New Medicare Guidelines Limit Physician Orders for Hospital Rehabilitation Patients

January 25, 2012

(Update: Medicare Issues Memorandum Clarifying Orders for Outpatient Services)

On November 18, 2011, the Centers for Medicare and Medicaid Services (CMS) released guidance (CMS Transmittal 72 [PDF]) to reportedly reflect regulatory changes in hospital rehabilitation and respiratory care services. The current regulations include broad language stating that services must be ordered by a qualified and licensed practitioner who is responsible for the care of the patient and who is authorized by the hospital medical staff to order the services. However, Transmittal 72, which is an interpretive guideline, indicates the practitioner must have medical staff privileges.

ASHA recognizes the barriers to care that result in this guidance as well as the inconsistencies with previous publications by CMS in the Federal Register (August 16, 2010, and October 24, 2011). ASHA staff are partnering with representatives from the American Physical Therapy Association (APTA), the American Occupational Therapy Association (AOTA), the American Medical Rehabilitation Providers Association (AMRPA), the Federation of American Hospitals (FAH), and the American Hospital Association (AHA) to request CMS to rescind Transmittal 72 and amend the guidelines to be consistent with previous CMS policy statements, which allow state laws and regulations, as well as hospital policy and staff, to determine ordering privileges of rehabilitation services.

Please contact Lisa Satterfield, ASHA's director of health care regulatory advocacy, at with any questions or concerns.

ASHA Corporate Partners