition of participation: Plan of care and physician involvement. For each patient in
need of outpatient physical therapy or speech pathology services there is a written plan
of care established and periodically reviewed by a physician, or by a physical therapist
or speech pathologist respectively. The organization has a physician available to furnish
necessary medical care in case of emergency. (a) Standard: Medical history and prior
treatment. The following are obtained by the organization before or at the time of
initiation of treatment: (1) The patient's significant past history. (2) Current medical
findings, if any. (3) Diagnosis(es), if established. (4) Physician's orders, if any. (5)
Rehabilitation goals, if determined. (6) Contraindications, if any. (7) The extent to
which the patient is aware of the diagnosis(es) and prognosis. (8) If appropriate, the
summary of treatment furnished and results achieved during previous periods of
rehabilitation services or institutionalization. (b) Standard: Plan of care. (1) For each
patient there is a written plan of care established by the physician or by the physical
therapist or speech-language pathologist who furnishes the services. (2) The plan of care
for physical therapy or speech pathology services indicates anticipated goals and
specifies for those services the-- (i) Type; (ii) Amount; (iii) Frequency; and (iv)
Duration. (3) The plan of care and results of treatment are reviewed by the physician or
by the individual who established the plan at least as often as the patient's condition
requires, and the indicated action is taken. (For Medicare patients, the plan must be
reviewed by a physician, nurse practitioner, clinical nurse specialist, or physician
assistant at least every 30 days, in accordance with Sec. 410.61(e) of this chapter.)
(4) Changes in the plan of care are noted in the clinical record. If the patient has an
attending physician, the therapist or speech-language pathologist who furnishes the
services promptly notifies him or her of any change in the patient's condition or in the
plan of care. (c) Standard: Emergency care. The organization provides for one or more
doctors of medicine or osteopathy to be available on call to furnish necessary medical
care in case of emergency. The established procedures to be followed by personnel in an
emergency cover immediate care of the patient, persons to be notified, and reports to be
prepared.
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