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QUAD ANov 1, 2023 3:22:53 PM2 min read

Outpatient Physical Therapy Administrator Roles

An increase in the number of questions has been received in the QUAD A Standards mailbox at standards@quada.org regarding the roles of the Outpatient Physical Therapy (OPT) Administrator and the Temporary Administrator. In addition, there has been a noticeable increase in the number of deficiencies being cited for standards that involve these roles Hopefully, this information will be helpful in aligning your OPT facility for success in compliance with standards related to the OPT Administrator and the Temporary Administrator.

The majority of the QUAD A OPT standards are cross-referenced to a Centers for Medicare and Medicaid Services (CMS) Conditions of Participation (CoPs). CMS has not updated the OPT CoPs since July 25, 2014, so these standards and requirements should not seem new.

QUAD A Standard 15-C-3 requires: The governing body appoints a qualified full-time administrator. The intent of this standard is that the governing body appoints ONE full-time employee to oversee the OPT including any extension sites associated with the OPT’s primary site. This means ONE OPT Administrator per CMS Certification Number (CCN).

Additionally, QUAD A Standard 15-C-6 requires: The governing body designates a competent individual to act during the temporary absence of the administrator. The intent of this standard is that the governing body must designate ONE alternate administrator for the OPT that is similarly qualified as the administrator and is always readily available (on the premises) to assume the administrator’s responsibilities when the administrator is unable to carry out delegated duties due to their absence. This one alternate administrator would also be the alternate administrator for all extension sites associated with the OPT’s primary site. This does not mean that there is an alternate administrator at each site. Again, this means one designated OPT alternate administrator per CCN.

The personnel requirements of the administrator are defined at §485.705 (c)(1)(i)(ii). These qualifications include:

(1) An administrator is a person who has a bachelor’s degree and;

(i) Has experience or specialized training in the administration of health institutions or agencies; or

(ii) Is qualified and has experience in one of the professional health disciplines.

Because the alternate administrator must be similarly qualified as the administrator, the personnel qualifications are the same for the alternate administrator.

Again, hopefully this information will align your OPT for success in overall compliance in meeting the standard requirements for the Administrator and the Temporary Administrator roles.

Should you have additional questions, please feel free to email them to standards@quada.org.

Since 1980, QUAD A (a non-profit, physician-founded and led global accreditation organization) has worked with thousands of healthcare facilities to standardize and improve the quality of healthcare they provide – believing that patient safety should always come first.