[Code of Federal Regulations]

[Title 42, Volume 3]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR485.56]



[Page 595-596]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 485_CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS--Table 

of Contents

 

    Subpart B_Conditions of Participation: Comprehensive Outpatient 

                        Rehabilitation Facilities

 

Sec. 485.56  Condition of participation: Governing body and 

administration.



    The facility must have a governing body that assumes full legal 

responsibility for establishing and implementing policies regarding the 

management and operation of the facility.

    (a) Standard: Disclosure of ownership. The facility must comply with 

the provisions of part 420, subpart C of this chapter that require 

health care providers and fiscal agents to disclose certain information 

about ownership and control.

    (b) Standard: Administrator. The governing body must appoint an 

administrator who--

    (1) Is responsible for the overall management of the facility under 

the authority delegated by the governing body;

    (2) Implements and enforces the facility's policies and procedures;

    (3) Designates, in writing, an individual who, in the absence of the 

administrator, acts on behalf of the administrator; and

    (4) Retains professional and administrative responsibility for all 

personnel providing facility services.

    (c) Standard: Group of professional personnel. The facility must 

have a group of professional personnel associated with the facility 

that--

    (1) Develops and periodically reviews policies to govern the 

services provided by the facility; and

    (2) Consists of at least one physician and one professional 

representing each of the services provided by the facility.

    (d) Standard: Institutional budget plan. The facility must have an 

institutional budget plan that meets the following conditions:

    (1) It is prepared, under the direction of the governing body, by a 

committee consisting of representatives of the governing body and the 

administrative staff.

    (2) It provides for--

    (i) An annual operating budget prepared according to generally 

accepted accounting principles;

    (ii) A 3-year capital expenditure plan if expenditures in excess of 

$100,000 are anticipated, for that period, for the acquisition of land; 

the improvement of land, buildings, and equipment; and the replacement, 

modernization, and expansion of buildings and equipment; and

    (iii) Annual review and updating by the governing body.

    (e) Standard: Patient care policies. The facility must have written 

patient care policies that govern the services it furnishes. The patient 

care policies must include the following:

    (1) A description of the services the facility furnishes through 

employees and those furnished under arrangements.

    (2) Rules for and personnel responsibilities in handling medical 

emergencies.

    (3) Rules for the storage, handling, and administration of drugs and 

biologicals.

    (4) Criteria for patient admission, continuing care, and discharge.

    (5) Procedures for preparing and maintaining clinical records on all 

patients.

    (6) A procedure for explaining to the patient and the patient's 

family the extent and purpose of the services to be provided.

    (7) A procedure to assist the referring physician in locating 

another level of care for--patients whose treatment has terminated and 

who are discharged.

    (8) A requirement that patients accepted by the facility must be 

under the care of a physician.

    (9) A requirement that there be a plan of treatment established by a 

physician for each patient.

    (10) A procedure to ensure that the group of professional personnel 

reviews



[[Page 596]]



and takes appropriate action on recommendations from the utilization 

review committee regarding patient care policies.

    (f) Standard: Delegation of authority. The responsibility for 

overall administration, management, and operation must be retained by 

the facility itself and not delegated to others.

    (1) The facility may enter into a contract for purposes of 

assistance in financial management and may delegate to others the 

following and similar services:

    (i) Bookkeeping.

    (ii) Assistance in the development of procedures for billing and 

accounting systems.

    (iii) Assistance in the development of an operating budget.

    (iv) Purchase of supplies in bulk form.

    (v) The preparation of financial statements.

    (2) When the services listed in paragraph (f)(1) of this section are 

delegated, a contract must be in effect and:

    (i) May not be for a term of more than 5 years;

    (ii) Must be subject to termination within 60 days of written notice 

by either party;

    (iii) Must contain a clause requiring renegotiation of any provision 

that CMS finds to be in contravention to any new, revised or amended 

Federal regulation or law;

    (iv) Must state that only the facility may bill the Medicare 

program; and

    (v) May not include clauses that state or imply that the contractor 

has power and authority to act on behalf of the facility, or clauses 

that give the contractor rights, duties, discretions, or 

responsibilities that enable it to dictate the administration, 

mangement, or operations of the facility.