1. (a) A frontier extended stay clinic must have the medical staff necessary to provide the care and services required in 7 AAC 12.453.

2. (b) The medical staff shall develop, for approval by the governing body of the clinic, bylaws and rules that provide for

   1. (1) eligibility for medical staff membership;

   2. (2) the biennial recommendation by the medical staff regarding the credentialing and privileges of each member of the medical staff, including establishing standards for

      1. (A) assessing the training, experience, and competence of medical staff;

      2. (B) a formal process that includes

         1. (i) querying the National Practitioner Data Bank; and
         2. (ii) verifying that medical staff meet professional licensing requirements;
      3. (C) a delineation of privileges as authorized by the governing body, including verification of education and training related to the privileges requested and to the level of care that will be provided;
      4. (D) the inclusion of quality assurance findings in ongoing credentialing of medical staff; and
      5. (E) the assurance of participation in continuing professional education;
   3. (3) quality assurance under 7 AAC 12.460;
   4. (4) medical records retention and protection under 7 AAC 12.483;
   5. (5) infection control;

   6. (6) pharmacy and therapeutics, including

      1. (A) development and maintenance of a formulary of drugs; and
      2. (B) development and implementation of procedures for the safe and effective control, storage, dispensing, and administration of prescribed drugs, chemicals, and biologicals; and
   7. (7) utilization review.

3. (c) The medical staff shall

   1. (1) ensure that a physician or a mid-level practitioner with training or experience in emergency care is, on a 24-hour-per-day basis,

      1. (A) on call;
      2. (B) immediately available by telephone or radio contact; and
      3. (C) able to be on site at the frontier extended stay clinic within 30 minutes after an emergency contact;
   2. (2) ensure that a mid-level practitioner is available on site to provide patient care services at least 60 percent of the time during the clinic's normal hours of operation, or a minimum of 32 hours a week, whichever is less;
   3. (3) require that an order by a practitioner, including a telephonic or other verbal order, be reduced to writing and authenticated within three days after the order was given; the authentication must be signed and dated by the practitioner who gave the verbal order;
   4. (4) require that a physician approve each standing order;
   5. (5) establish procedures for circumstances in which consultation, referral, or transfer is required;
   6. (6) ensure that the review required under 7 AAC 12.460(c)(1) is conducted at regular intervals, at least annually, and that the clinic maintains accurate medical records;
   7. (7) establish procedures for selection and supervision of mid-level practitioners; and
   8. (8) establish procedures for the annual review of policies and procedures, including clinical, administrative, and fiscal policies and procedures, by a group consisting, at a minimum, of a physician, a mid-level practitioner, and one person who is not an employee of the clinic.

4. (d) A physician shall be on site for sufficient periods of time, at least once in every three-month period, except in extraordinary circumstances, to provide the medical direction, medical care services, consultation, and supervision described in this section. Any extraordinary circumstance must be documented in the clinic's records. A site visit by a physician is not required if no patients have been treated since the last time a physician made a site visit. The clinic must

   1. (1) ensure that, in addition to the site visits required by this subsection, a physician will be

      1. (A) available 24 hours a day through direct radio or telephone communication for consultation, assistance with medical emergencies, or patient referral; and
      2. (B) in contact with the clinic telephonically or through telemedicine at least once in every two-week period;
   2. (2) demonstrate sufficient staffing during periods the physician is not onsite; and
   3. (3) ensure that the physician adheres to the plan submitted under 7 AAC 12.457(a)(6).

5. (e) A physician shall

   1. (1) provide medical direction, consultation, and medical supervision regarding the clinic's health care activities;

   2. (2) at regular intervals, no less than once each year, participate with a mid-level practitioner member of the clinic staff, either separately or together, in

      1. (A) developing, executing, and reviewing the clinic's written policies; and
      2. (B) the review of services provided to patients through the periodic program evaluation under 7 AAC 12.460(c), unless that review is conducted under contract;
   3. (3) review at least quarterly the clinic's patient records;
   4. (4) provide medical orders and medical care services to the clinic's patients; and
   5. (5) at least quarterly, sign the records of patients cared for by a mid-level practitioner.

6. (f) The onsite medical staff of a frontier extended stay clinic may consist exclusively of one or more mid-level practitioners if

   1. (1) the mid-level practitioners are subject to the oversight of a physician who is also a member of the clinic's medical staff, even though the physician might not be on site, if

      1. (A) that physician is

         1. (i) notified by a mid-level practitioner when a patient is admitted for extended stay; and
         2. (ii) available 24 hours per day through direct radio or telephone communication for consultation, assistance with medical emergencies, or patient referral; and
      2. (B) each contact with the physician is documented;

   2. (2) each mid-level practitioner participates

      1. (A) in the development, execution, and periodic review of the written policies governing the services provided by the clinic; and
      2. (B) in the periodic review of the medical records of patients with a physician as described in 7 AAC 12.460(c)(1), unless that review is conducted under contract; and

   3. (3) each mid-level practitioner performs the following functions when the functions are not performed by a physician:

      1. (A) provide services in accordance with the clinic's policies;
      2. (B) arrange for, or refer patients to, needed services that cannot be furnished at the clinic;
      3. (C) assure that adequate patient health records are maintained and transferred as required if patients are referred or services are arranged under (B) of this paragraph.
7. (g) A physician or a mid-level practitioner member of the staff may be an owner or employee of the clinic, or may be under contract or agreement with the clinic to carry out the responsibilities described in this section and in 7 AAC 12.470.

(Eff. 12/3/2006, Register 180)