Outpatient Rehabilitation Admission, Exclusion, Continued Stay, and Discharge Criteria

Policy/Purpose:  Individuals seeking outpatient rehabilitation services will be considered candidates for services when certain criteria are met.  The admission criteria include, but are not limited to, the below.

Responsible Personnel:

Admission Criteria:  The criteria for providing outpatient rehabilitation services include the following:

  1. There must be an order for rehabilitation services, except for patients seen through direct access.
  2. Services are deemed to be reasonable and necessary.
  3. Services require the skilled services of a licensed therapist.
  4. The person served must:
    1. Be medically stable to the degree that participation in treatment is safe and beneficial.
    2. Demonstrate a significant functional limitation that alters or prevents participation in desired life functions.
    3. Be expected to make significant functional improvement within a reasonable period of time as defined by the therapist in the rehabilitation plan of care.
    4. Have the ability to learn and benefit from rehabilitation.
    5. Be able to manage his/her own personal care or have a caregiver available to assist.
    6. Have the ability to travel and attend appointments as scheduled.

Exclusion Criteria:  The criteria for excluding one from receiving outpatient rehabilitation services include, but are not limited to, the following:

  1. Client demonstrates aggressive behaviors that post a threat to the safety of him/herself or others.
  2. Client has received a course of outpatient therapy for the same issues/goals and whose functional status remains unchanged or has not progressed.

Continuing Stay Criteria:  Each of the following conditions must be met in order to justify continuation of services.

  1. Services continue to be reasonable and necessary.
  2. The patient’s condition and treatment plan require the experience and expertise of a skilled therapist.
  3. The patient is able to tolerate and participate actively in therapy.
  4. The patient demonstrates potential for functional improvement.
  5. Continuous progress has been demonstrated and documented in the clinical notes.

Discharge Criteria:  Patients receiving outpatient rehabilitation services will be discharged from services when certain criteria are met.  The discharge criteria include, but are not limited to, the following:

  1. The person served has achieved the goals that were established or updated in the most recent plan of care.
  2. Services are no longer reasonable and necessary or the services of skilled therapists are no longer required, except individuals who are self-pay for maintenance programs.
  3. The individual’s progress has slowed or temporarily stopped and he/she is no longer benefiting from the services of the program.
  4. The presence of medical, psychological or social problems hinder the individual’s ability to participate.
  5. An interruption in therapy services has occurred for greater than 30 days unless it is part of the plan of care.
  6. The physician requests that therapy services be discontinued.
  7. The person served is non-compliant with the program.
  8.  The person repeatedly exhibits behaviors that cause safety concerns for others.
  9. The person served declines to continue care.
  10. The care of the person served is being transferred to another provider
  11. The person served has missed three scheduled appointments without contacting his/her clinic at least 24 hours in advance.  These individuals will be required to obtain a new physician’s order before more appointments are scheduled.


Medical Necessity – Services deemed “reasonable and necessary:”

  1. Must be specific and effective treatments for the patient’s condition.
  2. Must require the expertise, knowledge, clinical judgment, decision making, and abilities of a therapist or therapist assistant that other staff, caretakers, or the patient cannot provide independently.
  3. Should be reasonable under accepted standards of practice with regard to amount, frequency, and duration.