CMS Revises Outpatient Hospital Referral Policy

Last Updated March 12, 2012

In response to concerns raised by professional therapy associations and hospital organizations about a limitation on outpatient hospital rehabilitation, the American Occupational Therapy Association (AOTA) is pleased to report that the Centers for Medicare & Medicaid Services (CMS) reviewed and revised the problematic policy following advocacy efforts by the associations. AOTA worked with several organizations to resolve issues created by the CMS release of Transmittal 72.  The transmittal, dated November 18, 2011, revised the Conditions of Participation and Interpretive Guidelines for Hospitals. The most immediate concern was that Transmittal 72 required orders for inpatient and outpatient therapy services to come only from medical staff who have privileges at the hospital. Following outreach to CMS, AOTA and other therapy and hospital organizations submitted a joint letter to CMS to bring attention to this issue. AOTA participated in a conference call with CMS and other organizations on February 6, 2012, to explain the significant impact of the transmittal and to answer CMS officials’ questions. The organizations requested that CMS rescind the transmittal and modify it in the future. 

AOTA’s position is that CMS should defer to state law with respect to which qualified and licensed practitioners may order rehabilitation services and should defer to policies and procedures established by each hospital regarding who is authorized to order these services for the hospital outpatient department. During the call, CMS officials indicated that the transmittal was under careful review and they would reach out to accrediting agencies and state surveyors to communicate this review.

CMS issued a Survey and Certification Memorandum on February 17, 2012 that supersedes portions of Transmittal 72 and provides that outpatient services in hospitals may be ordered (and patients may be referred for hospital outpatient services) by a practitioner who is

• Responsible for the care of the patient;
• Licensed in, or holds a license recognized in the jurisdiction where he/she sees the patient;
• Acting within his/her scope of practice under State law; and
• Authorized by the medical staff to order the applicable outpatient services under a written hospital policy that is approved by the governing body. This includes both practitioners who are on the hospital medical staff and who hold medical staff privileges that include ordering the services, as well as other practitioners who are not on the hospital medical staff, but who satisfy the hospital’s policies for ordering applicable outpatient services and for referring patients for hospital outpatient services.

Please contact the AOTA Reimbursement and Regulatory Policy Department at rrpd@aota.org if you have survey issues as a result of Transmittal 72.

Additional Information:

CMS provided an update on Transmittal 72 during the Hospital & Hospital Quality Open Door Forum on Wednesday, February 22 at 2:00 p.m. eastern time. See agenda.

HHS Survey & Certification Memo dated February 17, 2012:Referring Practitioners Ordering Outpatient Services in Hospitals