[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: 42CFR485.631]



[Page 607-608]

 

                         TITLE 42--PUBLIC HEALTH

 

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

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 485_CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS--Table 

of Contents

 

 Subpart F_Conditions of Participation: Critical Access Hospitals (CAHs)

 

Sec. 485.631  Condition of participation: Staffing and staff 

responsibilities.



    (a) Standard: Staffing--(1) The CAH has a professional health care 

staff that includes one or more doctors of medicine or osteopathy, and 

may include one or more physician assistants, nurse practitioners, or 

clinical nurse specialists.

    (2) Any ancillary personnel are supervised by the professional 

staff.

    (3) The staff is sufficient to provide the services essential to the 

operation of the CAH.

    (4) A doctor of medicine or osteopathy, nurse practitioner, clinical 

nurse specialist, or physician assistant is available to furnish patient 

care services at all times the CAH operates.

    (5) A registered nurse, clinical nurse specialist, or licensed 

practical nurse is on duty whenever the CAH has one or more inpatients.

    (b) Standard: Responsibilities of the doctor of medicine or 

osteopathy. (1) The doctor of medicine or osteopathy--

    (i) Provides medical direction for the CAH's health care activities 

and consultation for, and medical supervision of, the health care staff;



[[Page 608]]



    (ii) In conjunction with the physician assistant and/or nurse 

practitioner member(s), participates in developing, executing, and 

periodically reviewing the CAH's written policies governing the services 

it furnishes.

    (iii) In conjunction with the physician assistant and/or nurse 

practitioner members, periodically reviews the CAH's patient records, 

provides medical orders, and provides medical care services to the 

patients of the CAH; and

    (iv) Periodically reviews and signs the records of patients cared 

for by nurse practitioners, clinical nurse specialists, or physician 

assistants.

    (2) A doctor of medicine or osteopathy is present for sufficient 

periods of time, at least once in every 2 week period (except in 

extraordinary circumstances) to provide the medical direction, medical 

care services, consultation, and supervision described in this 

paragraph, and is available through direct radio or telephone 

communication for consultation, assistance with medical emergencies, or 

patient referral. The extraordinary circumstances are documented in the 

records of the CAH. A site visit is not required if no patients have 

been treated since the latest site visit.

    (c) Standard: Physician assistant, nurse practitioner, and clinical 

nurse specialist responsibilities. (1) The physician assistant, the 

nurse practitioner, or clinical nurse specialist members of the CAH's 

staff--

    (i) Participate in the development, execution and periodic review of 

the written policies governing the services the CAH furnishes; and

    (ii) Participate with a doctor of medicine or osteopathy in a 

periodic review of the patients' health records.

    (2) The physician assistant, nurse practitioner, or clinical nurse 

specialist performs the following functions to the extent they are not 

being performed by a doctor of medicine or osteopathy:

    (i) Provides services in accordance with the CAH's policies.

    (ii) Arranges for, or refers patients to, needed services that 

cannot be furnished at the CAH, and assures that adequate patient health 

records are maintained and transferred as required when patients are 

referred.

    (3) Whenever a patient is admitted to the CAH by a nurse 

practitioner, physician assistant, or clinical nurse specialist, a 

doctor of medicine or osteopathy on the staff of the CAH is notified of 

the admission.



[58 FR 30671, May 26, 1993, as amended at 62 FR 46037, Aug. 29, 1997]