Rehabilitation Agencies
Medicare certified rehabilitation agencies provide an integrated multidisciplinary program designed to improve the physical function of individuals. At a minimum, a rehabilitation agency must provide physical therapy or speech pathology services.
Notices/Updates
Memo regarding the CMS initial survey priority for Rehab Agencies
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License/Certification Requirements
Certification is achieved by submission of a completed application, required documentation, and successful completion of a survey.
Unless required by the "Health Care Clinic Act", there are no state licensing requirements imposed by the Agency. Additional information on health care clinic licensure or exemption can be obtained from the Agency's Health Care Clinic webpage.
A change of address for a provider's primary practice location requires pre-notification to CMS (CMS-855A submitted to the Medicare Administrative Contractor) and an on-site survey by the approved accrediting organization (AO) or the state agency for non-accredited facilities. It is the responsibility of the provider to notify the AO that a survey is needed. An address change will not be approved for payment at the new location until the provider successfully passes the survey and the results are received by the state agency. Additional information can be found below under Regulations/Guidance.
Extension Locations for Rehabilitation Agencies
An extension location is defined at 42 CFR 485.703 as “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 agency. When a rehabilitation agency bills the Medicare program for services rendered from the premises of other institutions in an area set aside for rehabilitation care, these premises are considered extension units of a rehabilitation agency. Any instance in which the service is provided other than a patient's bedside or in a patient room is considered an extension unit. A premise that is owned or rented by the rehabilitation agency from which services are rendered is also considered an extension unit of the rehabilitation agency.
An extension location should be 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.” The extension location must be situated within a 30 mile radius of where 90 percent of the agency’s primary site’s population lives. Sites beyond that area may require the location to be independently certified as a primary site. Consideration may be given for greater or shorter distances based on unusual geographic features.
Regulations/Guidance
- 42 CFR, Part 485, Subpart H, Sections 485.701-.729
- CMS State Operations Manual[ ]
(See Sections 2290-2306) - Interpretive Guidelines - Appendix E[ ]
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Surveyors Checklist-CMS-1893
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Forms/Information
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Applicant Instructions
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- Request for Certification
in the Medicare Program - CMS Form 1856[ ] - Health Insurance Benefit Agreement - CMS Form 1561[ ]
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Medicare Administrative Contractor Choice Form
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Civil Rights Requirements
Rehabilitation Agencies must answer all questions and submit the Assurance of Compliance online to the Office of Civil Rights. The confirmation of successful submission must be included with paperwork submitted to the Agency. Click here for more information on Civil Rights Requirements.
Accreditation
Rehabilitation agencies accredited by an accrediting organization approved by CMS may be exempt from initial and recertification inspections by the Agency for Health Care Administration. A copy of the accreditation award letter and the complete accreditation report, including any corrective actions must be submitted to the Agency for review. If the accrediting organization does not include it in the award letter verification of Medicare deemed status must also be submitted.
NOTE: A change of address of the provider's primary practice location requires an on-site visit.
- Quad A
7500 Grand Avenue, Suite 200
Gurnee, IL 60031
Phone: Toll Free 888-545-5222
Email: [email protected]
Website: https://www.quada.org/
