[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

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

[CITE: 42CFR483.40]



[Page 538]

 

                         TITLE 42--PUBLIC HEALTH

 

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

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 483_REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES--Table of

Contents

 

          Subpart B_Requirements for Long Term Care Facilities

 

Sec.  483.40  Physician services.



    A physician must personally approve in writing a recommendation that 

an individual be admitted to a facility. Each resident must remain under 

the care of a physician.

    (a) Physician supervision. The facility must ensure that--

    (1) The medical care of each resident is supervised by a physician; 

and

    (2) Another physician supervises the medical care of residents when 

their attending physician is unavailable.

    (b) Physician visits. The physician must--

    (1) Review the resident's total program of care, including 

medications and treatments, at each visit required by paragraph (c) of 

this section;

    (2) Write, sign, and date progress notes at each visit; and

    (3) Sign and date all orders with the exception of influenza and 

pneumococcal polysaccharide vaccines, which may be administered per 

physician-approved facility policy after an assessment for 

contraindications.

    (c) Frequency of physician visits. (1) The resident must be seen by 

a physician at least once every 30 days for the first 90 days after 

admission, and at least once every 60 days thereafter.

    (2) A physician visit is considered timely if it occurs not later 

than 10 days after the date the visit was required.

    (3) Except as provided in paragraphs (c)(4) and (f) of this section, 

all required physician visits must be made by the physician personally.

    (4) At the option of the physician, required visits in SNFs after 

the initial visit may alternate between personal visits by the physician 

and visits by a physician assistant, nurse practitioner, or clinical 

nurse specialist in accordance with paragraph (e) of this section.

    (d) Availability of physicians for emergency care. The facility must 

provide or arrange for the provision of physician services 24 hours a 

day, in case of an emergency.

    (e) Physician delegation of tasks in SNFs. (1) Except as specified 

in paragraph (e)(2) of this section, a physician may delegate tasks to a 

physician assistant, nurse practitioner, or clinical nurse specialist 

who--

    (i) Meets the applicable definition in Sec.  491.2 of this chapter 

or, in the case of a clinical nurse specialist, is licensed as such by 

the State;

    (ii) Is acting within the scope of practice as defined by State law; 

and

    (iii) Is under the supervision of the physician.

    (2) A physician may not delegate a task when the regulations specify 

that the physician must perform it personally, or when the delegation is 

prohibited under State law or by the facility's own policies.

    (f) Performance of physician tasks in NFs. At the option of the 

State, any required physician task in a NF (including tasks which the 

regulations specify must be performed personally by the physician) may 

also be satisfied when performed by a nurse practitioner, clinical nurse 

specialist, or physician assistant who is not an employee of the 

facility but who is working in collaboration with a physician.



[56 FR 48875, Sept. 26, 1991, as amended at 67 FR 61814, Oct. 2, 2002]