Current through Register Vol. 49, No. 9, September, 2024
XIII
STANDARDS FOR LICENSURE
A. A class A agency shall meet the Conditions
of Participation as a home health agency under Title XVIII of the
Social Security Act and the regulations adopted thereunder (42 Code of Federal
Regulations 405.1201 et seg), which regulations are adopted by reference herein
for all purposes. Copies of the regulations adopted by reference in this
section are indexed and filed in the Division of Health Facility
Services, Ar tans as Department of Health, 5800 West Tenth, Suite 400, Little
Eoci, Arkansas 72204, and are available for public inspection during
regular working hours.
B. Agencies
providing both Class A and Class B services shall meet the licensure
reguirements for both Class A and Class B licensure.
C. No license may he issued to operate a
subunit or branch whose primary agency is not located within the state of
Arkansas.
D.
Where the Health,.,Service Agency
determines a Permit of Approval is required, this must be obtained for the
geographical area to be served by the agency before a license can be
issued.
XIV
STANDARDS FOR A Class B LICENSE
A. A Class B agency shall meet the standards
of this section and the Standards for Eutended Care Services, if applicable. In
no case shall the Division license a Class B agency to operate a branch office
or subunit unless the agency first is licensed to operate a primary home health
agency within the State of Arkansas.
B
Where the Health Service
Agency determines a Permit of Approval is required,
this must be obtained
for f-h<=> geographical area to be
served by the agency before a
license can be issued.
C. Organizational structure and operational
policies of the agency must be clearly stated in writing. It must include the
lines of authority and delegation of responsibility down to the patient care
level and the services provided.
1. The
ownership of the agency shall be involved in development, review and periodic
evaluation of agency budget, policies and services. Documentation shall be
maintained of such involvement.
XVI
STANDARDS FOR
EXTENDED CARE SERVICES
Extended Care is defined as six (6) or more hours of continuous
home health services provided in a twenty-four (24) hour period, by a licensed
agency which provides both skilled nursing and other home health services.
(Medicaid Personal Care is not included in the above definition.)
In addition to meeting the applicable standards for Class B
license, all agencies providing extended care must meet the following:
A. Shall make available in writing the hours
of service and provide a Registered Nurse Supervisor or a Registered Nurse and
Supervisor for consultation and triage at least during those hours. The agency
shall be responsible for assuring that each patient, or guardian if the patient
is mentally incompetent, is aware of the steps to take in an emergency or
unusual situation. The agency must have a contingency plan regarding how the
case is managed if a scheduled employee is unable to staff the case;
B. The patient's permanent medical record
shall be available at the licensed agency location that has been approved by
the Division to provide the services;
C. A medical record must also be maintained
in the home if a patient is receiving skilled extended care.
1. The record must contain:
a. Current plan of treatment (physician's
orders);
b. Medication
profile;
c. Clinical
notes;
d. Documentation of any
medication administered by agency staff including the date, time, dosage and
the manner of administration;
e.
Any other information deemed necessary by the licensed agency.
2. The information included in the
home record must be filed in the permanent medical record at least every two
(2) weeks if it is not already included in the permanent record.
3. If extended care aide service is the only
service being provided, a home record is not required. Written instructions for
the aide service must be maintained in the home and in the permanent
record;
D. For patients
receiving skilled extended care, a visit must be made to the patient's home by
a registered nurse, who is an employee of the licensed agency, no less
frequently than every two (2) weeks to supervise the services being provided.
Patients requiring extended care services beyond three (3) months and
classified by the licensed agency as chronic/stabilized will require
supervision once every month.
For patients receiving extended care aide services only, the
aide must be continually supervised and a visit must be made to the patient's
home by a Registered Nurse at least every thirty (30) days;
E. The agency must have an orientation plan
for the staff providing the care to the patients. Since extended care cases may
involve highly technical services, this plan must reflect how the agency
ensures that the individuals providing the extended care are qualified to
provide these types of services;
F-
Contracting for Extended Care Services. An Arkansas licensed home health agency
may contract with another entity to provide extended care in the licensed
agency's service area provided that administration, patient management and
supervision down to the patient care level is ultimately the responsibility of
the licensed agency.
A written contract is required and must specify the
following:
1. All referrals are
through the primary agency and patients are accepted for care only by the
primary agency;
2. The services to
be provided;
3. The contracted
entity conforms to all applicable agency policies, including personnel
qualifications;
4. The primary
agency is responsible for reviewing, approving and assuring the implementation
of the plan of treatment;
5. The
manner in which services will be controlled, coordinated and evaluated by the
primary agency;
6. The procedures
for submitting medical record documentation and scheduling of staff;
7. The procedure for how changes in the plan
of treatment will be communicated between the two (2)
agencies;
G. Conditional
Emergency Service- Notwithstanding the provisions of these Rules and
Regulations, the Division of Health Facility Services shall be empowered to
permit the provision of extended care to one (1) or more individuals by any
licensed extended care provider where such provider:
1. Certifies that the patient requires
conditional emergency services which shall be defined as; a medically indicated
skilled extended care case in which the patient requires specialized care of a
Registered Nurse or a Licensed Practical Nurse under the supervision of a
Registered Nurse, not available through licensed agencies in the area and
which, if not provided, would result in the patient being
institutionalized;
2. Furnishes
such information on forms prescribed by the Department regarding the patients
receiving conditional emergency services that would include but not be limited
to:
a. Name of patient;
b. Address of the patient;
c. Diagnosis;
d. The type of specialized skilled extended
care the patient requires and why the patient would require
institutionalization if the care was not provided;
3. Furnishes information to the Department
ensuring that all agencies whose extended care licensed area encompasses the
location of the patient were contacted to determine if the required services
could be provided. Such information should include the name of the agency
contacted, the name of the person contacted, the date and time of the contact,
and the reason given for not being able to provide the care. If the agency
contacted does not respond with an answer within twenty-four (24) hours of the
initial contact the agency seeking to provide the services may proceed as
required. The lack of response should be noted in the information furnished to
the Department.
In each case the Division of Health Facility Services shall
maintain a file or register concerning the Conditional Emergency Service and
notify both the Health Services Agency and any licensed providers whose
extended care geographical area includes the location of the service.
The approval will be for a period of one-hundred-eighty (180)
days. For each consecutive one-hundred-eighty (180) day period thereafter, the
agency will be required to submit documentation as required in G.
If, at the end of each one-hundred-eighty (180) day period
services are available through an agency licensed for the area, the agency
providing the service must notify the patient/caregiver of the availability of
services through a licensed agency in the area and offer the opportunity to
transfer.
The choice of transfer shall be the patient/caregiver's
decision.
An agency operating outside their licensed service area must
provide documentation to the Department at the beginning of each
one-hundred-eighty (180) day period that the patient was informed of any new
agencies providing extended care services in the area and was given the choice
of transferring. The information shall be submitted on forms prescribed by the
Department.
An agency operating outside their licensed geographic area to
provide extended care may provide all services required by the patient until
such time the skilled extended care is discontinued or the patient is
transferred to an agency licensed to provide extended care services in the
area. The discharging agency will be responsible for referring the patient to
an agency licensed to serve the area in which the patient resides if the
patient requires further service.
