216-RICR-40-10-17
216-RICR-40-10-17. Licensing Home Nursing Care Providers and Home Care Providers (version Amendment, 03/07/2018 to 03/07/2018)
17.1 Authority
These regulations are promulgated pursuant
to the authority conferred under R.I. Gen. Laws § 23-17-10 and
23-17-42 and are established for the purpose of adopting minimum
standards for licensed home nursing care and home care providers in
this state.
17.2 Incorporated Materials
These regulations hereby adopt and
incorporate 42 C.F.R. § 484 (1999) by reference, not including any
further editions or amendments thereof and only to the extent that
the provisions therein are not inconsistent with these regulations.
17.3 Definitions
A. Wherever
used in these rules and regulations the following terms shall be
construed to mean:
1. "Abuse"
means:
a. Any assault as defined in R.I.
Gen. Laws Chapter 11-5 , including, but not limited to, hitting,
kicking, pinching, slapping, or the pulling of hair; provided,
however, unless it is required as an element of the offense charged,
it shall not be necessary to prove that the patient or resident was
injured by the assault;
b. Any assault as defined in
R.I. Gen. Laws Chapter 11-37 ;
c. Any offense under
R.I. Gen. Laws Chapter 11-10 ;
d. Any conduct which harms or is likely to
physically harm the patient or resident except where the conduct is a
part of the care and treatment, and in furtherance of the health and
safety of the patient or resident;
e. Intentionally engaging in a pattern of
harassing conduct which causes or is likely to cause emotional or
psychological harm to the patient or resident, including but not
limited to, ridiculing or demeaning a patient or resident, making
derogatory remarks to a patient or resident or cursing directed
towards a patient or resident, or threatening to inflict physical or
emotional harm on a patient or resident.
2. "Administrator"
means an individual who:
a. Is a licensed physician; or
b. Has training and experience in health
service administration and at least one year of supervisory or
administrative experience in home nursing care or home care or
related health programs; or
c. Is a registered nurse who meets
qualifications of as set forth in 42 C.F.R. § 484 (1999).
3. "Attending
physician" means a physician identified by the
patient/client/family as having a significant role in the
determination and delivery of the individual's medical care.
4. "Branch
office" means a location from which a licensed home nursing care
provider or licensed home care provider provides services within a
portion of the total geographic area served by the licensed central
office.
5. "Change
in operator" means a transfer by the governing body or operator
of a home nursing care or home care provider to any other person
(excluding delegations of authority to the medical or administrative
staff of the facility) of the governing body's authority to:
a. Hire or fire the chief executive officer
of the home nursing care provider or home care provider;
b. Maintain and control the books and
records of the home nursing care provider or home care provider;
c. Dispose of assets and incur liabilities
on behalf of the home nursing care provider or home care provider; or
d. Adopt and enforce policies regarding
operation of the home nursing care provider or home care provider.
e. This definition is not applicable to
circumstances wherein the governing body of a home nursing care
provider or home care provider retains the immediate authority and
jurisdiction over the activities enumerated above.
6. "Change
in owner" means:
a. In the case of a home nursing care
provider or home care provider which is a partnership, the removal,
addition, or substitution of a partner which results in a new partner
acquiring a controlling interest in such partnership.
b. In the case of a home nursing care
provider or home care provider which is an unincorporated solo
proprietorship, the transfer of the title and property to another
person;
c. In the case of a home nursing care
provider or home care provider which is a corporation:
(1) A
sale, lease, exchange or other disposition of all, or substantially
all of the property and assets of the corporation; or
(2) A
merger of the corporation into another corporation; or
(3) The
consolidation of two (2) or more corporations, resulting in the
creation of a new corporation; or
(4) In
the case of a home nursing care provider or home care provider which
is a business corporation, any transfer of corporate stock which
results in a new person acquiring a controlling interest in such
corporation; or
(5) In
the case of a home nursing care provider or home care provider which
is a non- business corporation, any change in membership which
results in a new person acquiring a controlling vote in such
corporation.
7. "Director"
means the Director of the Rhode Island Department of Health.
8. “Equity”
means non-debt funds contributed towards the capital costs related to
an initial licensure or change in owner or change in operator of a
home nursing care provider or home care provider which funds are free
and clear of any repayment or liens against the assets of the
proposed owner and/or licensee and that result in a like reduction in
the portion of the capital cost that is required to be financed or
mortgaged.
9. "Fluency"
means the ability to converse freely in a language.
10. "Health
care facility" means any institutional health service provider,
facility or institution, place, building, agency, or portion thereof,
whether a partnership or corporation, whether public or private,
whether organized for profit or not, used, operated, or engaged in
providing health care services, including, but not limited to,
hospitals; nursing facilities; home nursing care providers (which
shall include skilled nursing services and may also include
activities allowed as a home care provider or as a nursing service
agency); home care provider (which may include services such as
personal care or homemaker services); rehabilitation centers; kidney
disease treatment centers; health maintenance organizations;
free-standing emergency care facilities and facilities providing
surgical treatment to patients not requiring hospitalization
(surgicenters); hospice care and physician office settings providing
surgical treatment. The term "health care facility" also
includes organized ambulatory care facilities which are not part of a
hospital but which are organized and operated to provide health care
services to outpatients such as central services facilities serving
more than one (1) health care facility or health care provider,
treatment centers, diagnostic centers, rehabilitation centers,
outpatient clinics, infirmaries and health centers, school-based
health centers, and neighborhood health centers; providing, however,
that the term "health care facility" shall not apply to
organized ambulatory care facilities owned and operated by
professional service corporations as defined in R.I. Gen. Laws
Chapter 7-5.1 (the "Professional Service Corporation Law"),
or to a private practitioner's (physician, dentist, or other health
care provider) office or group of the practitioners' offices (whether
owned and/or operated by an individual practitioner, alone or as a
member of a partnership, professional service corporation
organization, or association). Facilities licensed by the Department
of Behavioral Healthcare, Developmental Disabilities and Hospitals
and clinical laboratories licensed in accordance with R.I. Gen. Laws
Chapter 23-16.2, as well as Christian Science institutions, also
known as Christian Science Nursing Facilities, listed and certified
by the Commission for Accreditation of Christian Science Nursing
Organizations/Facilities, Inc. shall not be considered health care
facilities for purposes of these Regulations.
11. “Health
care provider” means any person licensed by the State of Rhode
Island to provide or otherwise lawfully providing health care
services, including, but not limited to, a physician, hospital,
intermediate care facility or other health care facility, dentist,
nurse, optometrist, podiatrist, physical therapist, psychiatric
social worker, pharmacist, or psychologist, and any officer, employee
or agent of that provider acting in the course and scope of his/her
employment or agency related to or supportive of health services.
12. “High
managerial agent" means an officer of a licensee, the
administrator and assistant administrator of the facility, the
director and assistant director of nursing services, or any other
agent in a position of comparable authority with respect to the
formulation of policies of the facility or the supervision in a
managerial capacity of subordinate employees.
13. "Home
care provider" means any person that provides, arranges to
provide, offers to provide, or in any other way provides for the
delivery of any direct health care services in the home requiring
supervision by a registered nurse (RN), but excludes the delivery of
direct nursing care by a registered (RN) or licensed practical (LPN)
nurse on an on-going basis; and includes services rendered by a
licensed health care professional, including but not limited to, a
speech pathologist/audiologist, physical, occupational, or
respiratory therapist. Also as used in these Regulations, "home
care provider" includes homemaker services as defined in these
Regulations. Nursing service agency services may also be provided
under this license provided such services are rendered in accordance
with the “Rules and Regulations for the Licensing of Nursing
Service Agencies.”
14. "Home
nursing care provider" means any person that provides, arranges
to provide, offers to provide, or in any other way provides for the
delivery of direct nursing services in the home by a registered (RN)
or practical (LPN) nurse. As used in these Regulations, "home
nursing care provider" may include home care provider services.
Nursing service agency services may also be provided under this
license provided such services are rendered in accordance with the
“Rules and Regulations for the Licensing of Nursing Service
Agencies.”
15. "Home
health aide" means "nursing assistant".
16. "Homemaker",
, means a trained non-professional worker who performs related
housekeeping services in the home for the sick, disabled, dependent
or infirm.
17. "Homemaker
services" means housekeeping services performed in the home for
the sick, disabled, dependent, or infirm by a trained
non-professional worker who is supervised in accordance with the
requirements of § 17.5.3(J)(2) of this Part.
18. "Licensing
agency" means the Rhode Island Department of Health.
19. "Medical
services" means such professional services and supplies rendered
by or under the direction of persons duly licensed under the laws of
the State of Rhode Island to practice medicine, surgery or podiatry
as may be specified by any medical service plan. Medical services
shall not be construed to include hospital services.
20. "Mistreatment"
means the inappropriate use of medications, isolation, or use of
physical or chemical restraints:
a. As punishment;
b. For staff convenience;
c. As a substitute for treatment or care;
d. In conflict with a physician's order; or
e. In quantities which inhibit effective
care or treatment, or which harms or is likely to harm the patient or
resident.
21. "Neglect"
means the intentional failure to provide treatment, care, goods, and
services necessary to maintain the health and safety of the patient
or resident, or the intentional failure to carry out a plan of
treatment or care prescribed by the physician of the patient or
resident, or the intentional failure to report patient or resident
health problems or changes in health problems or changes in health
conditions to an immediate supervisor or nurse, or the intentional
lack of attention to the physical needs of a patient or resident
including, but not limited to toileting, bathing, meals, and safety.
No person shall be considered to be neglected for the sole reason
that he or she relies on or is being furnished treatment in
accordance with the tenets and teachings of a well-recognized church
or denomination by a duly-accredited practitioner of a
well-recognized church or denomination.
22. "Nursing
assistant" means a nurse's aide, or home health aide, who is a
paraprofessional, registered, pursuant to the provisions of
R.I. Gen. Laws Chapter 23-17.9 , and who is trained to give
personal care and related health care and assistance based on his/her
level of preparation to individuals who are sick, disabled, dependent
or infirm, and who are residents of or receive services from health
care facilities licensed pursuant to
R.I. Gen. Laws Chapter 23-17 , or who are receiving services from
agencies licensed pursuant to R.I. Gen. Laws Chapter 23-17.7.1.
23. "Patient"
means a person who receives home nursing care or home care provider
services or who is judged to need home nursing care or home care
provider services based upon the results of an initial screening. The
terms "patient" and "client" are synonymous in
the context of these Regulations.
24. "Person"
means any individual, trust or estate, partnership, corporation
(including associations, joint stock companies, and insurance
companies) state or political subdivision or instrumentality of a
state.
25. "Personal
care services" means those services provided to a patient that
do not require the skills of a licensed nurse. These services may
include, but are not limited to: bathing, dressing, grooming, caring
for hair/nails, and assistance with ambulation.
26. "Physician"
means any individual licensed to practice medicine or osteopathy in
Rhode Island or any other state in the United States.
27. “Plan
of care” or “care plan”, as used of these Regulations, means
the comprehensive written plan for the patient’s care. The plan
shall include physician orders for medications, treatments,
procedures, or therapeutic services, where indicated; and shall also
encompass patient assessments and treatment goals/objectives,
including provisions for personal care and social needs. (For further
requirements related to the patient’s plan of care, see §§
17.4.4(A)(4) and 17.6.2(C) of this Part).
28. "R.I.
Gen. Laws" means the General Laws of Rhode Island, as amended.
29. "Service(s)
provided directly" means services rendered by employees of a
licensed home nursing care provider or home care provider.
30. "Supervision"
shall mean clinical guidance provided by a qualified person for the
assessment and monitoring of patient care management.
a. Registered nurses and other appropriate
professionals of the health care team, licensed, registered and/or
certified as may be required by the laws of Rhode Island, shall
supervise (directly or indirectly) nursing assistants. A registered
nurse shall supervise any acts, functions or tasks performed by a
nursing assistant that are nursing-related.
31. “Therapeutic
services”, as used in these Regulations, means those treatments
provided by a licensed health care professional that have medicinal
or healing properties, such as infusion, respiratory, occupational,
speech, or physical therapy and that are included in the patient’s
care plan.
32. “These
Regulations” mean all parts of Rhode Island rules and regulations
for Licensing of Home Nursing Care and Home Care Providers
(216-RICR-40-10-17).
33. "Uncompensated
care" means health care services provided by a home nursing care
or home care provider for which the home nursing care or home care
provider does not and has not expected payment and which health care
services are not recognized as either a receivable or as revenue in
the home nursing care or home care provider's financial statements.
17.4 General Requirements for
Licensure and Certificate of Need
Requirements
A. No
person acting
alone or
jointly with
any other
person, shall
establish, conduct
or maintain a home
nursing care provider or home care provider in Rhode Island without a
license in accordance with
the requirements
of R.I. Gen. Laws
§ 23-17-4
and in
conformity with
these Regulations. Provided, however, that any person, firm,
corporation or other entity which
provides volunteer
registered and
licensed practical
nurses to
the public
shall not
be required to have a license as a health care
facility.
B. A
certificate of
need is
required as
a precondition
to the
establishment and
initial licensure
of any home nursing care provider or home care provider and
such other activities in accordance with the “Rules and Regulations
for Determination of Need for New Health Care Equipment and New
Institutional Health Care Services.”
1. Any
certificate of need required as a precondition to the establishment
and initial licensure or
any change
in owner,
operator, or
lessee of
a licensed
home nursing
care provider or home care provider shall require prior review
by the Health Services Council and approval of the licensing agency
in accordance with §§ 17.2.2(C) and (E) of this Part,
as a
condition precedent
to the
issuance, transfer,
or assignment
of a new license.
C. No
facility shall
hold itself
or represent
itself as
a home
nursing care
provider or
home care provider
or use
the term
"home nursing
care provider
or home
care provider",
"home health
care provider" or other similar term in its advertising,
publicity or any other form of communication, unless licensed as a
home nursing care provider or home care provider in accordance with
the provisions of these Regulations.
1. Any
person establishing,
conducting, managing,
or operating
any home
nursing care
provider or home care provider without a license shall be fined not
more than five thousand dollars ($5,000) or imprisoned not more than
one year or both, in the discretion of the court, for each offense.
D. Each
home nursing
care provider
or home
care provider
that maintains
a branch
office shall
disclose to the licensing agency the location of their records (i.e.,
central office or branch office).
At a
minimum, all
clinical records
shall be
maintained at
the branch
office for
those patients served by the branch office.
E. Financial
Interest Disclosure
1. Any
health care
facility licensed
pursuant to
R.I. Gen. Laws Chapter
23-17
which
refers clients/patients
to another
such licensed
health care
facility or
to a
residential care/assisted
living facility licensed pursuant to R.I. Gen. Laws Chapter 23-17.4 ,
or to a certified adult day care program in which the referring
entity has a financial interest shall, at the time a referral is
made, disclose
in writing
the following
information to
the client/patient:
a. That
the referring
entity has
a financial
interest in
the facility
or provider
to which
the referral
is being
made;
b. That
the patient/client
has the
option of
seeking care
from a
different facility
or provider which
is also licensed and/or certified by the state to provide similar
services to the patient/client.
2. The
referring entity shall also offer the patient/client a written list
prepared by the Department of
Health of
all such
alternative licensed
and/or certified
facilities or
providers. Said written list may be obtained by
contacting:
Rhode Island Department of Health Division
of Facilities Regulation
Capitol Hill, Room
306
Providence, RI
02908
F. Non-compliance
with §§ 17.4(E)(1) and (2) of this Part shall constitute grounds to
revoke, suspend or otherwise discipline the licensee or to deny an
application for licensure by the Director,
or may
result in
imposition of
an administrative
penalty in
accordance with
R.I. Gen. Laws Chapter 23-17.10 .
17.4.2 Application
for Certificate
of Need
or Changes
in the
Owner, Operator,
or Lessee
A. Application
for a
Certificate of
Need for
a home
nursing care
provider or
home care
provider shall be made on forms provided by the licensing
agency, and shall contain, but not be limited
to. information
pertinent to
the statutory
purpose expressed
in R.I. Gen. Laws
Chapter 23-15
or to the considerations enumerated in the “Rules and
Regulations for Determination of Need for New Health Care Equipment
and New Institutional Health Care Services.”
1. Each
application for Certificate of Need filed pursuant the provisions of
§ 17.4.2 of this Part shall be accompanied by an application fee,
made payable to the General Treasurer, State of Rhode Island, in the
amount specified in the rules and regulations pertaining to the Fee
Structure for Licensing, Laboratory and Administrative Services
Provided by the Department of Health (Part 10-05-2 of this Title).
B. Application
for changes
in the
owner, operator,
or lessee
of a
home nursing
care provider
or home care provider shall be made on forms provided by the
licensing agency and shall contain but not be limited to information
pertinent to the statutory purpose expressed in R.I. Gen. Laws §
23-17-3
or to the considerations enumerated in § 17.4.3(G) of this Part.
1. Each
application for changes in the owner, operator, or lessee filed
pursuant the provisions of § 17.4.2 of this Part shall be
accompanied by a non-returnable, non-refundable application fee, made
payable to the Rhode Island General Treasurer, in the amount
specified in the rules and regulations pertaining to the Fee
Structure for Licensing, Laboratory and Administrative Services
Provided by the Department of Health (Part 10-05-2 of this Title).
C. Review of
an application for Certificate of Need for a home nursing care
provider or a home care
provider shall
be conducted
according to
the procedures
and criteria
set forth in the
“Rules and Regulations for Determination of Need for New Health
Care Equipment and New Institutional Health Care Services.” Review
of an
application for
changes in
the owner,
operator, or
lessee of
licensed home
nursing care provider or home care provider shall be conducted
according to the following procedures:
1. Within
ten (10) working days of receipt, in acceptable form of an
application for initial
licensure or
for a
license in
connection with
a change
in the
owner, operator
or lessee of
an existing
home nursing
care provider
or home
care provider,
the licensing
agency will notify and afford the public thirty (30) days to comment,
when practicable, on such application.
2. The
decision of
the licensing
agency will
be rendered
within ninety
(90) days
from acceptance of the
application.
3. The
decision of the licensing agency shall be based upon the findings and
recommendations of the Health Services Council unless the licensing
agency shall afford written justification for variance
therefrom.
4. All
applications reviewed
by the
licensing agency
and all
written materials
pertinent to licensing agency review, including minutes of all
Health Services Council meetings, shall be accessible to the public
upon request.
D. Except
as otherwise
provided in
R.I. Gen. Laws Chapter
23-17
, a
review by
the Health
Services Council
on an
application for
changes in
the owner,
operator, or
lessee of
a licensed home
nursing care
provider or
home care
provider may
not be
made subject
to any
criterion unless the
criterion directly
relates to
the statutory
purpose expressed
in R.I. Gen. Laws
§ 23-17-3 .
In conducting reviews of such an application the Health
Services Council shall specifically consider and it shall be the
applicant’s burden of proof to
demonstrate:
1. The
character, commitment, competence, and standing in the community of
the proposed owners,
operators or
directors of
the home
nursing care
provider or
home care provider, including but not limited to the
following:
a. In cases where the proposed owners,
operators, or directors of the health care facility
currently own,
operate, or
direct a
health care
facility, or
in the
past five years
owned, operated or directed a health care facility, whether within or
outside Rhode Island, the demonstrated commitment and record of that
(those) person(s):
(1) In
providing safe and adequate treatment to the individuals receiving
the health care facility's services;
(2) In
encouraging, promoting and effecting quality improvement in all
aspects of health care facility services; and
b. In providing appropriate access to
health care facility services;
2. A
complete disclosure of all individuals and entities comprising the
applicant; and
3. The
applicant’s proposed and demonstrated financial commitment to the
health care facility.
4. Any
other factors deemed relevant by the Health Services Council and the
Director.
E. The
extent to
which the
facility will
provide or
will continue,
without material
effect on its
viability at
the time
of change
of owner,
operator, or
lessee, to
provide safe
and adequate treatment
for individuals
receiving the
home nursing
care provider
or home care
provider's services, including but not limited to the
following:
1. The
immediate and long term financial feasibility of the proposed
financing plan;
a. The
proposed amount
and sources
of owner's
equity to
be provided
by the applicant;
b. The
proposed financial
plan for
operating and
capital expenses
and income for
the period
immediately prior
to, during
and after
the implementation
of the change in owner, operator or lessee of the health care
facility;
c. The relative availability of funds for
capital and operating needs;
d. The applicant's demonstrated financial
capability; and
e. Any other factors deemed relevant by the
Health Services Council or the Director.
F. The extent
to which the facility will provide or will continue to provide safe
and adequate treatment
for individuals
receiving the
home nursing
care provider
or home care
provider's services and the extent to which the facility will
encourage quality improvement in
all aspects
of the
operation of
the health
care facility,
including but not
limited to the following:
1. The
credibility and demonstrated or potential effectiveness of the
applicant's proposed quality assurance programs;
and
2. Any
other factors deemed relevant by the Health Services Council or the
Director.
G. The
extent to
which the
facility will
provide or
will continue
to provide
appropriate access with respect to traditionally underserved
populations, including but not limited to the
following:
1. In
cases where the proposed owners, operators, or directors of the
health care facility currently own, operate, or direct a health care
facility, or in the past five years owned, operated, or directed a
health care facility, both within and outside of Rhode Island, the
demonstrated record of that person(s) with respect to access of
traditionally underserved populations to its health care facilities;
a. The proposed immediate and long term
plans of the applicant to ensure adequate and appropriate access to
the programs and health care services to be provided by the health
care facility; and
b. Any other factors deemed relevant by the
Health Services Council or the Director.
H. In
consideration of
the proposed
continuation or
termination of
emergency, primary
care and/or other core health care services by the
facility:
1. The
effect(s) of such continuation or termination on the provision of
access to safe and
adequate treatment
of individuals,
including but
not limited
traditionally underserved populations.
2. And
in cases where the application involves a merger, consolidation or
otherwise legal affiliation
of two
(2) or
more health
care facilities,
the proposed
immediate and long
term plans
of such
health care
facilities with
respect to
the health
care programs to
be offered
and health
care services
to be
provided by
such health
care facilities
as a result of the merger, consolidation or otherwise legal
affiliation.
17.4.3 Application,
Issuance and Renewal of License
A. Application
for a license to conduct, maintain or operate a home nursing care
provider or home care provider shall be made to the licensing agency
upon forms provided by it, and shall
contain such
information as
the licensing
agency reasonably
requires, including
but not limited
to, evidence of ability to comply with the provisions of R.I. Gen.
Laws Chapter 23-17 and this Part.
1. Each
application shall be accompanied by a non-returnable, non-refundable
application fee,
made payable
to the
Rhode Island
General Treasurer,
in the
amount specified in
the rules and regulations pertaining to the Fee Structure for
Licensing, Laboratory and Administrative Services Provided by the
Department of Health (Part 10-05-2 of this Title) .
No additional licensure fee shall be charged when a home
nursing care provider or
home care
provider changes
location during
any calendar
year for
which an annual license fee has already been paid for that
home nursing care provider or home care
provider.
2. Each
home nursing care or home care provider that maintains a branch
office shall indicate on
the application
the location
of the
central office
as well
as the
location(s) of the branch office(s).
B. A
notarized listing
of names
and addresses
of direct
and indirect
owners whether
individual, partnership,
or corporation
with percentages
of ownership
designated shall
be provided
with the application
for licensure
and shall
be updated
annually. The
list shall
include each
owner (in whole or in part) of any mortgage, deed or trust,
note or other obligation secured (in whole or in part) by the home
nursing care provider or home care provider or any of the property or
assets of the home nursing care provider or home care
provider.
1. This
list shall also include all officers, directors and other persons of
any subsidiary corporation owning stock, if the home nursing care
provider or home care provider is organized as a corporation and all
partners if the home nursing care provider or home care provider is
organized as a partnership.
C. Upon
receipt of an application for a home nursing care provider license or
a home care provider license, the licensing agency
shall issue
the applicable license
or renewal
thereof for
a period
of no more
than one
(1) year,
if the
applicant meets
the requirements
of R.I. Gen. Laws
Chapter 23-17
and these Regulations.
1. Home
care provider licenses are exempt from the requirements of § 17.8 of
this Part.
D. The license issued, unless sooner
suspended or revoked, shall expire by limitation on the thirty-first
(31st) day of December following its issuance and may be renewed from
year to year subject to inspection and approval by the licensing
agency.
1. All
renewal applications shall be accompanied by a non-returnable,
non-refundable renewal fee, made payable to the Rhode Island General
Treasurer, in the amount specified in the rules and regulations
pertaining to the Fee Structure for Licensing, Laboratory and
Administrative Services Provided by the Department of Health (Part
10-05-2 of this Title).
E. Each license shall be issued only for
the premises and persons named in the application and shall not be
transferable or assignable except with the written approval of the
licensing agency. Home nursing care providers and home care providers
operating under a single license may establish branch offices under
that same single license and such license shall be maintained and
posted in the central office.
F. A license issued pursuant to these
Regulations shall be the property of the state and loaned to such
licensee and it shall be kept posted in a conspicuous place on the
licensed premises.
G. Subsequent to reviews conducted under §§
17.4.2(C) and (D) of this Part, the issuance of a license by the
licensing agency may be made subject to any condition, provided that
no condition may
be made
unless it
directly relates
to the
statutory purpose
expressed in
R.I. Gen. Laws § 23-17-3 ,
or to
the review
criteria set
forth in
§ 17.4.2(C) of this Part.
This shall
not limit the
authority of the licensing agency to require correction of condition
or defects which existed prior to the proposed change of owner,
operator, or lessee and of which notice had been given to the
facility by the licensing
agency.
H. Each
home nursing
care provider
shall meet
the statewide
community standard for
the provision
of uncompensated
care, established
by § 17.4.4
of this Part, as a condition of initial and continued
licensure.
17.4.4 Statewide
Standard for the Provision of Uncompensated
Care
The statewide
community standard for uncompensated care shall be one percent (1%)
of net patient revenue earned on an annual basis. Uncompensated care
shall be cost adjusted by applying a ratio of costs to charges from
the licensee's Medicare Cost Report. Licensees not filing Medicare
Cost Reports shall submit an audited financial report or such other
report as deemed acceptable to the Director.
17.4.5 Change of Ownership, Operation
and/or Location
A. When a
change of ownership or operation or location of a home nursing care
provider or home care
provider or
when discontinuation
or addition
of a
service(s) is
contemplated, the
licensing agency shall be notified in writing.
B. Thirty
(30) days
prior to
voluntary cessation
of any
facility license,
the Department
of Health
shall be notified and provided with a plan for orderly
closure; notification and transfer of patients; transfer, storage, or
proper disposal of medical records; and notification of the public.
C. A
license shall
immediately become
void and
shall be
returned to
the licensing
agency when a home
nursing care provider or home care provider discontinues services or
when any changes in ownership occur in accordance with these
Regulations and R.I. Gen. Laws § 23-17-6 .
1. When
there is a change in ownership or in the operation or control of the
home nursing care provider or home care provider, the licensing
agency reserves the right to extend the expiration date of such
license, allowing the home nursing care provider or home care
provider to operate under the same license which applied to the prior
licensee for such time as shall be required for the processing of a
new application or reassignment of patients, not to exceed six (6)
weeks.
17.4.6 Inspections
A. The
licensing agency
shall make,
or cause
to be
made, such
inspections and
investigations, including medical records, as deemed necessary
in accordance with R.I. Gen. Laws § 23-17-10
and this Part.
B. Refusal
to permit
inspections shall
constitute a
valid ground
for license
denial, suspension
or revocation.
C. Every home
nursing care provider or home care provider shall be given notice by
the licensing agency of all deficiencies reported as a result of an
inspection or investigation.
17.4.7 Deficiencies
and Plans of Correction
A. The
licensing agency
shall notify
the governing
body or
other legal
authority of
a facility
of violations of
individual standards
through a
notice of
deficiencies which
shall be
forwarded to the facility within fifteen (15) days of
inspection of the facility unless the Director determines
that immediate
action is
necessary to
protect the
health, welfare,
or safety
of the public or
any member thereof through the issuance of an immediate compliance
order in accordance with R.I. Gen. Laws § 23-1-21 .
B. A facility
which received a notice of deficiencies must submit a plan of
correction to the licensing
agency within
fifteen (15)
days of
the date
of the
notice of
deficiencies. The
plan of correction shall detail any requests for variances as
well as document the reasons therefore.
C. The licensing agency will be required to
approve or reject the plan of correction submitted by a facility in
accordance with § 17.4.7(B) of this Part within fifteen (15) days of
receipt of the plan of correction.
D. If the
licensing agency rejects the plan of correction, or if the facility
does not provide a plan of correction within the fifteen (15) day
period stipulated in § 17.4.7(C) of this Part, or if a facility
whose plan of correction has been approved by the licensing agency
fails to execute its plan within a reasonable time, the licensing
agency may invoke the sanctions enumerated in § 17.4.8 of this Part.
If the facility is aggrieved by the sanctions of the licensing
agency, the facility may appeal the
decision and
request a
hearing in
accordance with
R.I. Gen. Laws Chapter 42-35 .
17.4.8 Denial,
Suspension, Revocation of License or Curtailment of
Activities
A. The
licensing agency
is authorized
to deny,
suspend or
revoke the
license or
curtail activities
of any home nursing care provider or home care provider which:
1. Has
failed to comply with the
rules and
regulations pertaining
to the
licensing of
a home
nursing care
provider or home
care provider;
or
2. Has
failed to
comply with
the provisions
of R.I. Gen. Laws
Chapter 23-17 .
B. Reports
of deficiencies
shall be
maintained on
file in
the licensing
agency and
shall be considered
by the
licensing agency
in rendering
determinations to
deny, suspend or
revoke the
license or
to curtail
activities of
a home
nursing care
provider or
home care provider.
C. Whenever an action shall be proposed to
deny, suspend or revoke a home nursing care provider or home care
provider license, or curtail its activities, the licensing agency
shall notify the
home nursing
care provider
or home
care provider
by certified
mail, setting
forth reasons for
the proposed
action, and
the applicant
or licensee
shall be
given an
opportunity for a prompt and fair hearing in accordance with
R.I. Gen. Laws § 23-17-8
and R.I. Gen. Laws §
42-35-9 ,
and in
accordance with the provisions of § 17.9.2 of this Part.
However, if the licensing agency finds that public health, safety or
welfare of patients requires emergency action and incorporates a
finding to that effect in its order, the licensing agency may order
summary suspension of license or curtailment of activities pending
proceedings for revocation or other action in accordance
with R.I. Gen. Laws §§ 42-35-14
(c) and 23-1-21 .
D. The
appropriate state and federal agencies shall be notified of any
action taken by the licensing agency pertaining to either denial,
suspension, or revocation of license, or curtailment of
activities.
17.5 ORGANIZATION AND
MANAGEMENT
17.5.1 Governing
Body
A. Each
home nursing
care provider
or home
care provider
shall have
an organized
governing body or equivalent legal authority ultimately
responsible for:
1. The
management, fiscal affairs and operation of the home nursing care
provider or home care provider;
2. The
assurance of quality care and services; and
3. Compliance
with all federal, state and local laws
and regulations
pertaining to
a home
nursing care
provider or
home care
provider and these
Regulations.
B. The
governing body, or equivalent legal authority, shall provide
appropriate personnel, physical
resources and
equipment to
facilitate the
delivery of
prescribed services
and shall
furthermore:
1. Appoint
an administrator and/or director of nursing services in accordance
with the provisions of § 17.5.2(O) of this Part;
2. Identify
the range of services to be provided which must include no less than
those services required in § 17.7.2(B) and (D) of this Part as
applicable;
3. Define
the geographic areas to be served; and
4. Carry
out such other functions as may be relevant to the organization and
operation of the home nursing care provider or home care provider.
C. The governing body, or equivalent legal
authority, shall adopt and maintain by-laws or acceptable equivalent
which defines responsibilities for the operation and performance of
the organization, and shall identify purposes and means of fulfilling
same. In addition, the governing body or equivalent legal authority,
shall establish administrative policies pertaining to no less than
the following:
1. Responsibilities
of the administrator and/or director of nursing services;
2. Acquiring
and maintaining employee bonding insurance (theft and damage) (a
minimum amount of ten thousand dollars ($10,000.00) per loss) and
liability insurance (a minimum amount of five-hundred thousand
dollars ($500,000.00) per occurrence);
3. The
modalities of services to be provided;
4. Circumstances
under which definitive care cannot be provided and procedures for
referral;
5. Linkages
and referrals with other health care facilities, which shall include
a mechanism for recording, transmitting and receiving information
essential to the continuity of patient care. Such information shall
contain no less than the following:
a. Patient identification data such as:
name, address, age, gender, name of next-of- kin, health insurance
coverage, etc.
b. Diagnosis and prognosis, medical status
of patient, brief description of current illness, plan of care,
including such information as medications, treatments, dietary needs,
baseline laboratory data;
c. Functional status;
d. Therapeutic services such as: physical
therapy, infusion therapy, occupational therapy, or speech therapy;
e. Psychosocial needs; and
f. Such other information pertinent to
ensure continuity of patient care.
6. Reports
of patient's condition and transmission thereof to the patient's
attending physician;
7. Policies
and procedures
regarding persons
employed by
the facility;
Said policies
shall include, but not be limited to, the
following:
a. Compliance
with health
screening and
inservice education
requirements of
§ 17.5.3 of this Part;
b. Timely completion of the bureau of
criminal identification (BCI)
check;
c. Timely judgment regarding continued
employment of an employee upon whom disqualifying
information has
been found
(see §§
17.5.3(M) and (N) of this
Part).
8. Such
other matters as may be relevant to the organization and operation of
the home nursing care provider or home care
provider.
D. The
governing body
or other
legal authority
shall organize
services to
ensure an
integrated continuum of patient care. An organizational chart
with written description of the organization, authorities,
responsibilities, accountability, and relationships shall be
maintained which shall include but not be limited
to:
1. A
description of each service
offered;
2. Policies
and procedures pertaining to each
service;
3. A
description of the system for the maintenance of the patient's
clinical record; and
4. Standards
of clinical practice.
E. Quality
Improvement
1. The
governing body shall ensure that there is an effective, ongoing,
agency-wide quality improvement program to evaluate the provision of
patient care. Further, the home nursing care
provider or
home care
provider shall
have written
policies and
procedures establishing
a mechanism for
the annual
evaluation of
professional standards
of practice
and administrative
practices, conducted by professional personnel, including home
nursing care provider or home care provider
staff.
a. Such
evaluation shall
assess the
extent to
which the
home nursing
care provider’s
or home care
provider’s programs
and services
are appropriate,
adequate, effective
and efficient based on data such as: number of patients on
services, patient visits, reasons for discharge, diagnoses, sources
of referral, patients denied services, community
needs, staff
days for
each service
offered and
such other
criteria as
may be deemed
appropriate.
2. The
organized agency-wide
quality improvement
program shall
be ongoing
and shall
have a written
plan of
implementation. The
written quality
improvement plan
shall include
at least the
following:
a. Program
objectives;
b. Organization(s)
involved;
c. Oversight responsibility (e.g., reports
to the governing body);
d. Home nursing care provider-wide or home
care provider-wide scope;
e. Program administration and
coordination;
f. Involvement of all patient care
disciplines/services;
g. Methodology for monitoring and
evaluating quality of care;
h. Priority setting and problem
resolution;
i. Determination of the effectiveness of
action(s) taken;
j. Documentation of the quality improvement
plan review.
3. All
patient care services, including services rendered by a contractor,
shall be evaluated.
4. The
home nursing
care provider
or home
care provider
shall take
and document
appropriate remedial action to address problems identified
through the quality improvement program. The
outcome(s) of
the remedial
action shall
be documented
and submitted
to the
governing body for their consideration.
5. The
provisions of § 17.5.1(E)(2) of this Part shall be deemed to have
been met if the agency has met similar requirements of a national
accrediting body, as approved by the Director.
F. Uniform
Reporting System
1. Each
home nursing
care provider
or home
care provider
shall establish
and maintain
records and data
in such
a manner
as to
make uniform
a system
of periodic
reporting. The
manner in which
the requirements of these Regulations may be met shall be prescribed
from time to time in directives promulgated by the
Director.
2. Each
home nursing
care provider
or home
care provider
shall report
to the
licensing agency
detailed statistical
data pertaining
to its
operation and
services. Such
reports and
data shall be made
at such intervals and by such dates as determined by the
Director.
3. The
licensing agency
is authorized
to make
the reported
data available
to any
state or
federal agency concerned with or exercising jurisdiction over
the home nursing care provider or home care
provider.
4. The
directives promulgated by the Director pursuant to these Regulations
shall be sent to each home
nursing care
provider or
home care
provider to
which they
apply. Such
directives shall
prescribe the
form and
manner in
which the
statistical data
required shall
be furnished to
the licensing agency.
G. Disaster
Planning
1. The
plan and procedures shall be developed with the assistance of
qualified safety, emergency management, and/or other appropriate
experts.
2. Each
home nursing care provider or home care provider shall develop
back-up or contingency plans to address possible internal systems
and/or equipment failures.
H. Pending and
Actual Labor Disputes/Actions
1. Health
care facilities
shall provide
the licensing
agency with
prompt notice
of pending
and actual labor
disputes/actions which
would impact
delivery of
patient care
services including,
but not
limited to,
strikes, walk-outs,
and strike
notices. Health
care facilities
shall provide
a plan, acceptable to the Director, for continued operation of
the facility, suspension of operations, or closure in the event of
such actual or potential labor dispute/action.
I. Latex
1. Any
home nursing
care provider
or home
care provider
that utilizes
latex gloves
shall do
so in accordance with the provisions of the rules and
regulations pertaining to the Use of Latex Gloves by Health Care
Workers, In Licensed Health Care Facilities, and by Other Persons,
Firms, or
Corporations Licensed
or Registered
by the
Department promulgated
by the Department of Health
(Part 20-15-3 of this Title).
J. Reporting
of Resident Abuse, Mistreatment, or Neglect
1. Duty
to Report resident
abuse, mistreatment, or neglect is pursuant to
R.I. Gen. Laws Chapter
23-17.8 -2.
The report
shall be
on forms
provided by
the licensing
Agency and
shall contain
information as
outlined in R.I.
Gen. Laws § 23-17.8-2 .
17.5.2 Service
Accessibility
A. Accessibility
to agency: Each home nursing care provider or home care provider
shall establish a
mechanism to
enable patients
to make
telephone contact
with responsible
staff of the home
nursing care provider or home care provider on a twenty-four (24)
hour basis, seven (7) days a
week.
B. Medical
supplies and
equipment: Each
home nursing
care provider
or home
care provider
shall assist
patients in
arranging for
the procurement
of medical
supplies and
equipment as may
be prescribed in the plan of
care.
C. Written
Agreements
1. There
shall be written agreements for the provision of service(s) not
provided directly by the home nursing care provider or home care
provider which clearly delineate the responsibilities of the parties
involved and shall include no less than the following provisions:
a. Designation of service(s) to be provided
which must be within the scope and limitations set forth in the plan
of care and which must not be altered in type, amount, frequency, or
duration (except in case of adverse reaction) by the individual or
home nursing care provider or home care provider;
b. The responsibility of the licensed home
nursing care provider or home care provider for the provision of
services to the patient;
c. Assurance of compliance with the patient
care policies of the licensed home nursing care provider or home care
provider;
d. Establishment of procedures for and
frequency of patient care assessment and attendance at case
conferences;
e. Mechanism for submission of clinical
progress notes on patient care;
f. Documented evidence that personnel and
services under contract meet the requirements specified in these
Regulations for home nursing care provider or home care provider
personnel and services, including licensure, health screenings, and
criminal background checks. In instances where the contracted
services are provided by another Department of Health Division of
Facilities Regulation licensee, said license shall suffice to meet
the requirements of § 17.5.2(C) of this Part.
g. Reimbursement mechanism, charges and
terms for renewal or termination of the agreement; and
h. Such other provisions as may be mutually
agreed upon.
D. Scope of
Services
1. Each
home nursing
care/home care
provider shall
provide either
directly, or
by written
contractual agreement with another Department-licensed agency,
homemaker, nursing
assistant services or other therapeutic service(s) (e.g.,
physical/occupational therapy).
2. Additional
health services or related services may be provided by agencies as
may be deemed appropriate to meet community needs in a manner
consistent with professionally-recognized standards of practice and
all applicable current laws and regulations.
17.5.3 Personnel
A. Each
home nursing
care provider
or home
care provider
shall employ
a sufficient
number of
qualified personnel to provide effective patient care and other
related services.
B. A
job description
for each
classification of
position shall
be established,
clearly delineating
qualifications, duties, authority and responsibilities inherent in
each position.
C. Written
personnel policies supporting sound patient care and personnel
practices shall be made available to all full-time or part-time
personnel and shall include provisions
for:
D. Annual
evaluation of employee performance that is reviewed with and signed
by the employee within forty-five (45) days of the evaluation;
and
E. Such other
matters as deemed appropriate.
F. An
inservice educational program shall be conducted on an ongoing basis,
which shall include an orientation program for staff personnel
employed by the home nursing care provider or home care provider
providing direct care and a continuing program for the development
and improvement
of skills
of staff
to ensure
the delivery
of quality
home care
services. The inservice program shall include recognition and
reporting of abuse, neglect, mistreatment, and
exploitation.
G. A
mechanism to
establish an
audit trail
of employees
shall be
implemented and
shall include, at
a minimum,
for each
employee:
1. Date
of employment
by the
home nursing
care provider
or home care provider agency; and
2. Date(s),
name(s), and address(es) of each assignment.
H. For
every person
employed by
the home
nursing care
provider or
home care
provider who
is licensed, certified, or registered by the Department, a
mechanism shall be in place to electronically verify such licensure
via the Department's licensure
database.
I. Personnel
files shall
be maintained
for each
employee and
shall be
available at
all times
for inspection by the licensing agency. Such files shall
include no less than the following documentation:
1. A
certified copy of birth certificate or copy of the U.S. Immigration
and Naturalization Service Employment Eligibility Verification form
(“I-9”); or immigration papers or resident alien card;
2. Information
pertaining to qualifications for employment;
3. Records
of completion of required training and educational programs;
4. Evidence
of current licensure or certification as may be required by law;
5. Resume
of previous employment;
6. Records
of required health examination which shall be kept confidential and
in accordance with provisions of § 17.5.3(M) of this Part;
7. Documentation
of complaints and follow-up;
8. Findings
of a criminal records check, if employed after July 26, 1993;
9. Employee
orientation, evaluation (annual) and documentation of in-service
education; and
10. Such
other matters as may be relevant to the organization and operation of
the agency.
J. Supervision
of Homemakers
1. All
homemaker services performed by a homemaker shall be in accordance
with the provisions of R.I. Gen. Laws Chapter 23-17 ,
and these Regulations.
2. Homemaker services shall be rendered in
accordance with a plan of care and shall be supervised
by a
professional (registered)
nurse, licensed
in Rhode
Island, or
by an
individual with a
bachelor's degree
in social
work, home
economics, gerontology
or other
related field of
study, and who shall be responsible for no less than the
following:
a. Conducting the initial in-home
assessment and assessments no less than every three (3) months
thereafter or more frequently as the condition of the patient/client
may require;
b. Monitoring the performance of the
homemakers and maintaining appropriate clinical records;
c. Coordinating management of services
(inter and intra-agency);
d. Assigning only delegable duties in
accordance with § 17.5.3(L) of this Part;
e. Maintaining a record for each
patient/client with appropriate documentation of services rendered
which is signed by the homemaker rendering services;
f. Such other functions and activities as
may be deemed necessary and appropriate.
K. Training Program for Homemakers
1. Homemakers
shall be required to have successfully completed a basic training
program of twenty (20) hours of classroom instruction, and with no
less than five (5) hours of practical experience in addition to the
required classroom instruction. The course of instruction shall be
designed to provide skill in all the duties listed in § 17.5.3(L) of
this Part and to provide homemaker skills, information, and an
orientation to basic human needs. The course of instruction
curriculum must include, but is not limited to:
a. Orientation to homemaker agency,
including policies and procedures, ethical
responsibilities/accountability, confidentiality, and the function of
the homemaker as a team member;
b. Understanding basic human needs,
including the needs of children/aged people, physically disabled
people, people with terminal illness, and people with mental
illness/dementia;
c. Infection control, including hand
washing, cross contamination, and universal precautions appropriate
to the homemaker;
d. Emergency procedures; and
e. Care of the home, including planning and
serving meals, shopping, food preparation, basic nutrition,
cleanliness/general housekeeping, accident prevention, care of food
preparation areas/dishes, laundry and ironing, making unoccupied
beds, and disposal of trash/medical waste.
2. Upon
completion of the homemaker training program, each homemaker must
satisfactorily pass the final examination of the training program in
order to be eligible to function as a homemaker.
L. Duties of Homemakers
1. A homemaker who has satisfactorily
completed a training program approved by the Director, as described
in § 17.5.3(K) of this Part, may perform the following duties under
an established plan of care and under the supervision of a qualified
person in accordance with § 17.5.3(J) of this Part:
a. Change bed linens (unoccupied);
b. Grocery shopping;
c. General housekeeping (washing dishes,
cleaning kitchen, bathroom, patient’s/client's room);
d. Laundry and ironing;
e. Meal preparation;
f. Shopping, errand-running;
g. Recording services rendered.
2. Notwithstanding
the provisions of § 17.5.3(L)(1) of this Part, additional duties may
be assigned to homemakers provided such duties do not include the
duties of a nursing assistant, as listed in the “Rules and
Regulations Pertaining to Rhode Island Certificates of Registration
for Nursing Assistants, Medication Aides, and the Approval of Nursing
Assistant and Medication Aide Training Programs.”
a. Such additional duties must be clearly
delineated in agency policies and procedures, but may not be in
conflict with other state regulations.
3. A
health care facility shall require all persons, including students,
who examine, observe, or treat a patient or resident of the facility
to wear a photo identification badge which states, in a reasonably
legible manner:
a. The first name;
b. Licensure registration status, if any;
c. Fluency in languages other than English,
if any; and
d. Staff position of that person.
4. A
home nursing care provider or home care provider shall be considered
for all purposes an employer and those persons that it supplies on a
temporary basis shall be considered employees and not independent
contractors and home nursing care providers or home care providers
shall be subject to all state and federal laws which govern
employer/employee relationships.
M. Health Screening
1. Upon
hire and prior to delivering services, a pre-employment health
screening shall be required for each individual who has or may have
direct contact with a patient of the home care provider/home care
nursing provider. Such health screening shall be conducted in
accordance with the rules and regulations pertaining to Immunization,
Testing, and Health Screening for Health Care Workers (Part 20-15-7
of this Title) promulgated by the Department of Health.
N. Criminal
Records Check
1. Criminal
records checks shall be in accordance with R.I. Gen. Laws §
23-17-34.
O. Administrator
and/or Director of Nursing Services
1. A
full-time administrator
as defined
in these
Regulations shall
be appointed
by and be
responsible to
the governing
body or
other legal
authority for
no less
than the
following:
a. The management and operation of the
agency;
b. The implementation of policies,
statutory and regulatory provisions;
c. Acting as liaison between the governing
body and the professional and paraprofessional staff and the
community;
d. The preparation and implementation of an
effective budgeting, accounting and reporting system;
e. The establishment of standards of
professional practice developed in cooperation with the governing
board and staff;
f. The establishment of policies and
procedures governing the range of health care services provided by
the home nursing care provider or home care provider;
g. The establishment of a quality
improvement program which includes a review mechanism for patient
care management;
h. The preparation of an annual report;
i. The employment of qualified professional
and paraprofessional staff; and
j. For such other related functions as may
be delegated by the governing body or other legal authority.
2. In
the event that a non-nurse is appointed administrator of the home
nursing care provider or home care provider, the nursing service
shall be under the direction of a registered nurse who is licensed in
Rhode Island and who shall be responsible to the administrator for
the management of professional services, the standards of practice,
and other related professional aspects of patient care services.
17.6 Patient Care Management
17.6.1 Rights
of Patients
A. Each
patient/client of
a home
nursing care
provider or
home care
provider has
the right
to be informed of
his or her rights under R.I. Gen. Laws Chapter 23-17-19.1
and the home nursing care provider or home care provider must protect
and promote the exercise of these
rights.
B. The
home nursing
care provider
or home
care provider
must provide
the patient/client
with a written
notice of the patient/client rights in § 17.6.1(E) of this Part in
advance of furnishing care
to the
patient/client or
during the
initial evaluation
visit before
the initiation of
treatment.
C. A
copy of
the written
notice of
rights signed
by the
patient/client will
be maintained
in the
patient/client record by the home nursing care provider or home care
provider and in the patient/client's
home. The
home nursing
care provider
or home
care provider
must maintain
documentation showing that it has complied with the requirements of
this section.
D. The
provisions of § 17.6 of this Part shall not apply to nursing
services or home health services conducted by and for those who rely
exclusively upon spiritual means through prayer alone in accordance
with the creed or tenets of a recognized church or religious
denomination.
E. In addition
to the rights stated in R.I. Gen. Laws § 23-17-19.1:
1. No
charge shall
be made
for furnishing
a health
record or
part thereof
to a
patient, his/her
attorney or authorized representative if the record or part thereof
is necessary for the purpose of
supporting an
appeal under
any provision
of the
Social Security
Act (42 U.S.C. §
301 et seq.) and the request is accompanied by documentation of the
appeal. A
provider shall
furnish a
health record
requested pursuant
to this
section within
thirty (30) days of the request.
17.6.2 Confidentiality
Disclosure of
any health care information relating to individuals shall be subject
to the provisions of the "Confidentiality of Health Care
Communication and Information Act", R.I. Gen. Laws
Chapter 5-37.3 ,
and other
relevant statutory
and federal
requirements.
17.6.3 Admission
and Discharge Policies
A. Providers shall establish policies
pertaining to eligibility for admission to and discharge from home
nursing care provider or home care provider services. Such policies
shall be based on the following criteria:
1. Pre-admission
assessment of patient care needs;
2. Reasonable
expectations of the home nursing care provider’s or home care
provider’s capability to respond to the medical and nursing needs
of the patient;
3. Plan
of care;
4. Constraints
imposed by limitation of services, family conditions;
5. Community
or other resources to ensure continuity of patient care; and
6. Such
other criteria as may be deemed appropriate.
17.6.4 Clinical
Records
A. Accurate
and complete clinical records maintained in accordance with accepted
professional standards shall be kept on each patient and filed in an
accessible location within the home nursing care provider or home
care provider. Such records shall contain no less than the following
information:
1. Identifying
data (name, address, date of birth, gender, date of admission or
readmission);
2. Sources
of patient referral;
3. Name
of physician (including address and telephone number);
4. Original plan of care for services
provided;
a. personal care objectives;
b. homemaker objectives, as appropriate;
5. Medical
diagnosis and nursing assessment, therapeutic goals, prognosis and
all conditions relevant to the plan of care, including any known
allergies and reactions,
6. surgical
procedures, surgical complications, infections, prior diagnoses,
presence of pressure ulcers, incontinence, disabilities;
7. Documentation
of each patient contact;
8. Changes
in and reviews of the patient's plan of care, signed by responsible
professional;
9. Documentation
of an advance directive (if any) and a copy of the advance directive,
if provided to the facility by the patient; and
10. Discharge
summaries.
B. Home nursing care provider or home care
provider personnel involved in the care of patients shall
participate, to the extent possible, in developing care plans. When
practical, designated home nursing care provider or home care
provider personnel shall complete a “Continuity of Care” form as
approved by the Director for each patient who is discharged to
another health care facility, such as a hospital or nursing facility,
or other facility licensed under the provisions of R.I. Gen. Laws
Chapter 23-17 .
Said form shall be provided to the receiving facility, agency, or
provider prior to, upon transfer, or discharge of the patient. (See
the Department’s website for the approved form: health.ri.gov).
C. Records
shall be
maintained by
the home
nursing care
provider or
home care
provider for
a period of at least five (5) years following the date of
discharge and shall be safeguarded against loss or unauthorized use.
This requirement shall also apply to computerized or electronic
records.
1. Records
shall be maintained by the home nursing care provider or home care
provider for a minimum of five (5) years after a minor patient turns
eighteen (18) years of age.
D. Each home
nursing care provider or home care provider shall have written
policies and procedures to
govern the
use and
removal of
records and
determine the
conditions for
release of information in accordance with statutory provisions
pertaining to confidentiality.
17.6.5 Nursing
Assistant Services
A. Each home
nursing care provider or home care provider which chooses to provide
home nursing care and home care as provided in these Regulations
shall be subject to the same training requirements for nursing
assistants and the duties of the individuals shall be the same as
those prescribed in the “Rules and Regulations for the Registration
of Nursing Assistants, Medication Aides, and the Approval of Nursing
Assistant and Medication Aide Training Programs.”
B. Supervision
of Nursing Assistants
1. Supervision
of nursing assistants shall be directed to the management of
patients’/clients' care and services, the performance of duties,
and shall be available at all times during the established hours of
operation of the home nursing care provider or home care provider and
at such other times as they are providing services to
patients/clients.
2. Supervision
of nursing assistants as employees of a home nursing care provider or
home care provider:
3. Nursing
assistant services shall be:
a. Provided in accordance with a plan of
care; and
b. Monitored/supervised
no less
than once
every three
(3) months
by a
professional (registered)
nurse or other appropriate health care professional who is licensed
in Rhode Island; and
c. P rovided
in accordance with the “Rules and Regulations for the Registration
of Nursing Assistants, Medication Aides, and the Approval of Nursing
Assistant and Medication Aide Training Programs.”
d. Such supervision shall include the
following duties:
(1) Conducting
the initial in-home assessment prior to commencement of service,
unless documented extraordinary
circumstances prevent
such timing.
In these
cases the
initial in-home assessment must be conducted within
forty-eight (48) hours. Subsequent assessments and direct supervision
of the nursing assistant (at least one supervisory session) must be
conducted no less than every three (3) months thereafter or more
frequently as the condition of the patient/client may
require;
(2) Involving
other professional disciplines where personal care is provided, as
may be deemed necessary to ensure the provision of quality
care;
(3) Developing,
reviewing and
revising the
plan of
care, as
the condition
of the
patient/client may require but no less than once every three
(3) months;
(4) Assigning
only delegable duties as set forth in the “Rules and Regulations
for the Registration of Nursing Assistants, Medication Aides, and the
Approval of Nursing Assistant and Medication Aide Training Programs”
for nursing assistants;
(5) On-site
monitoring the
performance of
nursing assistants
no less
than once
every three (3)
months and maintaining appropriate records of such monitoring;
(6) Coordinating
the management of services (inter- and
intra-agency);
(7) Monitoring
the clinical record for each patient/client which includes
appropriate recording of the plan of care, services rendered, and
which is signed by the person rendering services; and
(8) Such
other functions and activities as may be deemed necessary and
appropriate.
17.6.6 Supervision
of Therapeutic Services
Therapeutic
services may include, but are not limited to, speech
pathology/audiology, physical therapy, occupational therapy and
respiratory care. Supervision of therapeutic services shall be in
accordance with applicable rules and regulations for licensing of
said therapists.
17.6.7 Reporting
of Communicable Diseases
Each facility
shall report promptly to the Rhode Island Department of Health,
Division of Disease Control, cases of communicable diseases
designated as "reportable diseases" by the Director of
Health, when such cases are diagnosed in accordance with the most
current “Rules and Regulations Pertaining to Reporting of
Infectious, Environmental and Occupational Diseases.”
17.7 Physical Plant
17.7.1 General
Provisions
A. Each
licensed home nursing care provider or home care provider shall
maintain an office(s) located in Rhode Island with adequate space and
equipment to accommodate staff personnel to carry out their
professional and administrative responsibilities in an efficient
manner within a safe environment.
B. Adequate space shall be provided for the
storage and maintenance of equipment, supplies and records necessary
for patient care services and for the operation of the home nursing
care provider or home care provider.
C. All equipment and furnishings shall be
maintained in good condition, properly functioning and replaced as
necessary.
D. Each home nursing care provider or home
care provider shall maintain an effective telephone communication
system accessible to patients and personnel on a twenty-four (24)
hour basis, seven (7) days a week, in accordance with § 17.5.2(A) of
this Part.
E. Medical Waste Disposal
1. In
accordance with the Medical Waste Regulations, 250-RICR-140-15-1,
medical waste generated by individuals on the premises of a
single-family home or single-family dwelling unit or by members of
households residing in single and multiple residences, hotels, and
motels which serve as a residence for individuals, provided the
dwelling is not serving as a commercial or professional office where
individuals who are not members of the family residing at such
dwelling are receiving medical care by a health care professional is
specifically excluded from the definition of regulated medical waste
and the requirements of the aforementioned regulations. Medical waste
generated by health care providers in private homes where they
provide medical services to individuals residing in said homes is
also exempt from the requirements of the Medical Waste Regulations,
250-RICR-140-15-1, promulgated by the Rhode Island Department of
Environmental Management.
17.8 Additional
Requirements - Home Nursing
Care Providers
In addition
to meeting the General Requirements as set forth in §§ 17.1 through
17.7.1 of this Part, home nursing care providers shall meet the
additional requirements of § 17.8.2 of this Part.
17.8.2 Governing
Body &
Management Professional Advisory
Committee
A. An
advisory group
of professional
personnel ("Professional
Advisory Committee")
shall be
established by the governing body or other legal authority which
shall include at least:
1. One
(1) physician and a registered nurse; and
2. A representative of each therapeutic
service offered by the home nursing care provider or home care
provider, which may also include appropriate representation from
other professional disciplines.
3. The
administrator of the home nursing care provider or home care provider
shall be ex- officio member of the committee.
4. At
least one (1) member shall neither be an owner nor an employee of the
home nursing care provider or home care provider.
5. The
Professional Advisory Committee shall meet at least twice (2) per
year to advise the agency on professional issues and to establish and
annually review the home nursing care provider’s or home care
provider’s policies pertaining to:
a. The scope of services offered;
b. Admission and discharge policies;
c. Plans of care;
d. Clinical records;
e. Personnel qualifications;
f. Program evaluation; and
g. Such other matter as may be deemed
appropriate by the governing body or other legal authority.
6. The
physician member of the Professional Advisory Committee shall attend
at least one (1) meeting per year and show evidence of participation
(e.g., review of agenda/minutes) in any other Professional Advisory
Committee meetings.
B. Scope of
Services
1. Each
home nursing care provider shall provide direct nursing services in
the home, or by contractual
agreement with
another
Department-licensed
agency, delivered
by a
registered (RN) or licensed practical (LPN)
nurse.
2. Each
home nursing care provider may provide homemaker and nursing
assistant services, either directly or by contractual agreement with
another Department-licensed agency; and may provide other therapeutic
service(s), to be provided either directly or by contractual
agreement.
3. Additional
health services or related services may be provided by a home nursing
care provider as may be deemed appropriate to meet community needs in
a manner consistent with acceptable standards of practice.
C. Medical Services
1. Patients
admitted for medical services shall be under the care of a licensed
physician responsible for the development of the plan of care.
a. A care plan prescribed by the attending
physician, if appropriate, shall contain no less than the following:
(1) Pertinent
diagnosis, including mental status, level of consciousness, ability
to communicate including language, speech and hearing;
(2) Types
of services and equipment required, frequency of visits, prognosis,
rehabilitative potential, functional limitations, activities
permitted, nutritional requirements, medications and treatments,
safety measures (if any), instructions for continuing care, referral
or discharge; dates/times of any follow-up appointment(s), when
known; and
2. The
physician's orders for any services which shall specify the
procedures and modalities to be used including the amount, frequency
and duration of therapy and/or care, including therapeutic services,
such as physical therapy, occupational therapy, speech therapy,
clinical social work, nutritional assessment, audiology, IV therapy,
PEG feeding, wound/dressing, surgical drains, central line, oxygen,
diet, all medications prescribed.
3. The
plan of care shall not be modified without consent of the attending
physician and shall furthermore be reviewed by the attending
physician and home nursing care provider or home care provider staff
as often as the severity of the patient's condition requires but no
less than once every sixty (60) days beginning with the start of care
date.
4. Direct
Nursing Services Direct nursing services shall be provided by
registered and/or practical nurses duly licensed in Rhode Island and
in accordance with the written plan of care, acceptable standards of
nursing practice and the “Rules and Regulations for the Licensing
of Nurses and Standards for the Approval of Basic Nursing Education
Programs.”
17.9 Variance Procedure, Practices
and Procedures, and Severability
17.9.1 Variance
Procedure
A. The licensing agency may grant a
variance either upon its own motion or upon request of the applicant
from the provisions of any rule or regulation in a specific case if
it finds that a literal enforcement of such provision will result in
unnecessary hardship to the applicant and that such variance will not
be contrary to the public interest, public health and/or health and
safety of patients.
B. A request for a variance shall be filed
by an applicant in writing setting forth in detail the basis upon
which the request is made.
1. Upon
the filing of each request for variance with the licensing agency and
within a reasonable time thereafter, the licensing agency shall
notify the applicant by certified mail of its approval, or in the
case of a denial, a hearing date, time and place may be scheduled if
the home nursing care provider or home care provider appeals the
denial.
17.9.2 Rules
Governing Practices and
Procedures
All hearings
and reviews required under the provisions of R.I. Gen. Laws Chapter
23-17
shall be held in accordance with the provisions of the rules
and regulations regarding Practices and Procedures Before the Rhode
Island Department of Health (Part 10-05-4 of this Title).