42 C.F.R. Subpart D—Comprehensive Outpatient Rehabilitation Facility (CORF) Services
Title 42 - Public Health
Subject to the conditions and limitations set forth in §§410.102 and 410.105, CORF services means the following services furnished to an outpatient of the CORF by personnel that meet the qualifications set forth in §485.70 of this chapter. (a) Physicians' services. The following services of the facility physician constitute CORF services: consultation with and medical supervision of non-physician staff, establishment and review of the plan of treatment, and other medical and facility administration activities. Those services are reimbursed on a reasonable cost basis under part 413 of this chapter. Diagnostic and therapeutic services furnished to an individual patient are not CORF physician's services. If covered, payment for these services would be made by the carrier on a reasonable charge basis subject to the provisions of subpart E of part 405 of this chapter. (b) Physical therapy services. (1) These services include— (i) Testing and measurement of the function or dysfunction of the neuromuscular, musculoskeletal, cardiovascular and respiratory systems; and. (ii) Assessment and treatment related to dysfunction caused by illness or injury, and aimed at preventing or reducing disability or pain and restoring lost function. (2) The establishment of a maintenance therapy program for an individual whose restoration potential has been reached is a physical therapy service; however, maintenance therapy itself is not covered as part of these services. (c) Occupational therapy services. These services include— (1) Teaching of compensatory techniques to permit an individual with a physical impairment or limitation to engage in daily activities. (2) Evaluation of an individual's level of independent functioning. (3) Selection and teaching of task-oriented therapeutic activities to restore sensory-integrative function; and (4) Assessment of an individual's vocational potential, except when the assessment is related solely to vocational rehabilitation. (d) Speech-language pathology services. These are services for the diagnosis and treatment of speech and language disorders that create difficulties in communication. (e) Respiratory therapy services. (1) These are services for the assessment, diagnostic evaluation, treatment, management, and monitoring of patients with deficiencies or abnormalities of cardiopulmonary function. (2) These services include— (i) Application of techniques for support of oxygenation and ventilation of the patient and for pulmonary rehabilitation. (ii) Therapeutic use and monitoring of gases, mists, and aerosols and related equipment; (iii) Bronchial hygiene therapy; (iv) Pulmonary rehabilitation techniques such as exercise conditioning, breathing retraining and patient education in the management of respiratory problems. (v) Diagnostic tests to be evaluated by a physician, such as pulmonary function tests, spirometry and blood gas analysis; and (vi) Periodic assessment of chronically ill patients and their need for respiratory therapy. (f) Prosthetic device services. These services include— (1) Prosthetic devices (excluding dental devices and renal dialysis machines), that replace all or part of an internal body organ or external body member (including contiguous tissue) or replace all or part of the function of a permanently inoperative or malfunctioning external body member or internal body organ; and (2) Services necessary to design the device, select materials and components, measure, fit, and align the device, and instruct the patient in its use. (g) Orthotic device services. These services include— (1) Orthopedic devices that support or align movable parts of the body, prevent or correct deformities, or improve functioning; and (2) Services necessary to design the device, select the materials and components, measure, fit, and align the device, and instruct the patient in its use. (h) Social services. These services include— (1) Assessment of the social and emotional factors related to the individual's illness, need for care, response to treatment, and adjustment to care furnished by the facility; (2) Casework services to assist in resolving social or emotional problems that may have an adverse effect on the beneficiary's ability to respond to treatment; and (3) Assessment of the relationship of the individual's medical and nursing requirements to his or her home situation, financial resources, and the community resources available upon discharge from facility care. (i) Psychological services. These services include— (1) Assessment, diagnosis and treatment of an individual's mental and emotional functioning as it relates to the individual's rehabilitation; (2) Psychological evaluations of the individual's response to and rate of progress under the treatment plan; and (3) Assessment of those aspects of an individual's family and home situation that affect the individual's rehabilitation treatment. (j) Nursing care services. These services include nursing services specified in the plan of treatment and any other nursing services necessary for the attainment of the rehabilitation goals. (k) Drugs and biologicals. These are drugs and biologicals that are— (1) Prescribed by a physician and administered by or under the supervision of a physician or a registered professional nurse; and (2) Not excluded from Medicare Part B payment for reasons specified in §410.29. (l) Supplies, appliances, and equipment. These include— (1) Non-reusable supplies such as oxygen and bandages; (2) Medical equipment and appliances; and (3) Durable medical equipment of the type specified in §410.38, (except renal dialysis systems) for use outside the CORF, whether purchased or rented. (m) Home environment evaluation. This is a single home visit to evaluate the potential impact of the home situation on the rehabilitation goals. [51 FR 41339, Nov. 14, 1986; 52 FR 4499, Feb. 12, 1987] None of the services specified in §410.100 is covered as a CORF service if the service— (a) Would not be covered as an inpatient hospital service if furnished to a hospital inpatient; (b) Is not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. An example would be services furnished as part of a maintenance program involving repetitive activities that do not require the skilled services of nurses or therapists. Services specified in §410.100 and not excluded under §410.102 are covered as CORF services if they are furnished by a participating CORF (that is, a CORF that meets the conditions of subpart B of part 485 of this chapter, and has in effect a provider agreement under part 489 of this chapter) and if the following requirements are met: (a) Referral and medical history. The services must be furnished to an individual who is referred by a physician who certifies that the individual needs skilled rehabilitation services, and makes the following information available to the CORF before or at the time treatment is begun: (1) The individual's significant medical history. (2) Current medical findings. (3) Diagnosis(es) and contraindications to any treatment modality. (4) Rehabilitation goals, if determined. (b) When and where services are furnished. (1) All services must be furnished while the individual is under the care of a physician. (2) Except as provided in paragraph (b)(3) of this section, the services must be furnished on the premises of the CORF. (3) Exceptions. (i) Physical therapy, occupational therapy, and speech pathology services may be furnished away from the premises of the CORF. (ii) The single home visit specified in §410.100(m) is also covered. (c) Plan of treatment. (1) The services must be furnished under a written plan of treatment that— (i) Is established and signed by a physician before treatment is begun; and (ii) Prescribes the type, amount, frequency, and duration of the services to be furnished, and indicates the diagnosis and anticipated rehabilitation goals. (2) The plan must be reviewed at least every 60 days by a facility physician who, when appropriate, consults with the professional personnel providing the services. (3) The reviewing physician must certify or recertify that the plan is being followed, the patient is making progress in attaining the rehabilitation goals, and the treatment is having no harmful effects on the patient. [51 FR 41339, Nov. 14, 1986, as amended at 56 FR 8841, Mar. 1, 1991]
Title 42: Public Health
PART 410—SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS
Subpart D—Comprehensive Outpatient Rehabilitation Facility (CORF) Services
§ 410.100 Included services.
§ 410.102 Excluded services.
§ 410.105 Requirements for coverage of CORF services.
