Specific Requirements for Expansion of Services

3222 - Specific Requirements for Expansion of Services (Rev. 1, 05-21-04) 3222A - HHA’s Request to Provide OPT Services on Its Premises (Rev. 1, 05-21-04) An HHA may provide OPT services on its premises as well as in patients’ homes. The HHA providing services on its premises must meet and should be surveyed for compliance with 42 CFR 485.723 and 485.727. These regulations do not apply to physical therapy services provided in patients’ homes. 3222B - RHC’s Request to Provide Visiting Nurse Services (Rev. 1, 05-21-04) After the clinic is approved as an RHC, it may also seek approval to provide covered visiting nurse services. An RN, LPN, or licensed vocational nurse must furnish these services. (See 42 CFR 405.2411, 405.2416, and 405.2417.) When a request is received, the RO must determine whether there is a shortage of HHAs in the area. If there is an existing HHA furnishing services in the RHC area, the SA contacts the HHA for a statement of its ability or inability to adequately furnish nursing services in the area. In addition, the SA obtains information from the local or State health planning organization. The SA transmits the request and all pertinent documentation to the RO. The SA does not approve the visiting nurse services at this point. If the RO determines that there is not a shortage of home health services for the area, authority to furnish visiting nursing services to homebound patients will be denied, and the RHC will be expected to refer its homebound patients to the HHA serving the area. The SA will receive a copy of the RO determination notice. For purposes of this development, a “homebound individual” is one permanently or temporarily confined to his/her place of residence because of a medical or health condition. The individual may leave the place of residence infrequently and still be considered homebound. However, an individual in a hospital or long term care facility is not “homebound” for purposes of visiting nurse services. If the RO determines that there is a shortage of home health services, it will request that the SA evaluate the qualifications of RHC personnel who are responsible for delivery of nursing services. The SA completes the applicable sections of the Rural Health Clinic Survey Report (Form CMS-30) for visiting nurse services and a written plan of care. The SA reviews records (plans of care and other appropriate records) to verify that such services are provided to homebound individuals and are furnished under written plans of care developed and signed by the supervising physician, nurse practitioner, physician assistant, or nurse midwife and reviewed by the supervising physician at least every 60 calendar days. If the service has recently been implemented, it may be necessary for the SA to follow-up later to determine that the 60-day requirement is being observed. When the above development has been completed and evaluated, the SA completes a supplementary certification for the visiting nurse service. Follow the procedure in §2274. (Also see Exhibit 27.)