[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: 42CFR484.52]



[Page 587]

 

                         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 C_Furnishing of Services

 

Sec. 484.52  Condition of participation: Evaluation of the agency's 

program.



    The HHA has written policies requiring an overall evaluation of the 

agency's total program at least once a year by the group of professional 

personnel (or a committee of this group), HHA staff, and consumers, or 

by professional people outside the agency working in conjunction with 

consumers. The evaluation consists of an overall policy and 

administrative review and a clinical record review. The evaluation 

assesses the extent to which the agency's program is appropriate, 

adequate, effective, and efficient. Results of the evaluation are 

reported to and acted upon by those responsible for the operation of the 

agency and are maintained separately as administrative records.

    (a) Standard: Policy and administrative review. As a part of the 

evaluation process the policies and administrative practices of the 

agency are reviewed to determine the extent to which they promote 

patient care that is appropriate, adequate, effective, and efficient. 

Mechanisms are established in writing for the collection of pertinent 

data to assist in evaluation.

    (b) Standard: Clinical record review. At least quarterly, 

appropriate health professionals, representing at least the scope of the 

program, review a sample of both active and closed clinical records to 

determine whether established policies are followed in furnishing 

services directly or under arrangement. There is a continuing review of 

clinical records for each 60-day period that a patient receives home 

health services to determine adequacy of the plan of care and 

appropriateness of continuation of care.



[54 FR 33367, Aug. 14, 1989; 66 FR 32778, June 18, 2001]



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