N.H. Admin. Code § He-P 809.15

Current through Register No. 45, November 7, 2024

Section He-P 809.15 - Required Services

(a) The licensee shall have a written contractual agreement for all services provided by arrangement.

(b) Any contractual agreement to provide care and services shall:

(1) Identify the care and services to be provided;

(2) Specify the qualifications of the personnel that will be providing the care and services;

(3) Require that the HHCP must authorize the services; and

(4) Stipulate the HHCP retains professional responsibility for all care and services provided.

(c) The licensee shall provide staff for the following positions:

(1) An administrator to oversee the HHCP, except as allowed by (e)(1) below; and

(2) A director of patient services.

(d) Any new administrator shall possess at least a bachelor's degree in business or a health related field, or be a registered nurse (RN).

(e) The administrator shall:

(1) Designate, in writing, an alternate administrator who shall assume the responsibilities of the administrator in his or her absence; and

(2) Be permitted to hold more than one position at the HHCP if:

a. The individual meets the qualifications of all positions; and

b. The duties and responsibilities of the positions can be accomplished by one individual.

(f) Any new director of patient services shall have at least 2 years' experience supervising personnel or providing direct home health care services and:

(1) Be a New Hampshire-licensed or compact registered nurse; or

(2) Have a bachelor's degree in a health related field.

(g) The director of patient services shall be responsible for the overall delivery of patient care and services.

(h) At the time of admission, personnel of the HHCP shall:

(1) Provide, both orally and in writing, to the patient, or the patient's guardian or agent, if applicable, the HHCP's:

a. Policy on patient rights and responsibilities, including a copy of the home care Clients' Bill of Rights, pursuant to RSA 151:21-b;

b. Complaint procedure;

c. List of services that are to be provided by the HHCP; and

d. List of the care and services that are provided by an independent contractor;

(2) Obtain written confirmation acknowledging receipt of the items in (1) above from the patient, or the patient's guardian or agent, if applicable;

(3) Collect and record the following information:

a. Patient's name, home address, home telephone number, and date of birth;

b. Name and telephone number of an emergency contact and guardian or agent, if applicable;

c. Name of patient's primary care provider and the provider's address and telephone number, as applicable;

d. Written and signed consent for the provision of care and services; and

e. Copies of all legal directives such as durable power of attorney, guardianship, or living will, as applicable;

f. Copy of order activating durable power of attorney, if applicable; and

g. Copy of DNR order, if applicable; and

(4) Obtain documentation of informed consent and consent for release of information.

(i) Each patient shall have a health assessment conducted by professional personnel in the specific discipline providing care, as authorized by their provider, to determine the level of care and services required by the patient, except as allowed by (k) and (l) below:

(1) Prior to initiating care for the specified discipline;

(2) At least every 90 days thereafter; and

(3) Whenever there is a significant change in the patient's condition.

(j) The assessment required by (i) above shall contain at a minimum the following:

(1) Pertinent diagnoses including mental status;

(2) Goals and objectives of the services that shall be provided by the HHCP;

(3) Estimated duration and frequency of care and services;

(4) Any equipment required;

(5) Prognosis;

(6) Functional limitations;

(7) Rehabilitation potential;

(8) Activities that are limited;

(9) Nutritional requirements;

(10) Medications and treatments administered or assisted by personnel of HHCP;

(11) Any safety precautions; and

(12) Discharge planning or referral information as applicable.

(k) Patients receiving only homemaker services shall not require an assessment or a care plan.

(l) For patients receiving only personal care services, the assessment in (i) above shall:

(1) Be performed initially and every 6 months thereafter by a registered nurse, licensed practical nurse (LPN), or the director of patient services to determine the services required; and

(2) At a minimum include (j)(1), (4), (6), (8), (9), (10), and (11) above.

(m) If the assessment required by (i) or (l)(1) and (2) above is completed by an LPN or the director of patient services who is not a registered nurse, the assessment shall be reviewed and co-signed by the registered nurse or physician prior to the development of the patient's care plan.

(n) For those patients receiving direct care or personal care services, the licensee shall develop a care plan within 3 business days of admission or prior to the initiation of services, if later, that is based on the results of the assessment required by (i) and (l) above.

(o) The care plan required by (n) above shall include:

(1) The date of the assessment;

(2) A description of the problem or need;

(3) The goals for the patient, if applicable, and identifying which services require medical, nursing, or other therapeutic professional care and which of these services can be provided by personal care service providers as defined by He-P 809.03(aq);

(4) The action or approach to be taken by HHCP personnel;

(5) The responsible person(s) or position;

(6) The date of re-evaluation, reassessment, and resolution; and

(7) Documentation that the patient and their legal representative, if applicable, were involved in the development of the care plan and any revisions made to the plan.

(p) The care plan shall be prepared by an interdisciplinary team that includes:

(1) The personnel performing the assessment;

(2) Other personnel in disciplines as determined by the patient's needs; and

(3) The patient or the patient's legal representative.

(q) The care plan shall be reviewed and revised at least every 90 days by the interdisciplinary team, or every 6 months if only personal care services are provided, and shall be made available to all personnel that assist the patient in the implementation of the plan.

(r) The licensee shall have an order for any service for which such order is required by the licensing statute of the licensed practitioner. Such orders shall be renewed at least annually.

(s) All personnel of the HHCP shall follow the orders of the licensed practitioner and carry out the goals stated in the care plan, as applicable.

(t) The licensee shall develop a discharge plan with the input of the patient or the patient's legal representative, if any, including:

(1) Date and reason for discharge;

(2) Discharge instructions and referrals, if applicable;

(3) Discharge or transfer summary; and

(4) Written and signed order for discharge, if applicable.

(u) Written notes shall be documented in the patient's record at the time of each visit for:

(1) All care and services provided by the HHCP including the:

a. Date and time of the care or service;

b. Description of the care or service;

c. Progress notes, including, as applicable:

1. Changes in the patient's physical, functional, and mental abilities;

2. Changes in the patient's behaviors such as eating or sleeping patterns; and

3. The patient's pain management, if applicable; and

d. Signature and title of the person providing the care or service; and

(2) Any reportable incident involving the patient when HHCP personnel are in the patient's home.

(v) For each patient accepted for care and services by the HHCP, a current and accurate record shall be maintained and include, at a minimum:

(1) The written confirmation required by (h)(2) above;

(2) The identification data required by (h)(3) above;

(3) Consent and medical release forms, as applicable;

(4) Consent for release of information, as applicable;

(5) The record of the assessments required by (i) or (l) above;

(6) All orders from a licensed practitioner, including the date and signature of the licensed practitioner required by (r) above;

(7) All care plans required by (n) above including documentation that the patient or their legal representative participated in the development of the care plan;

(8) All written notes required by (u) above;

(9) All daily medication records required by He-P 809.16(g)(7)d. and f.;

(10) A discharge plan or transfer summary as required by (t) above;

(11) Documentation of service authorization, if required, for a patient receiving third party payment including but not limited to Medicaid waiver services; and

(12) Documentation of any patient refusal to follow their licensed practitioner's written and signed orders.

(w) Patient records shall be available to:

(1) The patient, the patient's guardian, the patient's agent, and the patient's surrogate decision-maker;

(2) HHCP personnel as required by their job responsibilities and subject to the licensee's policy on confidentiality;

(3) Any individual given written authorization by the patient, the patient's guardian, the patient's agent, or the patient's surrogate decision-maker;

(4) Any individual authorized by a court of competent jurisdiction; and

(5) The department or any individual authorized by law.

(x) The licensee shall develop and implement a method for the written release of information in patient records that is consistent with federal and state law.

(y) The HHCP shall store all paper and electronic backup files of patient records in the primary or branch office except when they are being utilized by authorized personnel.

(z) Paper records shall be safeguarded against loss, damage, or unauthorized use by being stored in locked containers, cabinets, rooms, or closets except when they are being used by authorized personnel.

(aa) Electronic records shall be maintained as required by He-P 809.14(s).

(ab) Records shall be retained for a minimum of 4 years after discharge and in the case of minors, until one year after reaching age 18, but no less than 4 years after discharge.

(ac) The HHCP shall arrange for storage of, and access to, patient records as required by (ab) above in the event that the HHCP ceases operation.

(ad) If the HHCP is providing home hospice care, it shall be licensed in accordance with He-P 823.

(ae) Only personnel with documented phlebotomy training may collect human blood specimens from patients for laboratory testing.

(af) If CLIA-waived laboratory testing is performed by personnel of the HHCP, the licensee shall obtain a CLIA Certificate of Waiver and follow all CLIA requirements in the performance of the laboratory testing including the documentation of training and competency review of all testing personnel.

(ag) If the licensee collects human specimens for laboratory testing, it shall follow the manufacturer's instructions and/or the reference laboratory's instructions for collection and storage of human specimens.

(ah) If the licensee tests human specimens, it shall be licensed as a laboratory in accordance with He-P 808, except the licensee may perform CLIA-waived point of care tests without obtaining a laboratory license in accordance with He-P 809.15(af) and (aj).

(ai) The HHCP shall follow all manufacturer's instructions to include:

(1) Storage requirements for POC meters and devices, test strips, test cartridges, and test kits;

(2) Performance of test specimen requirements, testing environment, test procedure, troubleshooting error codes and messages, reporting results; and

(3) All recommended and required quality control procedures for POC meters and devices. If the manufacturer does not require or recommend procedures for external quality control performance, the licensee shall perform control testing using at least 2 levels of liquid quality control material for each test immediately before the first patient test each calendar day.

(aj) Licensee collecting human specimens for laboratory testing shall require a collecting station license in accordance with He-P 817 except when collected by a trained registered nurse or licensed nursing assistant.

(ak) Training consists of collection, storage, and transport of the specimens.

(al) Training will be done by a registered nurse trained in the collection, storage and transport of human specimens.

N.H. Admin. Code § He-P 809.15

#9466, eff 5-2-09

Amended by Volume XXXVII Number 19, Filed May 11, 2017, Proposed by #12167, Effective 4/29/2017, Expires 10/26/2017.

Amended by Volume XXXVIII Number 41, Filed October 11, 2018, Proposed by #12640, Effective 10/3/2018, Expires 10/3/2028.

Amended by Volume XXXIX Number 41, Filed October 10, 2019, Proposed by #12893, Effective 10/1/2019, Expires 10/1/2029.