AAAASF Cross Reference

MEDICARE OUTPATIENT PHYSICAL THERAPY (OPT) ACCREDITATION STANDARDS MANUAL

Version 3.1, Effective March 1, 2022

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SECTION 5:  IN CASE OF EMERGENCY

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​Sub-Section D: Emergency Preparedness Plan

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Disaster Preparedness Policy and Procedure

Emergency Management Plan

Disaster Code

Emergency Preparedness Box Inventory List

Emergency Resource Call List

Risk Assessment - 2020

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Sub-Section E: Emergency Preparedness Plan – Integrated Healthcare System

BELIEVE THERAPIES COMPLIANCE DOCUMENTS

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SECTION 11:  PERSONNEL

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Sub-Section E: Facility Staffing

BELIEVE THERAPIES COMPLIANCE DOCUMENTS

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Sub-Section J: Vaccination Status

BELIEVE THERAPIES COMPLIANCE DOCUMENTS

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SECTION 15: OUTPATIENT PHYSICAL THERAPY (OPT)

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Sub-Section A: Personnel Qualifications

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Sub-Section B: Compliance with Federal, State, and Local Law

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Policy and Procedure

State Fire Marshall Inspection and Report:  2020

Statement of Discontinuation of Fire Panel Monitoring - Federal Register Vol. 81, No. 86 (see page 26886)

Facility Inspections: 

• Annual Fire Extinguisher Inspection Invoice:  2020

• Monthly Fire Extinguisher Inspection Log (sample log - see Maintenance Binder for completed logs)

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Sub-Section C: Administrative Management

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Policy and Procedure

Organizational Board

Administrator Letter of Appointment by Managing Members (Original) - 2020, 2022

Alternate Administrator Letter of Appointment by Managing Members (Original) - 2020, 2022

Job Description Acknowledgement Form (Original)

Job Descriptions:

• Administrator - Business Administrator & Clinical Administrator

• Division 1 – Establishment Manager

• Division 2 – Client Services Manager

  • Authorizations

  • Intake Coordinator

  • Receptionist

• Division 3 – Finance Manager

  • Billing Specialist

  • Collections Specialist

• Division 4 – Therapy Services Manager

  • Occupational Therapist

  • Occupational Therapist Assistant

  • Physical Therapist

  • Physical Therapist Assistant

  • Speech Language Pathologist

  • Speech Language Pathologist Assistant

  • Therapy Technician

• Division 5 – Quality Manager

• Division 6 – Marketing Manager

Additional Hats:

• Senior Therapist

• Client Advocate

• HIPAA Security Officer

• HIPAA Privacy Officer

Business Administrator Performance Review (Original)

Clinical Administrator Performance Review (Original)

Employee Performance Review – Therapy Staff (Original)

Employee Performance Review – Office Staff (Original)

Proof of Purchase of Texas Workforce Postings (Receipt)

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Sub-Section D: Plan of Care and Physician Involvement

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Policy and Procedure

ATTACHMENTS

• Annual Committee Meeting

  • Meeting Guidelines​

  • Meeting Minutes:  2020 + Attachments / 2021 + Attachments / 2022 + Attachments

• Signed Physician’s Acknowledgement Letter (Dr. David Prier, 2012)

• Emergency Care Procedure (Posting)

• Incident Report Form (Original)

• Incident Report Annual Log (Original)

• Emergency Resource Call List (Posting)

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Sub-Section E: Physical Therapy Services

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Policy and Procedure

Biomedical Inspections - 2021, 2022

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Sub-Section F: Occupational Therapy Services

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**NEW SECTION - POLICY AND PROCEDURE NEEDS TO BE COMPLETED - NOW SPLIT FROM PHYSICAL THERAPY SERVICES (SUB-SECTION E)

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Sub-Section G: Speech Pathology Services

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Policy and Procedure

Audiometer Care and Use

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Sub-Section H: Rehabilitation Program

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Policy and Procedure

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Sub-Section I: Arrangements for Services to be Performed By Other Than Salaried Organization Personnel

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Policy and Procedure

Sample of Contract Employee Agreement

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Sub-Section J: Clinical Records

Policy and Procedure

ATTACHMENTS

• Quarterly Committee Meeting

  • Meeting Guidelines​

  • Meeting Minutes:  2020 (Q1, Q2, Q3, Q4), 2021 (Q1, Q2, Q3, Q4), 2022 (Q1, Q2, Q3, Q4)

• Chart Audit Form (Original)

• Confidentiality Statement (Original)

• Authorization for Request of Protected Health Information (Original)

• Authorization for Disclosure of Protected Health Information (Original)

• Client Request for Amendment to Protected Heath Information (Original)

• Client Intake Paperwork (Original)

• Compliance Plan Mandate (see Federal Register/Vol. 65, No. 194, page 59434)

• Compliance Plan

• HIPAA Training 

• HIPAA Training Quiz

• Client Complaint Policy

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Sub-Section K: Physical Environment

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Policy and Procedure

ATTACHMENTS

• Sample Maintenance Log Form (Original)

• Monthly Log for Inspection of the Grounds (Original)

• Bio-hazard Information (Receipt)

• OSHA Form 300 (Original)

**See Maintenance Binder for Working Maintenance Forms**

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Sub-Section L: Infection Control

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Policy and Procedure

COVID-19 Preparedness and Response, Policy and Procedure, and Compliance Audit Form

ATTACHMENTS

• Annual Committee Meeting

  • Meeting Guidelines​

  • Meeting Minutes:  2020 + Attachments / 2021 + Attachments / 2022 + Attachments

• Cleaning Guides

  • Ball Pit / Cloud Pit Cleaning Guide

  • Hydrocollator Cleaning Guide or Use of Hot / Cold Packs

  • Mat Cleaning Guide (within gym cleaning guide)

  • Whirlpool (footbath) Usage Guide / Cleaning Guide 

• Facility Cleaning Logs:

  • Gym​

  • Kitchen

  • Office

  • Restrooms

  • Storage Closets

  • Treatment Rooms

  • Waiting Rooms 

• Documentation of Pest Control​ 

  • Description of Current Lease Agreement​

  • Annual Documentation of Completed Services: 2021, 2022

• Wall Postings: 

  • Cleaning Station Supplies

  • Clean Up and Disposal of Vomit

  • Food Handling

  • Hand Washing 

  • Hand Sanitizing 

  • Stop the Spread of Germs

  • Washing Linens​

• Consent Form for Blood Borne Pathogens​ (Original)

• Authorization / Declination for Hepatitis B Vaccination (Original)

• Infection Control Monthly Maintenance Log (Original)

  • **Completed forms can be found in the Maintenance Binder

• Infectious Disease Annual Log (Original)​

  • **Completed forms can be found in the annual meeting minutes attachments​

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Sub-Section M: Program Evaluation

Policy and Procedure

ATTACHMENTS

• Annual Committee Meeting

  • Meeting Guidelines​

  • Meeting Minutes:  2020 + Attachments / 2021 + Attachments / 2022 + Attachments

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