(a)

1. (1) Extended care is defined as six (6) or more hours of continuous home health services provided in a twenty-four-hour period by a licensed agency that provides both:

   1. (A) Skilled nursing; and
   2. (B) Other home health services.
2. (2) The Medicaid Personal Care Program is not included in the above definition.

(b) In addition to meeting the applicable standards for a Class B license, all agencies providing extended care must meet the following:

1. (1)

   1. (A) Shall:

(i) Make available in writing the hours of service; and

1. (ii) Provide a registered nurse supervisor or a registered nurse and supervisor for consultation and triage at least during those hours.

   1. (B) The agency shall be responsible for ensuring that each patient, or guardian if the patient is mentally incompetent, is aware of the steps to take in an emergency or unusual situation.
   2. (C) The agency must have a contingency plan regarding how the case is managed if a scheduled employee is unable to staff the case;
2. (2) The patient's permanent medical record shall be available at the licensed agency location that has been approved by the Division of Health Facilities Services to provide the services;

3. (3)

   1. (A) A medical record must also be maintained in the home if a patient is receiving skilled extended care.

   2. (B) The record must contain:

      1. (i) Current plan of treatment (physician's or licensed practitioner orders);
      2. (ii) Medication profile;
      3. (iii) Clinical notes;
      4. (iv) Documentation of any medication administered by agency staff including the:

(b) (b) Manner of administration; and

1. (v) Any other information deemed necessary by the licensed agency.

   1. (C) The information included in the home record must be filed in the permanent medical record at least every two (2) weeks if it is not already included in the permanent record.

   2. (D)

      1. (i) If extended care aide service is the only service being provided, a home record is not required.
      2. (ii) Written instructions for the aide service must be maintained in the home and in the permanent record;

2. (4)

   1. (A) For patients receiving skilled extended care, a visit must be made to the patient's home by a registered nurse who is an employee of the licensed agency no less frequently than every two (2) weeks to supervise the services being provided.
   2. (B) Patients requiring extended care services beyond three (3) months and classified by the licensed agency as chronic/stabilized will require supervision once every month.

   3. (C) For patients receiving extended care aide services only:

      1. (i) The aide must be continually supervised; and
      2. (ii) A visit must be made to the patient's home by a registered nurse at least every thirty (30) days;

3. (5)

   1. (A) The agency must have an orientation plan for the staff providing the care to the patients.
   2. (B) Since extended care cases may involve highly technical services, this plan must reflect how the agency ensures that the individuals providing the extended care are qualified to provide these types of services; and

4. (6) Prior to withdrawing skilled nursing services for an extended-care patient, the home health agency shall:

   1. (A) Provide evidence that ongoing efforts were made to:

      1. (i) Recruit staff; or
      2. (ii) Place with another agency; and
   2. (B) Give the patient/family at least sixty (60) days’ notice in writing of the intent to discharge the patient.