Comprehensive Outpatient Rehabilitation Facility (CORF) Services

10 - Comprehensive Outpatient Rehabilitation Facility (CORF) Services Provided by Medicare (Rev. 111, Issued: 09-25-09; Effective Date: 07-07-08; Implementation Date: 10-26- 09) The purpose of a Comprehensive Outpatient Rehabilitation Facility (CORF) is to permit the beneficiary to receive multidisciplinary rehabilitation services at a single location in a coordinated fashion. Section 1861(cc) of the Social Security Act specifies that no service may be covered as a CORF service if it would not be covered as an inpatient hospital service if provided to a hospital patient. This does not mean that the beneficiary requires a hospital level of care or meets other requirements unique to hospital care. This provision merely requires that the service, if otherwise covered, would be covered if provided in a hospital. CORF services are covered only if they relate directly to the rehabilitation for the treatment of injured, disabled, or sick patients. CORF services are not covered if not reasonable and medically necessary for the diagnosis, or treatment of illness, or injury, or to improve the function of a malformed body member. Thus, there must be potential for restoration or improvement of lost or impaired functions. For example, treatments involving repetitive exercises (i.e., maintenance programs, general conditioning or ambulation) that do not require the skilled services of physical therapists, occupational therapists, speech-language pathologists or respiratory therapists are not covered. Nonmedical personnel such as family members or exercise instructors could perform these activities in the patient’s residence. It is not reasonable and medically necessary for such activities to be performed in a CORF setting by CORF personnel. See 42CFR 410.100 and sections 20.1 and 20.2 of this chapter for the list of required and optional services provided in a CORF. CORF services do not include the following: a) provision of hyperbaric oxygen services, b) infusion therapy services, c) cardiac rehabilitation services, or d) diagnostic sleep studies. They do not meet the definition of a CORF services and/or they do not relate to the rehabilitation plan of treatment. These services, and other services not specifically listed as CORF services, may be covered under another Medicare benefit category, such as physician services, incident-to physician services, and diagnostic services. Physical therapy, occupational therapy, and speech-language pathology services may be furnished in the patient’s home, as CORF services, when payment for these therapy services is not otherwise made under the Medicare home health benefit. However, since the CORF premise is the primary location for furnishing these services, it is expected that a clear majority of the physical therapy, occupational therapy and speech-language pathology services delivered will be provided on the CORF premises for all CORF patients. In addition to the above noted services, which may be provided in the home, a single home environment evaluation visit is a covered CORF service if it is included in the rehabilitation plan of treatment. The patient must be present during the home environment evaluation that is performed by the physical therapist, occupational therapist, or speech-language pathologist, as appropriate. The patient’s presence is necessary to assess the patient’s current or future ability to function safely in the home environment and to determine the potential impact the home situation will have on the patient’s rehabilitation goals. Services provided under the “incident to” benefit may not be recognized as CORF services. Services furnished by CORF personnel, including registered nurses, physical therapists, occupational therapists, speech-language pathologists, respiratory therapists, social workers and psychologists are not considered as furnished incident-to physician services. The CORF physician must be present in the facility for a sufficient time to ensure that CORF services are provided in accordance with accepted principles of medical practice. All CORF services must be provided within acceptable professional standards and practice (§§42CFR485.70, and 410.100).