[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: 42CFR484.18]



[Page 582-583]

 

                         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. 484.18  Condition of participation: Acceptance of patients, plan 

of care, and medical supervision.



    Patients are accepted for treatment on the basis of a reasonable 

expectation that the patient's medical, nursing, and social needs can be 

met adequately by the agency in the patient's place of residence. Care 

follows a written plan of care established and periodically reviewed by 

a doctor of medicine, osteopathy, or podiatric medicine.

    (a) Standard: Plan of care. The plan of care developed in 

consultation with the agency staff covers all pertinent diagnoses, 

including mental status, types of services and equipment required, 

frequency of visits, prognosis, rehabilitation potential, functional 

limitations, activities permitted, nutritional requirements, medications 

and treatments, any safety measures to protect against injury, 

instructions for timely discharge or referral, and any other appropriate 

items. If a physician refers a patient under a plan of care that cannot 

be completed until after an evaluation visit, the physician is consulted 

to approve additions or modifications to the original plan. Orders for 

therapy services include the specific procedures and modalities to be 

used and the amount, frequency, and duration. The therapist and other 

agency personnel participate in developing the plan of care.

    (b) Standard: Periodic review of plan of care. The total plan of 

care is reviewed by the attending physician and HHA personnel as often 

as the severity of the patient's condition requires, but at least once 

every 60 days or more frequently when there is a beneficiary elected 

transfer; a significant change in condition resulting in a change in the 

case-mix assignment; or a discharge and return to the same HHA during 

the 60-day episode. Agency professional staff promptly alert the 

physician to any changes that suggest a need to alter the plan of care.

    (c) Standard: Conformance with physician orders. Drugs and 

treatments are administered by agency staff only as ordered by the 

physician with the exception of influenza and pneumococcal 

polysaccharide vaccines, which may be administered per agency policy 

developed in consultation with a physician, and after an assessment for 

contraindications. Verbal orders are put in writing and signed and dated 

with the date of receipt by the registered nurse or qualified therapist 

(as defined in Sec. 484.4 of this chapter) responsible for furnishing 

or supervising the ordered services. Verbal orders are only accepted by 

personnel authorized to do so by applicable State and Federal laws and



[[Page 583]]



regulations as well as by the HHA's internal policies.



[54 FR 33367, August 14, 1989, as amended at 56 FR 32974, July 18, 1991; 

64 FR 3784, Jan. 25, 1999; 65 FR 41211, July 3, 2000; 67 FR 61814, Oct. 

2, 2002]