Medicare Certification Requirements for CORFs
July 1, 1997 2 minutes read
Medicare Certification Requirements for CORFs
A Comprehensive Outpatient Rehabilitation Facility (CORF) must meet all Conditions of Participation to be certified for Medicare reimbursement. The law states that a facility must, at a minimum:(a) be primarily engaged in providing (by or under the supervision of physicians) diagnostic, therapeutic, and restorative services to outpatients for the rehabilitation of injured, disabled, or sick persons;
(b) provide at least (I) the services of physicians who are available at the facility on a full- or part-time basis; (II) physical therapy; and (III) social or psychological services.
(c) maintain clinical records on all patients;
(d) have policies established by a group of professional personnel (associated with the facility), including one or more physicians to govern the comprehensive outpatient rehabilitation services it furnishes, and provide for the carrying out of such policies by a full- or part-time physician referred to in paragraph (b)(I);
(e) provide that every patient be under the care of a physician;
(f) in the case of a facility in any state in which state or applicable local law provides for the licensing of facilities of this nature, (I) be licensed pursuant to such law or (II) be approved by the agency of such state or locality responsible for licensing facilities of this nature as meeting the standard established for such licensing;
(g) have in effect a utilization review plan in accordance with regulations prescribed by the Secretary of Health and Human Services;
(h) have in effect an overall plan and budget;
(i) meet other such conditions of participation as the Secretary may find necessary in the interest of the health and safety of individuals who are furnished services by such facilities, including conditions concerning qualification of personnel in these facilities.
[Editor’s note: The American Rehabilitation Association, based in Reston, VA, has published a 96-page guidebook, How to Establish a CORF: Who They Are and What They Do. The book, updated in June 1996, reviews the history of CORFs as well legal requirements, reimbursement, cost reporting, and medical review. Cost is $45 for members and $69 for nonmembers. For more details, contact the American Rehabilitation Association, 1910 Association Drive, Suite 200, Reston, VA 20191. Telephone: (800) 368-3513.]
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