Subject 111-8-31 HOME HEALTH AGENCIES
Under the authority of O.C.G.A. § 31-7-150, the Department of Community Health is authorized and required to establish the licensing procedures and standards of operation for home health agencies operating in this State. These rules and regulations are provided for this purpose.
Each person, private or public organization, political subdivision, or other governmental agency desiring to operate a home health agency, as defined herein, must first apply for and obtain a license using the forms furnished by the Department of Community Health. A license is not assignable or transferable and is subject to suspension or revocation at any time for failure to comply with these rules and regulations.
Home health agencies which are required by state laws to obtain a certificate of need shall submit evidence that such requirements have been met when applying for a license.
These rules and regulations shall not apply to services which are provided under the following conditions:
|(a)||Persons who provide personal or paraprofessional health services, either with or without compensation when there is no claim that the service is provided as a part of a licensed home health agency;|
|(b)|| Persons who
provide professional services for which they are duly licensed under
Georgia laws, when there is no claim that the service is provided as a part of a licensed home health agency;
|(c)|| Services provided under the provisions of
any other license issued by the State of
Georgia when there is no claim that the service is provided as a part of a licensed or certified home health agency;
|(d)||Any home health agency certified in a federal program for reimbursement of Medicare or Medicaid services shall be exempt from an additional on-site licensure inspection upon presentation of evidence of such certification.|
For the purpose of insuring compliance with these rules and regulations, each home health agency shall be subjected to periodic inspections by an authorized representative of the Department. Such inspections shall take place during reasonable hours and, if possible, during scheduled operating hours. The administrator or his representative shall accompany the Department representative on tours of inspection and shall sign the completed checklist.
Unless a different meaning is required or given in the context, the following terms as used in these rules and regulations shall have the meaning respectively ascribed to them:
|(a)|| "Administrator" means the full-time
person by whatever title used, to whom the governing body has delegated the
responsibility for day-to-day administration of the home health agency,
including the implementation of the rules and policies adopted by the governing
body, and who:
|(b)||"Board" means the Board of Community Health.|
|(c)||"Branch Office" means a location or site identified in the application or endorsement thereto from which a home health agency provides services within a portion of the total geographic area served by the parent agency. The branch office is part of the home health agency and is located sufficiently close to share administration, supervision, and services in a manner that renders it unnecessary for the branch independently to meet the requirements of these rules and regulations.|
|(d)||"By-Laws" means a set of rules adopted by a home health agency for governing the agency's operation.|
|(e)||"Certificate of Need" shall have that meaning as defined in O.C.G.A. § 31-6-1et seq. and applicable rules.|
|(f)||"Clinical Note" means a dated and signed written notation by the providing member of the health team of a contact with a patient containing a description of signs and symptoms, treatment and drug given, the patient's reaction, and any changes in physical or emotional condition.|
|(g)||"Department" means the Georgia Department of Community Health.|
|(h)||"Governing Body" means the person or persons, natural or corporate, in which the ultimate responsibility, authority and accountability for the conduct of the home health agency is vested.|
|(i)||"Health Professionals" means those professionals engaged in the delivery of health services Who are currently licensed to practice in the State of Georgia, or are certified, or practice under authority consistent with Georgia laws.|
|(j)||"Home Health Agency" means: a public, non-profit, or proprietary organization; whether owned or operated by one or more persons or legal entities, which is engaged in providing home health services.|
|(k)|| "Home Health
Services" means those items and services provided to an individual, according
to a written plan of treatment signed by the patient's physician, by a home
health agency or others under arrangement with the home health agency on a
visit or hourly basis, in a place of temporary or permanent residence used as
the individual's home as follows:
|(l)||"License" means a license issued by the Department.|
|(m)||"Licensee" means the individual, corporation, or public entity with whom rests the ultimate responsibility for maintaining approved standards for the home health agency.|
|(n)||"Licensed Practical Nurse or LPN" means an individual who is currently licensed as a licensed practical nurse in Georgia.|
"Occupational Therapist" means a qualified individual who:
|(p)|| "Occupational Therapy Assistant" means a
qualified individual who:
|(q)||"Parent Home Health Agency" means the agency that develops and maintains administrative controls of subunits or branch offices.|
|(r)|| "Physical Therapist" means a qualified
"Physical Therapy Assistant" means a qualified individual who:
|(t)||"Physician" means an individual who is currently licensed or authorized to practice medicine and surgery in Georgia.|
|(u)||"Plan of Treatment" means an individual plan written, signed, and reviewed at least every sixty days by the patient's physician prescribing items and services for the patient's condition.|
|(v)||"Primary Home Health Agency" means the agency (parent or subunit) that is responsible for the service rendered to patients and for implementation of the plan of treatment.|
|(w)||"Progress Note" means a dated and signed written notation by the providing member of the health team, summarizing facts about care and the patient's response during a given period of time.|
|(x)||"Registered Nurse or RN" means an individual who is currently licensed as a registered professional nurse in Georgia.|
|(y)||"Service Area" means the geographical area in which a home health agency provides services, as defined by the State Health Planning and Development unit of the Department.|
|(z)||"Social Work Assistant" means an individual who meets the federal conditions of participation and applicable Georgia laws.|
|(aa)||"Social Worker" means an individual who meets the federal conditions of participation and applicable Georgia laws.|
|(bb)|| "Speech Pathologist"
and/or "Audiologist" means a qualified individual who:
|(cc)||"Subunit" means a semiautonomous organization, which serves patients in a geographic area different from that of the parent agency. The subunit by virtue of the distance between it and the parent agency is judged incapable of sharing administration, supervision, and services on a daily basis with the parent agency, and must, therefore, independently meet the licensing requirements for a home health agency, and shall be separately licensed.|
|(dd)||"Supervision" means authoritative procedural guidance by a qualified person for the accomplishment of a function or activity with initial direction and periodic inspection of the actual act of accomplishing the function or activity.|
|(1)||Organizations, Services, Administration. Organizations, services provided, administrative control, and lines of authority for the delegation of responsibility down to the patient care level shall be clearly set forth in written policies and procedures. Administrative and supervisory functions shall not be delegated to another agency or organization. Services not provided directly shall be monitored and controlled by the primary agency, including services provided through subunits of the parent agency. If an agency has subunits, appropriate administrative records shall be maintained for each subunit.|
|(2)||Governing Body. There shall be a governing body which assumes full legal authority and responsibility for the operation of each home health agency. The governing body shall appoint a qualified administrator, arrange for professional advice, adopt and periodically review written bylaws and oversee the management and fiscal affairs of the agency. The name and address of each officer, directors, and owner shall be disclosed to the Department. If the agency is a corporation, all ownership interests of five (5) percent or more (direct or indirect) shall also be disclosed.|
|(3)|| Group of
|(4)||Administrator. The administrator (who may also be the supervising physician or registered nurse), is responsible for organizing and directing the agency's ongoing functions; maintaining ongoing liaison among the governing body, the group of professional personnel, and the staff; employing qualified personnel and ensuring adequate staff education and evaluations; ensuring the accuracy of public information, materials and activities; and implementing an effective budgeting and accounting system. A qualified person shall be authorized in writing to act in the absence of the administrator.|
|(5)||Supervising Physician or Registered Nurse. Skilled nursing and other therapeutic services provided shall be under the supervision and direction of a physician or a registered nurse. This person or similarly qualified alternate shall be available at all times during operating hours and: participate in all activities relevant to the professional services provided, including the developing of qualifications and assignments of personnel.|
Policies. Personnel practices shall be supported by appropriate, written
personnel policies. Individual personnel records shall include job
descriptions, qualifications, licenses, performance evaluations, and health
examinations, and shall be kept current. If personnel under hourly or per visit
contracts are utilized by the home health agency, there shall be a written
contract between such personnel and the agency clearly designating:
|(7)||Planning and Budget. A home health agency, under the direction of the governing body, shall prepare an overall plan and budget which provides for an annual operating budget. If capital expenditures are anticipated, a three-year capital expenditure plan shall be provided and updated annually. The overall plan, budget and capital expenditure plan shall be reviewed and updated at least annually.|
A home health agency shall provide part-time or intermittent skilled nursing services and at least one other therapeutic service, e.g., physical, speech, or occupational therapy; medical social services; or home health aide services. Services shall be made available on a visiting basis, in a place of residence, as a patient's home.
|(a)|| Nursing Services. A home health agency
shall provide skilled nursing service by or under the supervision of a
registered nurse and in accordance with the plan of treatment.
|(b)|| Therapy Services. All therapy services
offered by the home health agency directly or under arrangement shall be given
by a qualified therapist in accordance with the plan of treatment. The
qualified therapist shall assist the physician in evaluating level of function,
help develop the plan of treatment (revising as necessary), prepare clinical
and progress notes, advise and consult with the family and other agency
personnel, and participate in inservice programs. Therapy services include, but
are not limited to:
|(c)||Medical Social Services. Medical social services, when provided, shall be given by a qualified social worker in accordance with the plan of treatment. The social worker shall assist the physician and other team members in understanding the significant social and emotional factors related to the health problems, participate in the development of the plan of treatment, prepare clinical and progress notes, work with the family, utilize appropriate community resources, participate in discharge planning and inservice programs, and act as a consultant to other agency personnel.|
|(d)|| Home Health
|(e)||Coordination of Patient Services. All personnel providing services shall maintain a liaison with the home health agency to assure that their efforts effectively complement one another and sup- port the objectives outlined in the plan of treatment. The clinical record shall contain dated minutes of case conferences verifying that effective interchange, reporting, and coordinated patient evaluation does occur. A written summary report of clinical and progress notes for each patient shall be sent to the attending physician at least every sixty (60) days and upon discharge. A copy of these reports shall become a permanent part of the patient's clinical record.|
|(f)||Services Under Arrangements. All services provided under arrangements shall be subject to a written contract. Contracts for home health services shall conform with the specific requirements of Rule 111-8-31.07(6)(a)through(g).|
Patients shall be accepted for treatment on the basis of a reasonable expectation that the patient's medical, nursing, and social needs can be met adequately by the agency in the patient's place of residence. Patients shall not be denied services because of their age, sex, race, religion, or national origin. Care shall follow a written plan of treatment established and periodically reviewed by a physician, and shall continue under the supervision of a physician.
|(a)||Plan of Treatment. An individual plan of treatment shall be developed for each patient in consultation with agency staff, and shall cover all pertinent diagnosis, including mental status, types of services and equipment required, frequency of visits, prognosis, rehabilitation potential, functional limitations, activities permitted, nutritional requirements, medications and treatments, safety measures to protect against injury, instructions for timely discharge or referral, and other appropriate items. If a physician refers a patient under a plan of treatment which cannot be completed until after an evaluation visit, the physician shall be consulted to approve additions or modifications to the original plan. Orders for therapy services shall specify the procedures and modalities to be used, and the amount, frequency, and duration.|
|(b)||Periodic Review of Plan of Treatment. The total plan of treatment shall be reviewed by the attending physician and home health agency personnel as often as the severity of the patient's condition requires, but at least once every sixty (60) days. Date of the review and approval of the plan shall be documented by the physician's signature. Agency professional staff shall promptly alert the physician to any changes that suggest a need to alter the plan of treatment.|
|(c)||Conformance with Physician's Orders. Drugs and treatment shall be administered by agency staff only as ordered by the physician. The nurse or therapist shall immediately record and sign oral orders and forward the written order within five (5) business days to the physician for countersignature. Documentation of the physician's countersignature must appear in the patient's medical record within thirty (30) days of the verbal order. Professional agency staff shall check all medicines a patient may be taking to identify possible ineffective drug therapy or adverse reactions, significant side effects, drug allergies, and contraindicated medication, and shall promptly report any problems to the physician.|
|(d)|| Clinical Records.
|(e)||Retention of Records. Clinical records shall be retained for a period of six years after the last patient encounter for adults, and for six years after a minor reaches the age of majority. These records may be retained as originals, microfilms, or other usable forms and shall afford a basis for complete audit of professional information. If the home health agency dissolves or changes ownership, a plan for record retention shall be developed and placed into effect. The Department shall be advised of the disposition and/or location of said records.|
|(f)||Protection of Records. Clinical record information shall be safeguarded against loss or unauthorized use. Written procedures shall govern the use and removal of records and conditions for release of information. A patient's written consent is required for release of information not authorized by law.|
Any person who operates a home health agency without first obtaining a license pursuant to the provisions of the Georgia Home Health Agency Act shall be deemed guilty of a misdemeanor, and upon conviction shall be fined not to exceed $500.00 or imprisoned for a period not to exceed six months or both.
Each application for initial and annual renewal licenses shall be accompanied by a fee as prescribed by the Department.
The administration and enforcement of these rules and regulations shall be as prescribed in the "Georgia Administrative Procedure Act," O.C.G.A. § 50-13-1et seq.
These regulations are applicable only to home health agencies as defined herein and the services they provide, and do not modify or revoke any of the provisions of other published rules of the Department.
In the event that any rule, sentence, clause or phrase of any of these rules and regulations may be construed by any court of competent jurisdiction to be invalid, illegal, unconstitutional, or otherwise unenforceable, such determination or adjudication shall in no manner affect the remaining rules or portions thereof and such remaining rules or portions thereof shall remain of full force and effect, as if such rule or portions thereof so determined, declared or adjudged invalid or unconstitutional were not originally a part hereof. It is the intent of the Board of Community Health to establish rules and regulations that are constitutional and enforceable so as to safeguard the health and well being of the people of the State.