In addition to meeting the general requirements, agencies providing skilled care shall meet the following:

1. (1)

   1. (A) Acceptance of patients.
   2. (B) Agencies shall only accept patients for treatment on the basis of a reasonable expectation that the patient's needs can be met adequately by the agency in the patient's place of residence.

   3. (C)

      1. (i) If an agency receives a referral on a patient who requires home health services that are not available at the time of referral, the agency shall contact the referral source and/or the patient's physician or licensed practitioner to let them know of the situation.
      2. (ii) The agency shall only admit the patient if no other agency licensed in the area has the service or services available;

2. (2)

   1. (A) Care and services.

   2. (B)

      1. (i) All services shall be rendered and supervised by skilled professionals.
      2. (ii) Skilled services such as nursing, physical therapy, occupational therapy, speech-language pathology, and medical social work shall provide services and supervision according to the scope of practice determined by their applicable licensing board.

   3. (C) Assessments.

      1. (i)

         1. (a) (a) An initial assessment shall be completed within forty-eight (48) hours of the referral/discharge.
         2. (b) (b) The initial assessment shall be completed by a registered nurse, if nursing services are provided, or other skilled professional, as appropriate.

      2. (ii) For patients receiving skilled services, the assessment shall be updated:

         1. (a) (a) Every sixty (60) days; or
         2. (b) (b) When a significant change in patient status occurs.

   4. (D) Plan of care.

      1. (i) At the time of the admission, the plan of care shall be developed in conjunction with the:

         1. (a) (a) Patient and/or family; and
         2. (b) (b) Skilled healthcare professional.

      2. (ii) Discharge planning shall be:

         1. (a) (a) The responsibility of the skilled healthcare professional rendering the service; and
         2. (b) (b) Documented in the record.

      3. (iii) The plan of care shall include:

         1. (a) (a) Potential services to be rendered;
         2. (b) (b) The frequency of visits and/or hours of service;
      4. (c) (c) Assignment of healthcare providers; and
      5. (d) (d) The estimated length of services.
      6. (iv) The plan of care shall be revised at least every sixty (60) days.
      7. (v) The plan of care shall be individualized according to each of the individual patient's needs.
      8. (vi) The plan of care and each verbal order obtained shall be signed by the physician, podiatrist, or licensed practitioner within thirty (30) days of the order.

   5. (E)

      1. (i) Case conferences shall be held at least every two (2) months on each patient.
      2. (ii) The clinical record or minutes of these case conferences shall reflect input by the disciplines providing care to the patient.

   6. (F)

      1. (i) For patients receiving extended care nursing services, a current medication administration record shall be:

         1. (a) (a) Maintained; and
         2. (b) (b) Incorporated into the clinical record.

      2. (ii) Notation shall be made in the clinical notes of:

         1. (a) (a) Medications not given; and
         2. (b) (b) Reason.

      3. (iii) Any untoward action shall be:

         1. (a) (a) Reported to the supervisor; and
         2. (b) (b) Documented.

   7. (G)

      1. (i) The clinical record shall include documentation of medication:

         1. (a) (a) Allergies or sensitivities; and
         2. (b) (b) Interactions.
      2. (ii) There must be a medication profile including the dose, frequency, and route of administration for each prescription medication the patient is receiving;

3. (3)

   1. (A) Twenty-four-hour availability.

   2. (B)

      1. (i) If an agency provides twenty-four-hour availability, the agency shall have a registered nurse available after hours.
      2. (ii) When an agency provides extended care, the agency shall provide twenty-four-hour coverage and availability.

      3. (iii) A licensed practical nurse may:

         1. (a) (a) Take the initial call; and
         2. (b) (b) Perform services as ordered on the plan of care.
      4. (iv) Any services outside the plan of care must be approved by a registered nurse prior to the services being rendered.

   3. (C) If twenty-four-hour availability is provided, the agency shall have a policy describing at least the following:

      1. (i) How patients will contact the agency after hours; and
      2. (ii) How the agency will ensure the registered nurse on call has access to all current patient information.
   4. (D) If twenty-four-hour availability is not offered by the agency, the agency shall be responsible for ensuring each patient is aware of the steps to take in an emergency or unusual situation;

4. (4)

   1. (A) Controlled drugs.
   2. (B) Agencies shall have a written policy stating how controlled drugs will be monitored if agency staff transports the drugs from the pharmacy to the patient.
   3. (C) If controlled drugs are being administered by the agency, there shall be a policy regarding how the drugs will be administered and monitored; and

5. (5) Home health aide services.

   1. (A) A home health aide shall have completed a seventy-five-hour aide training course that meets the requirements set forth in 20 CAR § 46-109.

   2. (B)

      1. (i) The agency is responsible for ensuring the home health aide has successfully completed competency testing.
      2. (ii) The competency evaluation must address each of the topics in Table 2.

      3. (iii) The following skills must be evaluated by the registered nurse by observing the aide's performance while carrying out the following tasks with a patient:

         1. (a) (a) Communication skills including the ability to read, write, and verbally report clinical information;
         2. (b) (b) Reading and recording:
6. (1) (1) Temperature;
7. (2) (2) Pulse; and

8. (3) (3) Respiration;

   1. (c) (c) Appropriate and safe techniques in performing personal hygiene and grooming tasks that include:
9. (1) (1) Bed bath;
10. (2) (2) Sponge, tub, and shower bath;

11. (3) (3) Hair shampooing in:

    1. (A) (A) Sink;
    2. (B) (B) Tub; and
    3. (C) (C) Bed;
12. (4) (4) Nail and skin care;
13. (5) (5) Oral hygiene; and

14. (6) (6) Toileting and elimination;

    1. (d) (d) Safe transfer techniques and ambulation; and

       1. (e) (e) Normal range of motion and positioning.
    2. (C) A registered nurse shall complete an aide assignment sheet to delegate services according to the Arkansas State Board of Nursing for each patient receiving home health aide services.
    3. (D) Each aide caring for the patient shall receive a copy of the assignment sheet.
    4. (E) Provide services as assigned.
    5. (F) A copy of the assignment sheet shall be left in the patient's home.
    6. (G) Each aide assignment sheet shall be individualized and specific according to the patient's needs.

    7. (H)

       1. (i) The qualified healthcare professional shall:

          1. (a) (a) Conduct a visit to the patient's place of residence; and
          2. (b) (b) Update the aide assignment sheet:
15. (1) (1) Every fourteen (14) days for the home health aide; and

16. (2) (2) Every sixty (60) days for the personal care aide.

    1. (ii) Aides shall receive a minimum of twelve (12) hours of in-service training per twelve (12) months.

       1. (iii) The in-services provided shall address areas that directly relate to the patient care aspects of the aide's job.