Recently-issued interpretive guidance related to rehabilitation and respiratory care services under hospital Conditions of Participation (CoPs) has prompted the American Hospital Association (AHA) to send a request to Centers for Medicare & Medicaid Services (CMS) to clarify the confusion caused by the guidance.  Specifically, Transmittal No. 72, issued on November 18, 2011, states that a practitioner must have medical staff privileges to order rehabilitation and respiratory care services, as opposed to simply being authorized to order those services.  The guidance may preclude a hospital from establishing a policy authorizing the orders of non-privileged practitioners to be accepted by a hospital outpatient department based on criteria set by hospital policy and state law. Instead, hospitals may be faced with the task of credentialing all practitioners who refer patients for services.  AHA contends that the interpretive guidance is inconsistent with the applicable regulations found at Section 482.56(b) and Sec. 482.57(b)(3) of the CoPs.  AHA’s January 27, 2012 letter to CMS expressing concern.