[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: 38CFR52.150]

[Page 858-859]
 
            TITLE 38--PENSIONS, BONUSES, AND VETERANS' RELIEF
 
          CHAPTER I--DEPARTMENT OF VETERANS AFFAIRS (CONTINUED)
 
PART 52--PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES--
Table of Contents
 
                          Subpart D--Standards
 
Sec. 52.150  Physician services.

    As a condition of enrollment in adult day health care program, a 
participant must obtain a written physician order

[[Page 859]]

for enrollment. Each participant must remain under the care of a 
physician.
    (a) Physician supervision. The program management must ensure that--
    (1) The medical care of each participant is supervised by a primary 
care physician;
    (2) Each participant's medical record must contain the name of the 
participant's primary physician; and
    (3) Another physician is available to supervise the medical care of 
participants when their primary physician is unavailable.
    (b) Frequency of physician reviews. (1) The participant must be seen 
by the primary physician at least annually and as indicated by a change 
of condition.
    (2) The program management must have a policy to help ensure that 
adequate medical services are provided to the participant.
    (3) At the option of the primary physician, required reviews in the 
program after the initial review may alternate between personal 
physician reviews and reviews by a physician assistant, nurse 
practitioner, or clinical nurse specialist in accordance with paragraph 
(e) of this section.
    (c) Availability of acute care. The program management must provide 
or arrange for the provision of acute care when it is indicated.
    (d) Availability of physicians for emergency care. In case of an 
emergency, the program management must provide or arrange for the 
provision of physician services when the program has participants under 
its care.
    (e) Physician delegation of tasks. (1) 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.
    (2) The primary physician may not delegate a task when the 
provisions of this part specify that the primary physician must perform 
it personally, or when the delegation is prohibited under State law or 
by the facility's own policies.

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

(The Office of Management and Budget has approved the information 
collection requirements in this paragraph under control number 2900-
0160.)