CMS Transmittal 72

In November 2011, CMS issued Transmittal #72: Updated guidance provided to reflect regulatory changes concerning Rehabilitation and Respiratory Care Services; clarification of guidance concerning nursing services and pharmacy requirements.  While this transmittal was intended to expand the categories of practitioners who could order rehabilitation and respiratory care services beyond physicians, it sparked a significant amount of confusion and was actually having an opposite effect. 
On first reading Transmittal #72, many hospitals, clinics, and medical staff professionals interpreted it as indicating that ALL providers writing orders for rehabilitation and respiratory care services would need to be privileged by the hospital or clinic providing those services – an impossible task!  NAMSS leadership immediately sought clarification from CMS.
On February 17, 2012, CMS released S&C-12-17-Hospitals to clarify Transmittal #72’s intent.  We're happy to report that, in the end, as reported in the Memorandum Summary it comes down to common sense. “Privileging” practitioners who are not members of the medical staff will not be required.  Orders may be made by any practitioner who is:

  • Responsible for the care of the patient
  • Appropriately licensed in the jurisdiction where they see their patients
  • Acting within their scope of practice – there are 50 states, all with different state laws – the greatest difference is with PA's and NP's.  Check your state statutes.
  • Authorized by the medical staff pursuant to a written policy approved by the governing body
  • And "those holding privileges that include ordering the service" – i.e., a pathologist would not write orders for outpatient rehab, but an internist could.

The final word:  It pays to be vigilant with all legislation and to question confusing and ambivalent regulations.  NAMSS is here to help!

Read the S&C-12-17-Hospitals Clarification Memo

Read the Original CMS Transmittal #72

Questions? Please contact Molly Giammarco at