902 KAR 20:081. Operations and services; home health agencies.
RELATES TO: KRS 216B.010-216B.130, 216B.990, 311.560(4), 314.011(8), 314.042(8), 320.210(2)
STATUTORY AUTHORITY: KRS 216B.042, 216B.105
NECESSITY, FUNCTION, AND CONFORMITY: KRS 216B.042 and 216B.105 require that the Kentucky Cabinet for Health Services regulate health facilities and health services. This administrative regulation provides licensure requirements for the operation of and services provided by home health agencies.
Section 1. Definitions. (1) "Coordination agreements" means agreements to coordinate health care services within the service area of the agency.
(2) "Home health aide" means a person who provides personal care and other related health services, as ordered by the attending physician.
(a) Selection of home health aides shall take into account the ability to:
1. Read and write;
2. Understand and carry out instructions;
3. Record messages; and
4. Keep simple records.
(b) Other factors to consider.
1. Emotional and mental maturity; and
2. Interest in and sympathetic attitude toward caring for the sick at home.
(3) "Intermittent nursing service" means service up to a few hours a day, one (1) day or several days per week or month. On occasion, service may be provided more frequently for more time per day up to seven (7) days per week.
(4) "Medical social worker" means a person who has a baccalaureate degree in social work, psychology, sociology, or other field related to social work and has at least one (1) year of social work experience in a health care setting. Such person shall be appropriately licensed, if required, by the State Board of Examiners of Social Work of Kentucky.
(5) "Occupational therapist" means a person who is registered by the American Occupational Therapy Association or a graduate of a program in occupational therapy approved by the Council on Medical Education of the American Medical Association in collaboration with the American Occupational Therapy Association and who is engaged in the required supervised clinical experience period prerequisite to registration by the American Occupational Therapy Association.
(6) "Physical therapist" means a person who is currently licensed by the Kentucky State Board of Physical Therapy.
(7) "Qualified medical social worker" means a person who has a master's degree from a school of social work accredited by the Council on Social Work Education and who has social work experience in a hospital, outpatient clinic, medical rehabilitation, medical care or mental health program. Such person shall be appropriately licensed, if required, by the State Board of Examiners of Social Work of Kentucky.
(8) "Speech pathologist" means a person who:
(a) Meets the education and experience requirements for a certificate of clinical competence in the appropriate area (speech pathology or audiology) granted by the American Speech and Hearing Association; or
(b) Meets the educational requirements for certification and is in the process of accumulating the supervised experience required for certification.
Section 2. Scope. A home health agency is a public agency or private organization, or a subdivision of such an agency or organization which provides intermittent health and health related services, to patients in their place of residence, either singly or in combination as required by a plan of treatment prescribed by a licensed physician.
Section 3. Administration and Operation. (1) The licensee shall be legally responsible for the operation of the home health agency and for compliance with federal, state, and local laws and regulations pertaining to the operation of the service.
(2) The licensee shall establish policies for the administration and operation of the service. The policies shall include:
(a) Acceptance of patients. The policy shall assure that the acceptance of patients is based on medical, nursing and social information provided by the physicians responsible for the patient's care, by institutional personnel and by staff of the home health agency.
(b) Establishment and review of plan of treatment. The policy shall assure that services and items to be provided are specified under a plan of treatment established, signed and regularly reviewed by the physician who is responsible for the care of the patient or other personnel acting within the limits of their statutory scope of practice.
(3) Home health services shall be available to the total population regardless of age, sex, and ethnic background.
(4) The total plan shall be reviewed by the attending physician, or other personnel acting within the limits of their statutory scope of practice, in consultation with agency professional personnel at such intervals as the severity of the patient's illness requires, but in any instance, at least once every two (2) months. verbal authorization to change the plan of treatment shall be reviewed and signed within twenty-one (21) days after the verbal order is issued.
(5) Clinical records. The home health agency shall maintain a clinical record for each patient which covers the services the agency provides directly and those provided through arrangements with another agency; and which contains pertinent past and current medical, nursing, and social information, including the plan of treatment. All records must be confidential.
(6) Original drug orders and changes in orders. The following shall be signed by the physician or other ordering personnel acting within the limits of their statutory scope of practice and incorporated in the patient record maintained by the agency:
(a) Original orders for drugs; and
(b) Changes in orders for the administration of those drugs subject to federal and state controlled substance acts, and other legend drugs, i.e., requiring prescriptions. Verbal authorization to change drug orders shall be reviewed and signed by the same ordering personnel within twenty-one (21) days after order is issued.
(7) Evaluation. The agency shall have procedures which provide for systematic evaluation of its program at least once every two (2) years. The agency staff shall conduct the evaluation. The program evaluation shall include:
(a) Measures to determine whether the policies established are followed in providing services. These shall include a review of patient records on a sample basis in order to determine that services are being used appropriately and the extent to which the needs of the patients the agency serves are being met both quantitatively and qualitatively;
(b) A mechanism for reviewing overall management aspects of its service to assure economy and efficiency of operations.
(8) Planning. Each agency shall develop and annually review a long range plan which includes:
(a) Assessment of needs for services in the service area of the agency.
(b) Identification of agency's role in meeting those needs.
(c) Staff expansion for a two (2) year period.
(d) Establishment of goals and objectives.
(e) Coordination of volunteer services, community education and community development activities if these services are provided by the agency.
(9) Subdivision operating as home health agency. When a subdivision of an agency (e.g., the home care department of a hospital or the nursing division of a health department) applies for license, the subdivision rather than the parent organization must be licensed as a home health agency and maintain records in such a way that subdivision activities and expenditures attributable to services provided are identifiable. The parent organization shall determine who signs the coordination agreements and other official documents, and receive and disburse funds.
Section 4. Personnel; Supervision and Training. (1) Personnel policies. The agency shall have written policies concerning qualifications, responsibilities, and conditions of employment for each type of personnel (including licensure where this is required by state law). The policies shall be written and available to staff and cover:
(a) Wage scales, hours of work, vacation and sick leave;
(b) Preemployment criminal conviction information;
(c) A plan for preemployment and periodic medical examination, tuberculin test and/or chest x-ray, and other appropriate tests;
(d) Plans for orientation and for on-the-job training, where necessary;
(e) Periodic evaluation of employee performance; and
(f) Job descriptions for each category of health personnel which are specific and include the type of activity each may carry out.
(2) Agency supervision. The home health agency shall designate a physician or registered nurse to supervise the agency's performance in providing home health services in accordance with the orders of the physician responsible for the care of the patient and under a plan of treatment established by such physician.
(3) Supervision of therapy services. When services of aides or other personnel providing supplementary services are utilized in providing home health services, they shall be trained and supervised by appropriate professional personnel. When such supervision is less than full-time, e.g., for a limited number of hours or days each week, the supervision shall be provided on a planned basis and shall be frequent enough to assure adequate review of individual treatment plans and progress.
(4) Supervision of home health aides. A registered nurse shall provide direct supervision as necessary and be readily available at other times by telephone. The supervisor shall be constantly evaluating the home health aide in terms of the aide's ability to carry out assigned duties, to relate well to the patient, and to work effectively as a member of a team of health workers. The registered nurse, or appropriate professional staff member, if other services are provided, shall make a supervisory visit to the patient's residence at least every two (2) weeks either when the aide is present to observe and assist, or when the aide is absent to assess relationships and determine whether goals are being met.
(5) Training of home health aides. The home health agency shall require that home health aides receive or have received a basic training program for home health aides. A home health aide shall be trained in:
(a) Methods of assisting patients to achieve maximum self-reliance;
(b) Principles of nutrition and meal preparation;
(c) The aging process and the emotional problems of
(d) Procedures for maintaining clean, healthful and pleasant environment;
(e) Awareness of changes in patient's condition that should be reported;
(f) Work of the agency and the health team; and
(g) Ethics, confidentiality and recordkeeping.
Section 5. Provision of Services. (1) The home health agency shall provide intermittent skilled nursing services and other services for restoring, maintaining and promoting health and/or rehabilitation with minimum disruption of daily living.
(2) Services shall range from skilled nursing services to basic health related services to unskilled supportive services.
(3) Services shall be available five (5) days a week with back-up arrangements for weekend and emergency services.
(4) In addition to intermittent skilled nursing services, the agency shall provide home health aide services, medical supplies and equipment services. When a home health agency provides therapeutic and medical social services, the following conditions shall be met:
(a) Physical, speech or occupational therapy. When an agency provides or arranges for physical, speech or occupational therapy, service shall be given in accordance with a physician's written orders by or under the supervision of a therapist meeting the respective qualifications as set forth in Section 1(5), (6), and (8) of this administrative regulation.
(b) Respiratory therapy. When an agency provides or arranges for respiratory therapy, services shall be given in accordance with a physician's written order, by or under the supervision of a licensed nurse with experience and/or training in the field of respiratory therapy.
(c) Medical social services. When an agency provides or arranges for medical social services, services shall be given in accordance with a physician's written order by a qualified medical social worker or a medical social worker meeting the qualifications set out in Section 2 of this administrative regulation.
(5) Home health aide services. Visits of the home health aide for providing personal care and other related health services must be ordered by the physician and included in a plan of treatment approved by the physician.
(6) Services arranged for with another licensed provider. When a home health agency makes arrangements for the provision of home health services by another agency which is a licensed provider of services, there shall be a written agreement which:
(a) Designates the services which are being arranged for. Services provided are to be within the scope and limitations set forth in the plan of treatment. Such services may be altered only upon the specific orders of the initiating home health agency issued as a result of a change made by the physician in the patient's plan of treatment;
(b) Describes how the contracted personnel, where applicable, are to be supervised; and
(c) Provides for the recording of the progress notes and observations of the contracted personnel in the home health agency records for purposes of planning and evaluating patient care.
(7) Services arranged for with a nonlicensed provider. When a home health agency arranges for services with an agency that is not a licensed provider of services, a contract shall be written. The contract shall:
(a) Designate the services which are being arranged;
(b) Specify the period of time the contract is to be in effect and how frequently it is to be reviewed;
(c) Describe how the contracted personnel are to be supervised;
(d) State that home health services provided to the patient are in accordance with a plan established by the patient's physician in conjunction with home health agency staff and, when appropriate, others involved in the patient's care. Services provided shall be within the scope and limitations set forth in the plan and shall not be altered in type, scope, or duration by the secondary agency; and
(e) Assure that personnel and services contracted for meet the same requirements as those specified for home health agency personnel and services, including personnel qualifications, functions, supervision, orientation, basic training program for home health aides, and in-service training.
(8) Service agreements with other health care facilities. Coordination agreements as defined in Section 2 of this administrative regulation shall be developed with the major health care providers in the service area including: hospitals, skilled, intermediate and personal care facilities and family care homes. (8 Ky.R. 243; eff. 11-5-81; Am. 16 Ky.R. 998; eff. 1-12-90; 25 Ky.R. 623; 1071; 1364; eff. 12-16-98.)