Current through Register No. 40, October 3, 2024
(a) The licensee
shall have a written contractual agreement for all services provided by
arrangement.
(b) Any contractual
agreement to provide care and services shall:
(1) Identify the care and services to be
provided;
(2) Specify the
qualifications of the personnel that will be providing the care and
services;
(3) Require that the HHCP
must authorize the services; and
(4) Stipulate the HHCP retains professional
responsibility for all care and services provided.
(c) The licensee shall provide staff for the
following positions:
(1) An administrator to
oversee the HHCP, except as allowed by (e) (1) below; and
(2) A director of patient services.
(d) Any new administrator shall
possess at least a bachelor's degree in business or a health related field, or
be a registered nurse (RN) .
(e)
The administrator shall:
(1) Designate, in
writing, an alternate administrator who shall assume the responsibilities of
the administrator in his or her absence; and
(2) Be permitted to hold more than one
position at the HHCP if:
a. The individual
meets the qualifications of all positions; and
b. The duties and responsibilities of the
positions can be accomplished by one individual.
(f) Any new director of patient
services shall have at least 2 years' experience supervising personnel or
providing direct home health care services and:
(1) Be a New Hampshire-licensed or compact
registered nurse; or
(2) Have a
bachelor's degree in a health related field.
(g) The director of patient services shall be
responsible for the overall delivery of patient care and services.
(h) At the time of admission, personnel of
the HHCP shall:
(1) Provide, both orally and
in writing, to the patient, or the patient's guardian or agent, if applicable,
the HHCP's:
a. Policy on patient rights and
responsibilities, including a copy of the home care Clients' Bill of Rights,
pursuant to
RSA
151:21-b;
b. Complaint procedure;
c. List of services that are to be provided
by the HHCP; and
d. List of the
care and services that are provided by an independent contractor;
(2) Obtain written confirmation
acknowledging receipt of the items in (1) above from the patient, or the
patient's guardian or agent, if applicable;
(3) Collect and record the following
information:
a. Patient's name, home address,
home telephone number, and date of birth;
b. Name and telephone number of an emergency
contact and guardian or agent, if applicable;
c. Name of patient's primary care provider
and the provider's address and telephone number, as applicable;
d. Written and signed consent for the
provision of care and services; and
e. Copies of all legal directives such as
durable power of attorney, guardianship, or living will, as
applicable;
f. Copy of order
activating durable power of attorney, if applicable; and
g. Copy of DNR order, if applicable;
and
(4) Obtain
documentation of informed consent and consent for release of
information.
(i) Each
patient shall have a health assessment conducted by professional personnel in
the specific discipline providing care, as authorized by their provider, to
determine the level of care and services required by the patient, except as
allowed by (k) and (l) below:
(1) Prior to
initiating care for the specified discipline;
(2) At least every 90 days thereafter;
and
(3) Whenever there is a
significant change in the patient's condition.
(j) The assessment required by (i) above
shall contain at a minimum the following:
(1)
Pertinent diagnoses including mental status;
(2) Goals and objectives of the services that
shall be provided by the HHCP;
(3)
Estimated duration and frequency of care and services;
(4) Any equipment required;
(5) Prognosis;
(6) Functional limitations;
(7) Rehabilitation potential;
(8) Activities that are limited;
(9) Nutritional requirements;
(10) Medications and treatments administered
or assisted by personnel of HHCP;
(11) Any safety precautions; and
(12) Discharge planning or referral
information as applicable.
(k) Patients receiving only homemaker
services shall not require an assessment or a care plan.
(l) For patients receiving only personal care
services, the assessment in (i) above shall:
(1) Be performed initially and every 6 months
thereafter by a registered nurse, licensed practical nurse (LPN), or the
director of patient services to determine the services required; and
(2) At a minimum include (j) (1), (4), (6) ,
(8), (9), (10), and (11) above.
(m) If the assessment required by (i) or (l)
(1) and (2) above is completed by an LPN or the director of patient services
who is not a registered nurse, the assessment shall be reviewed and co-signed
by the registered nurse or physician prior to the development of the patient's
care plan.
(n) For those patients
receiving direct care or personal care services, the licensee shall develop a
care plan within 3 business days of admission or prior to the initiation of
services, if later, that is based on the results of the assessment required by
(i) and (l) above.
(o) The care
plan required by (n) above shall include:
(1)
The date of the assessment;
(2) A
description of the problem or need;
(3) The goals for the patient, if applicable,
and identifying which services require medical, nursing, or other therapeutic
professional care and which of these services can be provided by personal care
service providers as defined by
He-P 809.03(aq)
;
(4) The action or approach to be taken by
HHCP personnel;
(5) The responsible
person(s) or position;
(6) The date
of re-evaluation, reassessment, and resolution; and
(7) Documentation that the patient and their
legal representative, if applicable, were involved in the development of the
care plan and any revisions made to the plan.
(p) The care plan shall be prepared by an
interdisciplinary team that includes:
(1) The
personnel performing the assessment;
(2) Other personnel in disciplines as
determined by the patient's needs; and
(3) The patient or the patient's legal
representative.
(q) The
care plan shall be reviewed and revised at least every 90 days by the
interdisciplinary team, or every 6 months if only personal care services are
provided, and shall be made available to all personnel that assist the patient
in the implementation of the plan.
(r) The licensee shall have an order for any
service for which such order is required by the licensing statute of the
licensed practitioner. Such orders shall be renewed at least
annually.
(s) All personnel of the
HHCP shall follow the orders of the licensed practitioner and carry out the
goals stated in the care plan, as applicable.
(t) The licensee shall develop a discharge
plan with the input of the patient or the patient's legal representative, if
any, including:
(1) Date and reason for
discharge;
(2) Discharge
instructions and referrals, if applicable;
(3) Discharge or transfer summary;
and
(4) Written and signed order
for discharge, if applicable.
(u) Written notes shall be documented in the
patient's record at the time of each visit for:
(1) All care and services provided by the
HHCP including the:
a. Date and time of the
care or service;
b. Description of
the care or service;
c. Progress
notes, including, as applicable:
1. Changes
in the patient's physical, functional, and mental abilities;
2. Changes in the patient's behaviors such as
eating or sleeping patterns; and
3.
The patient's pain management, if applicable; and
d. Signature and title of the person
providing the care or service; and
(2) Any reportable incident involving the
patient when HHCP personnel are in the patient's home.
(v) For each patient accepted for care and
services by the HHCP, a current and accurate record shall be maintained and
include, at a minimum:
(1) The written
confirmation required by (h) (2) above;
(2) The identification data required by (h)
(3) above;
(3) Consent and medical
release forms, as applicable;
(4)
Consent for release of information, as applicable;
(5) The record of the assessments required by
(i) or (l) above;
(6) All orders
from a licensed practitioner, including the date and signature of the licensed
practitioner required by (r) above;
(7) All care plans required by (n) above
including documentation that the patient or their legal representative
participated in the development of the care plan;
(8) All written notes required by (u)
above;
(9) All daily medication
records required by
He-P 809.16(g) (7)
d. and f.;
(10) A discharge plan or transfer summary as
required by (t) above;
(11)
Documentation of service authorization, if required, for a patient receiving
third party payment including but not limited to Medicaid waiver services;
and
(12) Documentation of any
patient refusal to follow their licensed practitioner's written and signed
orders.
(w) Patient
records shall be available to:
(1) The
patient, the patient's guardian, the patient's agent, and the patient's
surrogate decision-maker;
(2) HHCP
personnel as required by their job responsibilities and subject to the
licensee's policy on confidentiality;
(3) Any individual given written
authorization by the patient, the patient's guardian, the patient's agent, or
the patient's surrogate decision-maker;
(4) Any individual authorized by a court of
competent jurisdiction; and
(5) The
department or any individual authorized by law.
(x) The licensee shall develop and implement
a method for the written release of information in patient records that is
consistent with federal and state law.
(y) The HHCP shall store all paper and
electronic backup files of patient records in the primary or branch office
except when they are being utilized by authorized personnel.
(z) Paper records shall be safeguarded
against loss, damage, or unauthorized use by being stored in locked containers,
cabinets, rooms, or closets except when they are being used by authorized
personnel.
(aa) Electronic records shall be
maintained as required by
He-P
809.14(s) .
(ab) Records shall be retained for a minimum
of 4 years after discharge and in the case of minors, until one year after
reaching age 18, but no less than 4 years after discharge.
(ac) The HHCP shall arrange for storage of,
and access to, patient records as required by (ab) above in the event that the
HHCP ceases operation.
(ad) If the
HHCP is providing home hospice care, it shall be licensed in accordance with
He-P 823.
(ae) Only personnel with
documented phlebotomy training may collect human blood specimens from patients
for laboratory testing.
(af) If
CLIA-waived laboratory testing is performed by personnel of the HHCP, the
licensee shall obtain a CLIA Certificate of Waiver and follow all CLIA
requirements in the performance of the laboratory testing including the
documentation of training and competency review of all testing
personnel.
(ag) If the licensee
collects human specimens for laboratory testing, it shall follow the
manufacturer's instructions and/or the reference laboratory's instructions for
collection and storage of human specimens.
(ah) If the licensee test human specimens, it
shall be licensed as a laboratory in accordance with He-P 808, except the
licensee may perform the following CLIA-waiverd point of care test without
obtaining a laboratory license in accordance with He-P 808:
(1) Glucose;
(2) PT/INR;
(3) Dipstick Urinalysis; and
(4) Occult blood.
(ai) The licensee shall hold the appropriate
CLIA certificate to perform any laboratory tests.
(aj) Licensee collecting human specimens for
laboratory testing shall require a collecting station license in accordance
with He-P 817 except when collected by a trained registered nurse or licensed
nursing assistant.
(ak) Training
consists of collection, storage, and transport of the specimens.
(al) Training will be done by a registered
nurse trained in the collection, storage and transport of human
specimens.
#9466, eff
5-2-09
