[Code of Federal Regulations]
[Title 38, Volume 2]
[Revised as of July 1, 2003]
From the U.S. Government Printing Office via GPO Access
[CITE: 38CFR51.150]

[Page 835-836]
 
            TITLE 38--PENSIONS, BONUSES, AND VETERANS' RELIEF
 
          CHAPTER I--DEPARTMENT OF VETERANS AFFAIRS (CONTINUED)
 
PART 51--PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES--Table 
of Contents
 
                          Subpart D--Standards
 
Sec. 51.150  Physician services.

    A physician must personally approve in writing a recommendation that 
an individual be admitted to a facility. Each resident must remain under 
the care of a physician.
    (a) Physician supervision. The facility management must ensure that-
-
    (1) The medical care of each resident is supervised by a primary 
care physician;
    (2) Each resident's medical record lists the name of the resident's 
primary physician, and
    (3) Another physician supervises the medical care of residents when 
their primary physician is unavailable.
    (b) Physician visits. The physician must--
    (1) Review the resident's total program of care, including 
medications and treatments, at each visit required by paragraph (c) of 
this section;
    (2) Write, sign, and date progress notes at each visit; and
    (3) Sign and date all orders.
    (c) Frequency of physician visits. (1) The resident must be seen by 
the primary physician at least once every 30 days for the first 90 days 
after admission, and at least once every 60 days thereafter, or more 
frequently based on the condition of the resident.
    (2) A physician visit is considered timely if it occurs not later 
than 10 days after the date the visit was required.
    (3) Except as provided in paragraphs (c)(4) of this section, all 
required physician visits must be made by the physician personally.
    (4) At the option of the physician, required visits in the facility 
after the initial visit may alternate between personal visits by the 
physician and visits by a physician assistant, nurse practitioner, or 
clinical nurse specialist in accordance with paragraph (e) of this 
section.
    (d) Availability of physicians for emergency care. The facility 
management must provide or arrange for the provision of physician 
services 24 hours a day, 7 days per week, in case of an emergency.
    (e) Physician delegation of tasks. (1) Except as specified in 
paragraph (e)(2) of this section, a primary physician may delegate tasks 
to:
    (i) a certified physician assistant or a certified nurse 
practitioner, or
    (ii) a clinical nurse specialist who--
    (A) Is acting within the scope of practice as defined by State law; 
and
    (B) Is under the supervision of the physician.

    Note to paragraph (e): An individual with experience in long term 
care is preferred.

    (2) The primary physician may not delegate a task when the 
regulations specify that the primary physician must perform it 
personally, or when the delegation is prohibited under

[[Page 836]]

State law or by the facility's own policies.

(Authority: 38 U.S.C. 101, 501, 1710, 1741-1743)