Outpatient Physical Therapy-Speech Pathology Survey Report {CMS-1893} | Pdf Fpdf Doc Docx | Official Federal Forms

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Outpatient Physical Therapy-Speech Pathology Survey Report {CMS-1893} | Pdf Fpdf Doc Docx | Official Federal Forms

Outpatient Physical Therapy-Speech Pathology Survey Report {CMS-1893}

This is a Official Federal Forms form that can be used for Centers For Medicare And Medicaid Services.

Alternate TextLast updated: 4/13/2015

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OUTPATIENT PHYSICAL THERAPY -- SPEECH PATHOLOGY SURVEY REPORT 42 CFR 485.703 Definitions (a) Clinic. A facility that is established primarily to furnish outpatient physician services and that meets the following tests of physician involvement: (1) The medical services are furnished by a group of three or more physicians practicing medicine together. (2) A physician is present during all hours of operation of the clinic to furnish medical services, as distinguished from purely administrative services. (b) Organization. A clinic, rehabilitation agency, or public health agency. (c) Public health agency. An official agency established by a State or local government, the primary function of which is to maintain the health of the population served by performing environmental health services, preventive medical services, and in certain cases, therapeutic services. (d) Rehabilitation agency. An agency that provides an integrated multidisciplinary rehabilitation program designed to upgrade the physical functioning of handicapped disabled individuals by bringing specialized rehabilitation staff together to perform as a team; and provides at least the following services: physical therapy or speech-language pathology services. (e) Extension location. A location or site from which a rehabilitation agency provides services within a portion of the total geographic area served by the primary site. The extension location is part of the rehabilitation agency. The extension location is located sufficiently close to share administration, supervision, and services in a manner that renders it unnecessary for the extension location to independently meet the conditions of participation as a rehabilitation agency. (f) Supervision. Authoritative procedural guidance that is for the accomplishment of a function or activity and that includes initial direction and periodic observation of the actual performance of the function or activity; and is furnished by a qualified person whose sphere of competence encompasses the particular function or activity; and who (unless otherwise provided in this subpart) is on the premises if the person performing the function or activity does not meet the assistant level practitioner qualifications specified in 485.705. (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(ll)(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-- 42 CFR 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. (1) Administrator. 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) Occupational Therapist. An occupational therapist must meet the qualifications set forth in § 484.4 of this chapter. (3) Occupational Therapy Assistant. An occupational therapy assistant must meet the qualifications set forth in § 484.4 of this chapter. (4) Physical Therapist. A physical therapist must meet the qualifications set forth in § 484.4 of this chapter. (5) Physical Therapist Assistant. A physical therapist assistant must meet the qualifications set forth in § 484.4 of this chapter. (6) Psychologist. A person who: (i) Holds a doctoral degree in psychology from a training program approved by the American Psychological Association; or (ii) Has attained certification or licensing by the State, or non-statutory certification by the State psychological association. (7) Speech-language pathologist. A person who meets either of the following requirements: (i) The education and experience requirements for a Certificate of Clinical Competence in speech-language pathology granted by the American Speech-Language-Hearing Association. (ii) The educational requirements for certification and is in the process of accumulating the supervised experience required for certification. Form CMS-1893 (01/13) American LegalNet, Inc. www.FormsWorkFlow.com 1 (8) Nurse practitioner. 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) Clinical nurse specialist. 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; or (iii) Be certified as a clinical nurse specialist by the American Nurses Credentialing Center. (10) Physician Assistant. A person who: (i) Has graduated from a physician assistant educational program that is accredited by the National Commission on Accreditation of Allied Health Education Programs; and (ii) Has passed the national certification examination that is certified by the National Commission on Certification of Physician Assistants; and (iii) Is licensed by the State as a physician assistant to practice as a physician assistant. Form CMS-1893 (01/13) American LegalNet, Inc. www.FormsWorkFlow.com 2 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES OUTPATIENT PHYSICAL THERAPY -- SPEECH PATHOLOGY SURVE

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