La. Admin. Code tit. 50 § II-10119

Current through Register Vol. 50, No. 11, November 20, 2024

Section II-10119 - Physician Services

A. Medical Director. The nursing facility shall have a written agreement with a physician who shall serve as the medical director on a full-time or part-time basis. Whether the physician is employed full-time or part-time shall be based on the residents' needs.

1. The medical director shall not have peer restriction in regard to overseeing total medical care.

2. The medical director is responsible for:

a. implementation of resident care policies; and

b. coordination of medical care in the facility.

3. Residents shall be admitted to a facility only with a physician's order, and medical care shall be under a physician's supervision. Each resident shall have freedom of choice of physicians.

B. Physician Supervision; Ongoing Care. All facilities shall develop policies and procedures to ensure that each resident's health care is under a Louisiana physician's continuing supervision. Each resident must remain under the care of a physician. The care of every skilled/NRTP resident shall be under the supervision of a licensed physiatrist, certified in physical medicine and rehabilitation.

C. A physician visit is considered timely if it occurs not later than ten days after the date the visit was required. At the option of the physician, required visits after the initial visit may be made by a physician assistant, nurse practitioner or clinical nurse specialist. Otherwise, all physician visits shall be made by the physician personally. This does not relieve the physician of his/her obligation to visit a resident when the resident's medical condition makes that visit necessary.

D. Physicians may delegate tasks to a physician's assistant, nurse practitioner, of clinical nurse specialist who:

1. meets the applicable definitions as outlined in 42 CFR 491.2;

2. is acting within the scope of practice as defined by state law; and

3. is under the supervision of a physician.

E. A physician may not delegate a task when the regulations specify that the physician shall perform it personally or when the delegation is prohibited under state law or by the facility's own policies.

F. The facility shall provide or arrange for the provision of physician services 24 hours a day in case of emergency.

G. Alternate Physicians. When continuing care by the attending physician is interrupted by that physician's illness or vacation, the attending physician shall arrange for a designated attending physician to provide coverage.

H. Frequency of Visits. Physician visits shall conform to the following schedule.

1. For SNFs and NFs the resident shall be seen at least once very 30 days for the first 90 days after admission and at least once every 60 days thereafter.

I. Physician Responsibilities. The attending physician's services shall include but shall not be limited to the following:

1. making arrangements for the resident's medical care when he/she is not available;

2. performing an examination when visiting and recording the findings in the medical record;

3. reviewing a resident's total program of care, including medication treatment regiment and comprehensive care plan at least once every 90 days; and

4. signing and dating all orders;

5. ordering and/or performing the following:

a. medications;

b. diagnostic tests;

c. specialized rehabilitative services;

d. treatment procedures;

e. medical appliances;

f. psychosocial services;

g. discharge evaluations;

6. entering legible progress notes in the medical record, signing and dating his/her entry at each visit;

7. discussing new treatments, medications, and discharge potential and/or plans with the resident, if at all possible;

8. updating the medical record with any subsequent diagnosis which the resident may have acquired since admission and ensuring that all pertinent diagnoses are recorded in one place in the medical record; and

9. giving telephone orders only to physicians, pharmacists, physician's assistants and licensed nurses. The physician shall sign telephone orders within seven days;

10. ordering rehabilitative services with a written plan of care under the following conditions:

a. in consultation with appropriate therapist(s) and the nursing service staff; and

b. with progress being reviewed after the rehabilitative care plan implementation being re-evaluated with the therapist(s) as necessary but at least every 30 days.

J. Physician's Signature. Whenever a physician's signature is required, the actual signature shall be written. The physician may use initials only if an original legend sheet with a full signature and the initials which will be used is placed on the record. Use of signature stamps by physicians is allowed when the signature stamp is authorized by the individual whose signature the stamp represents. The administration office of the nursing facility should have on file a signed statement to the effect that he/she is the only one who has the stamp and uses it. There is no delegation to another individual.

1. Electronic signatures, where automated, are acceptable. Orders may be faxed if:

a. original orders are retained by the physician and provided if requested, or sent to facility at a later date; and

b. the facility should photocopy fax to prevent fading of document over time.

La. Admin. Code tit. 50, § II-10119

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 22:34 (January 1996).

AUTHORITY NOTE: Promulgated in accordance with R.S. 46:153.