Arkansas Administrative Code
Agency 007 - Arkansas Department of Health
Division 05 - Health Facility Services
Rule 007.05.97-004 - Revisions to the Rules and Regulations for Home Health Agencies in Arkansas
Universal Citation: AR Admin Rules 007.05.97-004
Current through Register Vol. 49, No. 9, September, 2024
RULES AND REGULATIONS FOR
HOME HEALTH AGENCIES IN ARKANSAS
ARKANSAS DEPARTMENT OF HEALTH 1997
(Pursuant to Act 956 of 1987)
I PREFACE
These rules and regulations have been prepared for the purpose of establishing a criterion for minimum standards for the licensure of Home Health Agencies in Arkansas that is consistent with current trends in patient care practices. By necessity they are of a regulatory nature but are considered to be practical minimal design and operational standards for these facilities. These standards are not static and are subject to periodic revisions in the future as new knowledge and changes in patient care trends become apparent. However, it is expected that facilities will exceed these minimum requirements and that they will not be dependent upon future revisions in these standards as a necessary prerequisite for improved services. Each Home Health Agency has a strong moral responsibility for providing optimum patient care and treatment for the patients it serves.
II
AUTHORITY
The following Rules and Regulations for Home Health Agencies in Arkansas are duly adopted and promulgated by the Arkansas State Board of Health pursuant to the authority expressly conferred by the laws of the State of Arkansas in Act 956 of 1987.
III PURPOSE
In accordance with Act 956 of 1987, rules, regulations and minimum standards for home health programs operating in the State of Arkansas are hereby established. These rules will ensure high quality professional care for patients in their home by providing for the sqfe, appropriate care of all admitted to a home health program regardless of setting and shall apply to both new and existing agencies.
IV DEFINITIONS
The following words and terms, when used in these sections, shall have the stated meanings, unless the context clearly indicates otherwise:
1.
Administrator-A person who is an agency employee and is a
physician, registered nurse, or an individual with at least one year of
supervisory or administrative experience in home health care or in related
health provider programs.
2.
Assistance with Medication-Anci 1 lary aid needed by a patient to
self-administer medication, such as reminding a patient to take a medication at
the prescribed time, opening and closing a medication container, and returning
a medication to the proper storage area. Such ancillary aid shall not include
administration of any medication by injection, inhalation, ingestion, or any
other means, calculation of a pati ent' s medi cation dosage, or al teri ng the
form of the medication by crushing, dissolving, or any other method.
3.
Branch Office-A location or
site from which a home health agency provi des servi ces wi thi n a portion of
the total geographi c area served by the primary agency. The branch office is
part of the primary agency and is located sufficiently close (within a 50 mile
radius) to share administrative supervision and services in a manner that
renders it unnecessary to obtain a separate license as a home health agency. A
branch office shall have at least one registered nurse assigned to that office
on a full time basis.
4.
Certified Agency-A home health agency which holds a letter of
approval signed by an official of the Department of Health and Human Services.
The agency must be currently in compliance with the Conditions of Participation
in the Social Security Act, Title XVIII.
5.
Clinical Note-A dated,
written or electronic and signed notation by agency personnel or a contact with
a parent including a description of signs and symptoms, treatment
ap"d/or medication given, the patient's response,
other health services provided, and any changes in physical and/or emotional
condition.
6.
Clinical
Record-An accurate account of services provided for each patient and
maintained by the agency in accordance with accepted medical
standards.
7.
Contractor-An entity or individual proving services for the agency
who does not meet the definition of employee.
8.
Coordinating-Bringing needed
services iPto
a common action, movement or condition for
the health of the patieht-
9.
Department-The Arkansas Department of Health,
Division of Health Facility Services.
10.
Director-The Director of the
Division of Health Facility Services-Arfcansas Department of Health.
11.
Discharge Summary-A
recapitulation of all services provided by the home health agency before
discharge of a patient.
12.
Division-The Division of Health Facility Services of the Arkansas
Department of Health.
13.
Employee-Any individual for whom the agency is required to issue a
form W-2.
14.
Geographic
Area-The land area, for which the agency shall be licensed, consisting
of not more than a 50 mile radius surrounding the home health agency's primary
or submit location.
15.
Health-The condition of being sound in body, mind and spirit,
especially freedom from physical disease or pain.
16.
Health Assessment-A
determination of a patient's physical and mental status performed by medical
professionals.
17.
Home
Health Agency-Any person, partnership, association, corporation, or
other organization, whether public or private, proprietary, or non-profit, that
provides a home health service for pay or other consideration in a patient's
residence.
18.
Home Health
Aide/Personal Care Aide-A person who provides personal care/personal
services for a person in the home under the supervision of a registered
nurse.
19.
Home Health
Services-The provi di ng or coordi nati ng of acute, restorative,
rehabilitative, maintenance, preventive, or health promotion services through
professional nursing or by other therapeutic services such as physical therapy,
speech therapy, occupational therapy, medical social services, home health aide
or personal services in a client's residence.
20.
Licensed Occupational Therapy
Assistant-A person who is currently licensed under the laws of Arkansas
to use the title, Licensed Occupational Therapy Assistant.
21.
Licensed Physical Therapy
Assistant-A person who is currently licensed under the laws of Arkansas
to use the title, Licensed Physical Therapy Assistant.
22.
Licensed Practical Nurse-A
person who is currently licensed under the laws of Arkansas to use the title,
Licensed Practical Nurse.
23.
Maintenance-To keep in an existing state.
24.
Medical Social Worker-A
person who i s currently licensed under the laws of Arkansas as a social worker
and who has a Master's Degree from a school accredited by the Council on Social
Work Education and has one year of social work experience in a health care
setting.
25.
Occupational
Therapist-A person who is currently licensed under the laws of Arkansas
to use the title, Occupational Therapist Registered.
26.
Parent Agency-The agency
physically located within the state that develops and maintains administrative
control of subunits and/or branches.
27.
Patient Care Conference-A
documented conference among the home health agency staff or contractors
providing care to a patient to evaluate patient care needs and the delivery of
service.
28.
Personal
Care-Health related assistance in activities of daily living, hygiene
and grooming for the sick or debilitated.
29.
Physical Therapist-A person
who is currently licensed under the laws of Arkansas to use the title,
Registered Physical Therapist.
30.
Physician-A person who is currently licensed under the Arkansas
Medical Practices Act.
31.
Place of Business-Any office of a home health agency that
maintains home health service patient records or directs home health services.
Thi s shal1 i nclude a suboffi ce, a branch office, or any other subsidiary
location.
32..
. Plan of
Care-A written plan which specifies scope, frequency and duration of
services that is signed by a physician or podiatrist.
33.
Podiatric Medicine-The
diagnosis and medical, mechanical, and surgical treatment of ailments of the
human foot.
34.
Podiatrist-A person currently licensed by the Board of Podiatric
Medicine to use the title, Podiatrist.
35.
Preventive-To keep from
happening or existing.
36.
Primary Agency-The agency physically located within the state
responsible for the service rendered to patients and for implementation of the
plan of care.
37.
Psychiatric
Nurse-A registered nurse who is currently licensed under the laws of
Arkansas and:
a. Has a Master's Degree in
Psychiatric or Mental Health Nursing; or
b. Has a Baccalaureate Degree in Nursing with
one year of experience in an active treatment unit in a psychiatric or mental
health hospital or outpatient clinic; or
c. Has a Diploma or Associate Degree with two
years experience in an active treatment unit in a psychiatric or mental
hospital or outpatient clinic.
NOTE: Experience must have been within the last five years. If not, documentation must support psychiatric retraining or classes or CEUs to update psychiatric knowledge.
38.
Quality of Care-Clinically
competent care which meets professional standards, supported and directed in a
planned pattern to achieve maximum dignity at the required level of comfort,
preventive health measures and self management.
39.
Registered Nurse-A person
who Is currently..licensed under the laws of Arkansas to use the title,
Registered Nurse.
40.
Rehabilitative-To restore or bring to a condition of health or
useful and constructive activity.
41.
Residence-A place where a
person resides, including a home, nursing home, residential care facility or
convalescent home for the disabled or aged.
42.
Restorative-Something that
serves to restore to consciousness, vigor or health.
43.
Service Area-The land area
for which the agency shall be licensed, which shall be consistent with their
Certification of Need (CON) or Permit of Approval CPOA), if one is required,
but in no case shall the service area consist of more than a 50 mile radius
from the home health agency's primary or subunit location.
44.
Skilled Care Services-Any
service delivered by a health care professional requiring orders from a
physician or podiatrist.
45.
Social Hork Assistant-A person who is currently licensed under the
laws of Arkansas as a social worker.
46.
Speech-Language
Pathologist-A person who is currently licensed under the laws of
Arkansas to use the title, Speech-Language Pathologist.
47.
Sufaunit-A semi-autonomous
organization, which serves patients in a geographic area different from that of
the parent agency. The subunit by virtue of the distance between it and the
parent agency is judged incapable of sharing administration, supervision, and
services on a daily basis with the parent agency and shall, therefore,
independently meet the Conditions of Participation for home health agencies
and/or shall independently meet the regulations and standards for licensure. A
subunit may not have a branch office. The parent agency of the subunit shall be
located and licensed within the state.
48.
Supervision-Authoritative procedural guidance by a
qualified person for the accomplishment of a function or activity with initial
direction and periodic inspection of the actual act of accomplishing the
function or activity.
6. A home,
nursing home, convalescent home, or other institution for the disabled or aged
that provides health services only to residents of the home or
institution;
7. A person who
provides one health service through a contract with a person
licensed;
8. A durable medical
equipment supply company;
9. A
pharmacy or wholesale medical supply company that furnishes those services to
persons in their homes that relate to drugs and supplies;
10. A hospital or other 1icensed health care
facility serving only inpatient residents; and
11. A visiting nurse service or home aide
service constructed by and for the adherents of a religious denomination for
the purpose of providing service for those who depend upon spiritual means
through prayer alone for healing.
B. Nhen
there is a question about the subject of regulation status of a person, and the
person claims exemption under the Act, the Director shall ask the person to
make a written claim to the Department, citing the subsection of the Act under
which exemption is claimed and including any and all documentation supporting
the exemption claim.
C. The
Director shall evaluate the information received and determine if the person is
exempt. The Director shall notify the person in writing upon the completion of
the evaluation.
VII APPLICATION FOR LICENSE
A. Any person,
partnership, association, corporation or other organization, whether public or
private, proprietary or nonprofit who supplies individuals to provide any of
the services listed below shall be considered an agency.
B. Agencies shall be required to obtain a
license if the following services are provided to an individual in their home
or place of residence. These services include:
1. Skilled Nursing Services;
2. Physical Therapy Services;
3. Occupational Therapy Services;
4. Speech-Language Pathology
Services;
5. Medical Social Work
Services;
6. Home Health Aide
Services;
7. Personal Care Aide
Services;
8. Extended Care
Services.
C. Prior to
applying for a license an agency shall obtain a Permit of Approval (POA), if
applicable. Each agency must serve the area which is consistent with their
Certificate of Need (CON) or POA. Any agency not required to obtain a POA shall
not routinely serve greater than a 50 mile radius. Under conditional emergency
circumstances an agency may be allowed to provide extended care to an
individual patient who resides beyond a 50 mile radius based on approval by
Health Facility Services, Arkansas Department of Health. (See requirements for
. Extended Care Services.)
D.
Application for temporary license shall be on forms prescribed by the
Department and shall be for a period not to exceed six months.
E. Annual license applications shall be on
forms prescribed by the Department and shall be effective on a calendar year
basis with an expiration date of December 31.
F.
1. Each agency shall receive
either a Class A or Class B license. If the agency is certified to participate
in the Title XVIII Medicare program, a Class A license shall be issued. 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 seq), 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, Arkansas Department of Health, 5800 West Tenth, Suite
400, Little Rock, Arkansas 72204, and are available for public inspection
during regular working hours.
2. If
the agency is not certified to participate in the Medicare program but provides
home health services as defined by Act 956 of 1987 a Class B license shall be
issued.
3. Each Class A or Class B
license shal1 designate whether an agency provides the following categories of
service: intermittent skilled care, extended care and/or personal care
only.
4. When a category of service
is added the agency shall notify the Division of Health Facility Services of
the intent.- The Division shall then request from the agency the appropriate
information needed to determine if the agency meets the regulatory requirements
for the category of service being requested. Once this determination is made
the Division shall make the appropriate changes to the license.
5. If a category of service is being
discontinued, the agency shall notify the Division. Notification must include
information on how the agency will ensure appropriate transfer of
patients.
6. Each agency that is
licensed Class A or Class B shall meet the General Requirements section of
these regulations. According to services provided, agencies shall also be
required to meet other sections as follows:
a.
Skilled Care - General Requirements (Section XI), Skilled Care
Services (Section XII);
b. Extended
Care - General Requirements (Section XI), Skilled Care Services (Section XII),
Extended Care Services (Section XIII);
c Personal "Cafe ""General Requirements
(Section XI), Personal Care Services (Section XIV).
7. No license shall be issued to operate a
subunit or branch whose primary agency is not located within the State of
Arkansas.
G. No license
shall be transferred from one entity to another. If a person, partnership,
organization or corporation is considering acquisition of a licensed agency, in
order to insure continuity of patient services, the entity shall submit a
license application at least 60 days prior to the acquisition for each place of
business.
H. No license shall be
transferred from one location to another without prior approval from the
Division as provided in this subsection. If an agency is considering
relocation, the agency shall complete and submit a form provided by the
Division 30 days prior to the intended relocation.
1. A relocation shall be approved by the
Division if the new location is within the existing service area.
2. All other relocations shall not be
approved, and the licensee shall submit a new application for a
license.
I. The agency
shall notify the Division of any of the following:
1. Addition or deletion of services
provided;
2. Request to change
license classification;
3. Request
to withdraw home health designation;
4. Notification of termination of provision
of home health services;
5. If a Class A agency, notification of
changes in certified status;
6. Any
change in telephone number;
7. Any
name changes i n the agency wi thi n fi ve working days after the effective
date of the name change; and
8.
Address changes.
VIII INSPECTIONS
A. An onsite inspection shall determine if
standards for licensure are being met before the initial license is issued. If
an agency wishes to add an additional service category to an already existing
license, the Department may determine if specific standards are met by mail or
by an onsite visit.
B. Once the
initial inspection is conducted and the agency becomes licensed, subsequent
inspections shall be conducted on an every year or every two year basis.
Agencies which are placed on a yearly cycle will be those meeting one or more
of the following provisions:
1. Agencies
which have been licensed for less than three years;
2. Agencies which have had a change of
ownership or a significant change in management staff;
3. Agencies who have had a substantiated
complaint since the last inspection;
4. Agencies which received deficiencies
during the last inspection.
Agencies not meeting any of the above provisions shall be placed on a two year survey cycle.
C. If the inspection is conducted in order to
determine compliance with standards, the agency shall come into compliance
within 60 days. An onsite follow-up visit or a follow-up by mail shall be
conducted to determine if deficiencies have been corrected. If the agency fails
to comply, the Director may propose to suspend or revoke the license in
accordance with the section relating to License Denial, Suspension, or
Revocation.
IX DENIAL. SUSPENSION. REVOCATION QF LICENSE
A. The Division may deny issuing a license
to an agency if the agency fails to comply with these rules.
B. The Division may suspend the license of an
agency for one or more of the following reasons:
1. Violation of the provisions of the statute
or of any of the standards in these rules;
2. Mi sstatement of a materi al fact on any
documents requi red to be submitted to the Division or requirements to be
maintained by the agency pursuant to these rules;
3. Commission by the agency or its personnel
of a false, misleading, or deceptive act or practice;
4. Materially altering any license issued by
the Department.
C. The
Division may revoke the license of an agency for one or more of the following
reasons:
1. A repeat violation within a 12
month period which -resulted in a license suspension;
2. An intentional or negligent act by the
agency or its employees which materially affects the health and safety of a
patient.
D. If the
Director of the Division of Health Facility Services of the Department proposes
to deny, suspend, or revoke a license, the Director shall notify the agency of
the reasons for the proposed action and offer the agency an opportunity for a
hearing. The agency may request a hearing within 30 days after the date the
agency receives notice. The request shall be in writing and submitted to the
Director, Division of Health Facility Services, Arkansas Department of Health,
5800 West Tenth, Suite 400, Little Rock, Arkansas 72204. A hearing shall be
conducted pursuant to the Administrative Procedures Act. If the agency does not
request a hearing in writing after receiving notice of the proposed action, the
agency is deemed to have waived the opportunity for a hearing and the proposed
action shall be taken.
E. The
Division may suspend or revoke a license to be effective immediately when the
health and safety of patients are threatened. The Division shall notify the
agency of the emergency action and shall notify the agency of the date of a
hearing, which shall be within seven days of the effective date of the
suspension or revocation. The hearing shall be conducted pursuant to the
Administrative Procedures Act.
X BRANCH OFFICES
A. The agency shall notify the Department in
writing in advance of the plan to establish a branch office. Included in the
notification shall be a description of the services to be provided (must be the
same as the parent agency), the geographic area to be served by the branch
office and a description of exactly how supervision by the parent agency will
occur. All branch offices shall be subject to approval by the Division. Once
the agency receives approval by the Division to establish the requested branch
office the agency shall notify the Division of the branch office address,
telephone number, and the name of the registered nurse supervisor.
B. Onsite supervision of the branch office
shall be conducted by the parent/primary agency at least every two months. The
supervisory visits shall be documented and include the date of the visit, the
content of the consultation, the individuals in attendance, and the
recommendations of the staff. In addition, branch supervision shall Include
clinical record review of the branch records, inclusion in the agency's quality
assurance activities, meetings with the branch supervisor, and home
visits.
C. A full-time registered
nurse shall be assigned to the branch office and shall be available during all
operating hours. This person shall be an employee of the agency.
D. All admissions shall be coordinated
through the parent/primary agency and a current roster of patients shall be
maintained by the parent agency at all times.
E. A branch office shall offer the same
services as those offered by the parent/primary agency.
XI GENERAL REQUIREMENTS
A. Operational
Policies
1. The agency shall have a written
plan of operation including:
a. Organizational
chart showing ownership and lines of authority down to the patient care
level;
b. The services offered,
including hours of operation and lines of delegation of responsibility down to
the patient care level;
c. Criteria
for patient acceptance, referral, transfer and termination;
d. Evidence of direct administrative and
supervisory control and responsibility for all services including services
provided by branch offices;
e. An
annual operating budget approved by the governing body;
f. Hritten contingency plan in the event of
dissolution of the agency.
2. Policies shall be developed and enforced
by the agency and include the following:
a.
Orientation of all personnel to the policies and objectives of the
agency;
b. Participation by all
personnel in appropriate employee development programs, including a specific
policy on the number of inservice hours that will be required for registered
nurses, licensed practical nurses and aides;
c. Periodic evaluation of employee
performance;
d. Personnel
policies;
e. Patient care
policies;
f. Disciplinary actions
and procedures;
g. Job description
(statement of those functions which constitute job requirements) and job
qualifications (specific education and training necessary to perform the job)
for each position with the agency; and
h. Infection control policies including the
prevention of the spread of i nfectious and communi cable di seases from agency
personnel to clients.
3.
A personnel record shal1 be mai ntai ned for each employee. A personnel record
shall include, but not be limited to, the following: job description;
qualifications; application for employment; verification of licensure, permits,
references, job experience, and educational requirements as appropriate;
performance evaluations and disciplinary actions; and letters of commendation.
All information shall be kept current. In lieu of the job description and
qualifications for employment, the personnel record may include a statement
signed by the employee that the employee has read the job description and
qualifications for the position accepted.
4. It shall be the responsibility of the
administration to establish written policies concerning pre-employment
physicals and employee health. The policies shall include but not be limited
to:
a. Each employee shall have an up-to-date
health file;
b. At a minimum, each
employee shall be tested or evaluated annually for tuberculosis in accordance
with the applicable section of the Tuberculosis Manual of the Arkansas
Department of Health;
c. Work
restrictions shall be placed on home health personnel who are known to be
affected with any disease in a communicable stage or to be a carrier of such
disease, to be afflicted with boils, jaundice, infected wounds, diarrhea or
acute respiratory infections. Such individuals shall not work in any area in
any capacity in which there is the likelihood of transmitting disease to
patients, agency personnel or other individuals withi n the home or a potential
of contami nati ng food, food contact surfaces, supplies or any surface with
pathogenic organisms;
d. Other
tests shall be performed as required by agency
policy.
B.
Governing Body
1. The governing body, or a
committee designated by the governing body, of the agency shall establish a
mechanism to:
a. Approve a quality assurance
plan whereby problems are identified, monitored and corrected;
b. Adopt and periodically review written
bylaws or an acceptable equivalent;
c. Approve wri tten poli ci es and procedures
related to safe, adequate services and operation of the agency with annual or
more frequent review by administrative or supervisory personnel;
d. Appoint an administrator and approve a
plan for an alternate in the absence of the administrator;
e. Oversee the management and fiscal affairs
of the agency;
f. Approve a method
of obtaining regular reports -on participant satisfaction.
2. The governing board shall insure the
agency has an administrator who is an employee of the agency or related
institution to:
a. Organize and direct the
agency's ongoing functions;
b.
Maintain an ongoing liaison between the governing body and the
personnel;
c. Employ qualified
personnel and ensure appropriate ongoing education and supervision of personnel
and volunteers;
d. Ensure the
accuracy of public information materials and activities;
e. Implement a budgeting and accounting
system; and
f. Ensure the presence
of an alternate administrator to act in the administrator's
absence.
3. The governing
board shall be responsible for ensuring the agency has a full-time supervising
registered nurse to supervise clinical services. Full-time shall be according
to established business hours of the agency. The administrator and supervising
nurse may be the same individual.
4.
If a licensed agency contracts with another entity for services, the governing
body shall ensure that administration, patient management and supervision down
to the patient care level are ultimately the responsibility of the licensed
agency.
C. Services
Provided by Contractors
An Arkansas licensed home health agency may contract to provide services in the licensed agency's service area provided that administration, patient management and supervision down to the patient care level are 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 submi tti ng medi cal record documentation and scheduling of
staff;
7. The procedure for how
changes i n the pi an of treatment wi 11 be communicated between the two
agencies; and
8. The procedures for
determining charges and reimbursement.
D. Quality Improvement
1. An agency shall adopt, implement and
enforce a policy on a quality improvement program which provides for
accountability and desired outcomes.
2. Those responsible for the quality
improvement program shall:
a. Implement and
report on activities and mechanisms for monitoring the quality of
care;
b. Identify, and when
possible, resolve problems; and
c.
Make suggestions for improving care.
3. As part of the quality improvement program
a clinical record review shall be conducted at least quarterly by appropriate
professionals. A minimum of ten percent of both active and closed records shall
be reviewed or a minimum of ten records per quarter if the case load is less
than 99. The purpose of the clinical record review is to evaluate all services
provided for consistency with professional practice standards for home health
agencies and the agency's policies and procedures, compliance with the plan of
care, the appropriateness, effectiveness and adequacy of the services offered,
and evaluations of anticipated patient outcomes. Evaluations shall be based on
specific record review criteria that are consistent with the
agency1s admission policies and other agency
specific care policies and procedures.
E. Patient Rights
1. The agency shall provide each patient and
family with a copy of the Bill of Rights affirming the patient's right to:
a. Be informed of the services offered by the
agency and those being provided to the patient;
b. Participate in the development of the plan
of care and to be informed of the dates and approximate time of
service;
c. Receive an explanation
of any responsibilities the participant may have in the care process;
d. Be informed of the name of agency and how
to contact that agency during all hours of operation;
e. Be informed of the process for submitting
and addressing complaints to the agency and be notified of the State Home
Health Hotline number;
f. Be
informed orally and in writing of any charges which insurance might not cover
and for which the patient would be responsible;
g. Courteous and respectful treatment,
privacy and freedom from abuse and discrimination;
h. Confidential management of participant
records and information;
i. Access
information in the participant's own record upon request;
and
j.
Receive prior notice and an explanation for the reasons of termination,
referral, transfer, discontinuance of service or change in the plan of
care.
2. The agency shall provide each patient and
family with a written list of responsibilities affirming the patient's
responsibility to:
a. Assist in developing
and maintaining a safe environment;
b.
Treat all agency staff with courtesy and respect;
c. Participate in the development and update
of the plan of care;
d. Adhere to
the plan of care or services as developed by the agency and to assist in the
care as necessary.
F. Advance Directives
1. The agency shall have written policies and
procedures regarding advance directives.
2. The agency shall inform and distribute
written information to each patient on the initial evaluation visit concerning
its policies on advance directives. Written information shall include notifying
patients of their right to:
a. Make decisions
about their medical care;
b. Accept
or refuse medical or surgical treatment; and
c. Formulate, at the individual's option, an
advance directive.
3. The
agency shall document in the patient's medical record whether he or she has
executed an advance directive.
G. Services Provided
All services shall be rendered and supervised by qualified personnel. An agency shall provide at least one of the following:
1. If nursing service is provided, a
registered nurse shall be employed by the agency to supervise nursing care. A
licensed practical nurse may only provide services under the supervision of a
registered nurse. The administrator shall designate a registered nurse to serve
as an alternate supervisor;
2. If
physical therapy is provided, a registered physical therapist shall be employed
by or under contract with the agency to provide services and/or supervision. A
licensed physical therapy assistant may only provide services under the
supervision of a registered physical therapist;
3. If occupational therapy service is
provided, a licensed occupational therapist shall be- employed by or under
contract with the agency to provide services. A licensed occupational therapy
assistant may only provide services under the supervision of a registered
occupational therapist;
4. If
speech-language pathology services are provided, a licensed speech-language
pathologist shall be employed by or under contract with the agency to provide
services and/or supervision;
5. If
medical social work is provided, a licensed medical social worker shall be
employed by or under contract with the agency. A social work assistant may only
provide social services under the supervision of a licensed medical social
worker;
6. If home health/personal
care aide service is provided, a home health/personal care aide shall be
employed by or under contract to provide home health aide services. The aide
shall be supervised by a registered nurse at least every 62
days.
H. Nursing Services
1. A registered nurse shall make the initial
evaluation visit and initiate the plan of care and necessary revisions. The
initial evaluation routinely must be performed within 72 hours of the initial
referral or discharge from an inpatient facility.
2. A registered nurse shall regularly
re-evaluate the patient's nursing needs. A visit to the patient's home by the
registered nurse shall be conducted at least every 62 days and after each
hospitalization.
3. The registered
nurse and the licensed practical nurse shall prepare clinical notes and furnish
services according to agency policy.
4. If a patient is under a psychiatric plan
of care, a psychiatric nurse shall be available to make the initial evaluation
visit, re-evaluate the patient's nursing needs at least every 30 days and
complete clinical notes.
I. Physical Therapy Services
1. The registered physical therapist shall
assist the physician in evaluating the level of function and help develop the
plan of care (revising it as necessary). The initial evaluation shall be
conducted within five working days of the referral. or sooner if medical
necessity dictates.
2. If a licensed
physical therapy assistant is used, the registered physical therapist shall
conduct a visit to the patient's home at least every 62 days to re-evaluate the
patient's condition and supervise the licensed physical therapy
assistant.
3. The regi stered physi
cal therapi st i s responsi ble for di scharge planning from physical therapy
services and for communicating this plan to the patient.
4. The registered physical therapist and the
licensed physical therapy assistant shall prepare clinical notes and furnish
services according to agency policy.
J. Occupational Therapy Services
1. The registered occupational therapist
shall assist the physician in evaluating the level of- function and help
develop the plan of care (revising it as necessary). The initial evaluation
shall be conducted within five working days of the referral or sooner if
medical necessity dictates.
2. If a
licensed occupational therapy assistant is used, the registered occupational
therapist shall conduct a visit to the patient's home at least every 62 days to
re-evaluate the patient's condition and supervise the licensed occupational
therapy assistant.
3. The
registered occupational therapist is responsible for discharge pianning from
occupational therapy services and for communicating this plan to the
patient.
4. The registered
occupational therapist and the 1icensed occupational therapy assistant -shall
prepare clinical notes and furnish services according to agency
policy.
K.
Speech-Language Pathology Services
1. The
licensed speech-language pathologist shall assist the physician in evaluating
the level of function and help develop the plan of care (revising it as
necessary). The initial evaluation visit shall occur within five working days
of the referral or sooner if medical necessity dictates.
2. The licensed speech-language pathologist
shall prepare clinical notes and furnish services according to agency
policy.
L. Medical Social
Services
1. The licensed medical social
worker shall participate in evaluating the patient's need for services and in
the development of the plan of care.
2.
The licensed medical social worker shall supervise the social
work assistant according to agency policy.
3. The licensed medical social worker and
social work assistant shall prepare clinical notes and provide services
according to agency policy.
M. Home Health Aide Services/Personal Care
Aide Services
1. Each home health/personal
care aide shall meet at least one of the following requirements:
a. Have at least one year of experience in an
institutional setting (home health agency, hospital, hospice, or long-term care
facility). This experience shal1 be verified by a previous employer;
b. Have a certificate issued by the State of
Arkansas for working in long-term care facilities. A copy of this certificate
shall be available for review;
c.
Have completed a 40 hour aide training course that meets the requirements set
forth in these regulations.
NOTE: In lieu of the requirement for completion of the home health aide training course, a nursing student may qualify as a home health aide by submitting-documentation from the Director of programs and/or the Dean of a School of Nursing that states that the nursing student has demonstrated competency in providing basic nursing care in accordance with the school's curriculum.
2. The
agency is responsible for evaluating the competency of any aide who has not
been employed as an aide in an institutional setting in the last 24 months. At
a minimum, the aide shall be observed by a registered nurse performing the
skills required to care for a patient including bathing, transferring, range of
motion exercises, toileting, dressing, nail care and skin care. The registered
nurse shall observe the aide performing these skills on a person. Any other
tasks or duties for which the aide may be responsible may be evaluated by
written test, oral test or observation. There shall be documentation by the
agency to show evidence of this evaluation.
3. A registered nurse shall complete an aide
assignment sheet for each patient receiving aide services. Each aide caring for
the patient shall receive a copy of the assignment sheet and provide services
as assigned. A copy of the assignment sheet shall be left in the patient's
home.
4. Each aide assignment sheet
shall be individualized and specific according to the patient's
needs.
5. The registered nurse
shall conduct a visit to the patient's place of residence at least every 62
days to supervise the aide and update the aide assignment sheet.
6. In no event shall a home health aide be
assigned to receive or reduce to writing orders from a physician. A home health
aide shall not perform any steri1e procedure or any procedure requi ring the
application of medication requiring a prescription.
7. Upon a request by a patient and/or family
member for assistance with medications, the registered nurse may assign a home
health aide to assist with oral medications which are normally
self-administered. Assistance shall be limited to reminding a patient to take a
medication at a prescribed time, opening and closing a medication container and
returning a medication to a proper storage area.
8. Except as otherwise provided in these
rules, duties of the home health aide may include:
a. Personal care: bathing, grooming, feeding,
ambulation, exercise, oral hygiene, and skin care;
b. Assistance with medications ordinarily
self-administered as assigned;
c.
Household services essential to health care in the-home;
d. Completion of records and reporting to
appropriate supervisor;
e. Taking
and charting vital signs;
f.
Charting intake and output;
g.
Extension of therapy services; and
h. Any duty consistent with the State Board
of Nursing Regulations on Delegation of Duties may be assigned by a registered
nurse to meet the individual needs of the patient.
9. If the training is provided by the agency,
the training program for home health aides shal1 be conducted under the
supervision of a registered nurse. The training program may contain other
aspects of learning, but shall include the following:
a. A minimum of 40 hours of classroom and
clinical instruction related particularly to the home health setting;
b. Written course objectives with expected
outcomes and methods of evaluation; and c. An assessment that the student knows
how to read and write English and to carry out directions.
10. Course and clinical work content shall
include, but not be 1imi ted to, bathing, ambulation and exercise, personal
grooming, principles of nutrition and meal preparation, health conditions,
developmental stages and mental status, household services essential to health
care at home, assistance with medication, safety in the home, completion of
appropri ate records and reporti ng changes to appropri ate
supervisor.
11. Aides shall receive
a minimum of 12 hours of inservice training per 12 months. The inservices
provided shall address areas that directly relate to the patient care aspects
of the aide's job.
N.
Records and Documentation.
1. The home health
agency shal1 maintain records which are orderly, intact, legibly written and
available and retrievable either in the agency or by electronic means and
suitable for photocopying or printing.
2. Records shall be stored in a manner which:
a. Prevents loss or manipulation of
information;
b. Protects the record
from damage; and
c. Prevents access
by unauthorized persons.
3. Records shall be retained for a minimum of
five years after discharge of the patient or two years after the age of
majority.
4. Each record shall
include:
a. Appropriate identifying
information;
b. Initial assessment
(performed by a registered nurse or therapist). If the agency is unable to
perform the initial evaluation for physical therapy, occupational therapy or
speech-language pathology in the required time frame, the reason for the delay
shall be documented. If delays are due to the agency not having the staff to
perform the initial evaluation and/or provide services, there shall be
documentation to show the patient and the physician were notified of the delay
and were given an estimated date when services would begin. The patient and
physician shall also be informed of other agencies in the area available to
provide the ordered services;
c.
Plan of care (which shall include as applicable, medication, dietary,
treatment, activities);
d. Clinical
notes; and e. Acknowledgement of recei vi ng i nformation regardi ng advance
directives.
5. The
following shall be included, if applicable:
a.
Physician and/or podiatrist orders;
b. Records of supervisory visits;
c. Medication administration
records;
d. Records of case
conferences; and
e. Discharge
summary.
6. Clinical
notes are to be written the day the service is rendered and incorporated into
the record no less often than every 14 days.
7. Provisions shall be made for the
protection of records in the event an agency ceases operation.
O. Discharge Planning
1. There shall be a specific plan for
discharge in the clinical record and there must be ongoing discharge planning
with the patient.
P.
Complaints
Each agency shall keep a record of complaints received. Documentation shall be kept on each complaint regarding the name of the complainant, the relationship to the patient (if applicable), the nature of the complaint, and the action taken to resolve the complaint.
XII STANDARDS FOR SKILLED CARE SERVICE5
In addition to meeting the General Requirements, agencies providing ski lied care shall meet the following:
A. Acceptance of Patients
1. Agencies shall only accept patients for
treatment on the basis of a reasonable expectation that the patient's needs can
be met adequately by the agency in the patient's place of residence.
2. If an agency receives a referral on a
patient who requires home health services that are not available at the time of
referral, the agency shall contact the referral source and/or the patient's
physician to let them know the situation. The agency shall only admit the
patient if no other agency licensed in the area has the service(s)
available.
B. Care and
Services
1. An initial assessment shall be
completed in the patient's residence by an employee of the agency who has
completed orientation/training in the initial assessment procedures of the
agency and has demonstrated competency in the performance of these skills. The
initial assessment shall be completed by a registered nurse or licensed
therapist, as appropriate.
2. At the
time of the admission, the plan of care shall be developed in conjunction with
the patient and/or family and the appropriate health care
professional.
3. The plan of care
shall include potential services to be rendered; the frequency of visits and/or
hours of service, assignment of health care providers and the estimated length
of services. The plan of care shall be revised at least every 62 days. The plan
of care shall be individualized according to each of the individual patient's
needs.
4. The plan of care and each
verbal order obtained shall be signed by the physician or podiatrist within 30
days of the order.
5. Case
conferences shall be held at least every two months on each patient. The
clinical record or minutes of these case conferences shall reflect input by the
disciplines providing care to the patient.
6. For patients receiving extended care
nursing services, a current medication administration record shall be
maintained and incorporated into the clinical record. Notation shall be made in
the clinical notes of medications not given and reason. Any untoward action
shall be reported to the supervisor and documented.
7. The clinical record shal1 include
documentation of medication allergies or sensitivities and medication
interactions. There must be a medication profile, including the dose, frequency
and route of administration for each prescription medication the patient is
receiving.
C. 24 Hour
Availability
1. If an agency provides 24 hour
availability, the agency shall have a registered nurse available after hours.
When an agency provides extended care, the agency shall provide 24 hour
coverage and availability. A licensed practical nurse may take initial call and
perform services as ordered on the plan of care. - Any services outside the
plan of care must be approved by a registered nurse prior to the services being
rendered.
2. If 24 hour availability
is provided, the agency shall have a policy describing at least the following:
a. How patients will contact the agency after
hours; and
b. How the agency wi 11
ensure the regi stered nurse on cal 1 has access to all current patient
information.
3. If 24
hour availability is not offered by the agency, the agency shall be responsible
for assuring each patient is aware of the steps to take in an emergency or
unusual situation.
D.
Control led Drugs
1. Agencies shall have a
written policy stating how controlled drugs will be monitored if agency staff
transports the drugs from the pharmacy to the patient.
2. If controlled drugs are being administered
by the agency, there shall be a poli cy regard!ng how the drugs wi11 be admi ni
stered and monitored.
XIV STANDARDS FOR PERSONAL CARE SERVICES
A. The registered nurse
shall perform an initial evaluation visit within five days of a specific
request for personal care aide services.
B. If the agency cannot perform an initial
evaluation visit within five days of a specific request for services, there
shall be documentation regarding the reason, the anticipated date the
evaluation will be conducted, and notification of the patient regarding when
the evaluation will be performed.
C. If the agency does not have services
available at the time of the initial evaluation, the agency shall explain this
to the patient. If the agency cannot staff the case within two weeks of the
initial evaluation, the agency shall be responsible for contacting other
agencies in the area to determine if services are available. If another agency
can provide the services in a shorter length of time, the patient shall be
informed and given the choice of changing agencies.
D. If an aide misses a scheduled visit, there
shall be documentation that the patient was contacted prior to the missed
visit. Every attempt shall be made to send a substitute aide to provide the
care.
E. For individuals receiving
personal care services only, the agency is not required to have the plan of
care signed by a physician, unless otherwise required by other agencies or
laws. However, a plan of care shall be developed outlining the scope, frequency
and duration of services.
F. If
care is ordered per hour, the aide shall document the time the aide arrived at
the home and the time the aide departed.
G. Each aide shall document each visit the
tasks that were performed. If a task is not completed that is specifically
ordered on the aide assignment sheet, there shall be a documented reason why.
Patient care problems noted by the aide during the course of care shall be
reported to the registered nurse.
H. The registered nurse shall make a visit to
each patient's home at least every 62 days to supervise aide services. A
registered nurse shall be available for consultation during operating
hours.
Disclaimer: These regulations may not be the most recent version. Arkansas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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