[Code of Federal Regulations]

[Title 42, Volume 3]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR484.14]



[Page 580-582]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 484_HOME HEALTH SERVICES--Table of Contents

 

                        Subpart B_Administration

 

Sec. 484.14  Condition of participation: Organization, services, and 

administration.



    Organization, services furnished, administrative control, and lines 

of authority for the delegation of responsibility down to the patient 

care level are clearly set forth in writing and are readily 

identifiable. Administrative and supervisory functions are not delegated 

to another agency or organization and all services not furnished 

directly, including services provided through subunits are monitored and 

controlled by the parent agency. If an agency has subunits, appropriate 

administrative records are maintained for each subunit.

    (a) Standard: Services furnished. Part-time or intermittent skilled 

nursing services and at least one other therapeutic service (physical, 

speech, or occupational therapy; medical social services; or home health 

aide services) are made available on a visiting basis, in a place of 

residence used as a patient's home. An HHA must provide at least one of 

the qualifying services directly through agency employees, but may 

provide the second qualifying service and additional services under 

arrangements with another agency or organization.

    (b) Standard: Governing body. A governing body (or designated 

persons so functioning) assumes full legal authority and responsibility 

for the operation of the agency. The governing body appoints a qualified 

administrator, arranges for professional advice as required under Sec. 

484.16, adopts and periodically reviews written bylaws or an acceptable 

equivalent, and oversees the management and fiscal affairs of the 

agency.

    (c) Standard: Administrator. The administrator, who may also be the 

supervising physician or registered nurse required under paragraph (d) 

of this section, organizes and directs the agency's ongoing functions; 

maintains ongoing liaison among the governing body, the group of 

professional personnel, and the staff; employs qualified personnel and 

ensures adequate staff education and evaluations; ensures the accuracy 

of public information materials and activities; and implements an 

effective budgeting and accounting system. A qualified person is 

authorized in writing to act in the absence of the administrator.

    (d) Standard: Supervising physician or registered nurse. The skilled 

nursing and other therapeutic services furnished are under the 

supervision and direction of a physician or a registered nurse (who 

preferably has at least 1 year of nursing experience and is a public 

health nurse). This person, or similarly qualified alternate, is 

available at all times during operating hours and participates in all 

activities relevant to the professional services furnished, including 

the development of qualifications and the assignment of personnel.

    (e) Standard: Personnel policies. Personnel practices and patient 

care are supported by appropriate, written personnel policies. Personnel 

records include qualifications and licensure that are kept current.

    (f) Standard: Personnel under hourly or per visit contracts. If 

personnel under hourly or per visit contracts are used by the HHA, there 

is a written contract between those personnel and the agency that 

specifies the following:

    (1) Patients are accepted for care only by the primary HHA.

    (2) The services to be furnished.

    (3) The necessity to conform to all applicable agency policies, 

including personnel qualifications.

    (4) The responsibility for participating in developing plans of 

care.

    (5) The manner in which services will be controlled, coordinated, 

and evaluated by the primary HHA.

    (6) The procedures for submitting clinical and progress notes, 

scheduling of visits, periodic patient evaluation.

    (7) The procedures for payment for services furnished under the 

contract.

    (g) Standard: Coordination of patient services. All personnel 

furnishing services maintain liaison to ensure that their efforts are 

coordinated effectively and support the objectives outlined in the plan 

of care. The clinical record or minutes of case conferences establish



[[Page 581]]



that effective interchange, reporting, and coordination of patient care 

does occur. A written summary report for each patient is sent to the 

attending physician at least every 60 days.

    (h) Standard: Services under arrangements. Services furnished under 

arrangements are subject to a written contract conforming with the 

requirements specified in paragraph (f) of this section and with the 

requirements of section 1861(w) of the Act (42 U.S.C. 1495x(w)).

    (i) Standard: Institutional planning. The HHA, under the direction 

of the governing body, prepares an overall plan and a budget that 

includes an annual operating budget and capital expenditure plan.

    (1) Annual operating budget. There is an annual operating budget 

that includes all anticipated income and expenses related to items that 

would, under generally accepted accounting principles, be considered 

income and expense items. However, it is not required that there be 

prepared, in connection with any budget, an item by item identification 

of the components of each type of anticipated income or expense.

    (2) Capital expenditure plan. (i) There is a capital expenditure 

plan for at least a 3-year period, including the operating budget year. 

The plan includes and identifies in detail the anticipated sources of 

financing for, and the objectives of, each anticipated expenditure of 

more than $600,000 for items that would under generally accepted 

accounting principles, be considered capital items. In determining if a 

single capital expenditure exceeds $600,000, the cost of studies, 

surveys, designs, plans, working drawings, specifications, and other 

activities essential to the acquisition, improvement, modernization, 

expansion, or replacement of land, plant, building, and equipment are 

included. Expenditures directly or indirectly related to capital 

expenditures, such as grading, paving, broker commissions, taxes 

assessed during the construction period, and costs involved in 

demolishing or razing structures on land are also included. Transactions 

that are separated in time, but are components of an overall plan or 

patient care objective, are viewed in their entirety without regard to 

their timing. Other costs related to capital expenditures include title 

fees, permit and license fees, broker commissions, architect, legal, 

accounting, and appraisal fees; interest, finance, or carrying charges 

on bonds, notes and other costs incurred for borrowing funds.

    (ii) If the anticipated source of financing is, in any part, the 

anticipated payment from title V (Maternal and Child Health and Crippled 

Children's Services) or title XVIII (Medicare) or title XIX (Medicaid) 

of the Social Security Act, the plan specifies the following:

    (A) Whether the proposed capital expenditure is required to comform, 

or is likely to be required to conform, to current standards, criteria, 

or plans developed in accordance with the Public Health Service Act or 

the Mental Retardation Facilities and Community Mental Health Centers 

Construction Act of 1963.

    (B) Whether a capital expenditure proposal has been submitted to the 

designated planning agency for approval in accordance with section 1122 

of the Act (42 U.S.C. 1320a-1) and implementing regulations.

    (C) Whether the designated planning agency has approved or 

disapproved the proposed capital expenditure if it was presented to that 

agency.

    (3) Preparation of plan and budget. The overall plan and budget is 

prepared under the direction of the governing body of the HHA by a 

committee consisting of representatives of the governing body, the 

administrative staff, and the medical staff (if any) of the HHA.

    (4) Annual review of plan and budget. The overall plan and budget is 

reviewed and updated at least annually by the committee referred to in 

paragraph (i)(3) of this section under the direction of the governing 

body of the HHA.

    (j) Standard: Laboratory services. (1) If the HHA engages in 

laboratory testing outside of the context of assisting an individual in 

self-administering a test with an appliance that has been cleared for 

that purpose by the FDA, such testing must be in compliance with all 

applicable requirements of part 493 of this chapter.



[[Page 582]]



    (2) If the HHA chooses to refer specimens for laboratory testing to 

another laboratory, the referral laboratory must be certified in the 

appropriate specialties and subspecialties of services in accordance 

with the applicable requirements of part 493 of this chapter.



[54 FR 33367, August 14, 1989, as amended at 56 FR 32973, July 18, 1991; 

56 FR 51334, Oct. 11, 1991; 57 FR 7136, Feb. 28, 1992; 66 FR 32778, June 

18, 2001]