On April 3, 2015, CMS issued letter guidance and an update to the State Operations Manual (SOM), which will be of interest to outpatient therapy (OPT)  providers.  Medicare issued new clarifications on the survey requirements for off-premises activities for Outpatient Physical Therapy Providers, including addressing the oft-raised issue of whether a rehab agency can render services in assisted living facilities and under what circumstances.  The clarifications are effective immediately.

Among other things, CMS notes that the organization may provide therapy services in the patient’s private residence or in a patient’s room in a SNF/NF, in an assisted living facility, or in an independent living facility without becoming a certified extension location so long as such services areintermittent.  In contrast, CMS notes that an OPT provider would be considered to have a permanent presence if it has a dedicated therapy gym; stores equipment, supplies, or medical records at the facility; or has OPT staff regularly assigned to work at that facility directing an ongoing rehabilitation program at the facility.  Any of these situations would require the OPT provider to have the other location become separately certified or become approved as an extension location.

CMS also “reminds” providers of the policy that OPT providers must have “at least two persons (either of its own personnel or its contracted personnel) on duty anytime rehabilitation treatment is being provided to a patient.”  CMS notes that this is not a new requirement, but one that is “sometimes overlooked, particularly at a rehabilitation agency’s extension locations.”  In this clarification, CMS notes that the two person requirement was extended to anywhere a provider offers rehabilitation services, “including in assisted living and independent living facilities, in order to meet the regulation at 42 CFR 485.723(a)(6).”  Currently, the only exception for the two person duty requirement is when rehabilitation services are being provided at a patient’s private residence.  CMS clarifies that services provided in a patient’s room within an ALF or ILF are considered to be provided in a private residence and that common or general use areas of the facility, such as a hallway, are considered to be an extension of the patient’s room and residence and are also exempt from the two person requirement.