4223 ADMINISTRATION AND STAFFING FOR PERSONAL CARE AIDE SERVICES

4223.1 Each provider of personal care aide services shall have a current organizational chart that clearly defines the organizational structure, staff responsibilities, and lines of authority.

4223.2 Each provider of personal care aide services shall have available to all staff and subcontractors a current policy manual which sets forth all of its policies and procedures.

4223.3 Each policy manual shall include, but not be limited to, the following information:

1. (a) Governance of the organization;
2. (b) A description of the services to be provided;
3. (c) Policies and procedures for recipient care and recipient safety;
4. (d) Financial policies including the reimbursement methodology or fee schedules;
5. (e) Personnel policies to include personnel management, job description, employee orientation and periodic training, performance evaluations, and employee discipline and grievance procedures; and
6. (f) Quality assurance standards.

4223.4 Each provider of personal care aide services shall be staffed with individuals who are qualified to:

1. (a) Provide quality services in accordance with a recipient's ISP; and
2. (b) Coordinate the provision of personal care aide services with other home health services to avoid duplication of services and to ensure coordination of care.

4223.5 Each provider of personal care aide services shall employ a registered nurse who is responsible for the following:

1. (a) Performing the initial evaluation of the recipient and regularly re-evaluating the recipient's needs;
2. (b) Monitoring the quality of the personal care services on an ongoing basis;
3. (c) Providing on-site supervision of Personal Care Aides at least once every month;
4. (d) Developing and reviewing the ISP and preparing monthly progress notes and quarterly reviews;
5. (e) Coordinating services and informing the physician, case manager, staff, and other providers of changes in the recipient's condition and needs;
6. (f) Assessing the recipient's condition and the need for continued care;
7. (g) Counseling the recipient and the family regarding meeting nursing and related needs;
8. (h) Developing an assignment and reviewing the assignment with the recipient or representative and the aide; and

(i) Reviewing and updating the assignment of the aide as changes in the recipient's condition occur, but at least every six (6) months.

4223.6 A registered nurse shall initially visit each recipient within forty-eight (48) hours of initiating personal care services to monitor the quality of services and monthly thereafter, for assessment and evaluation of the recipient and update of the ISP. At a minimum, the ISP shall be updated and revised quarterly.

4223.7 The registered nurse may provide an additional supervisory visit to each recipient if the situation warrants an additional visit, such as the assignment of a new personal care aide or changes in the recipient's health status. The registered nurse shall make an in-home supervisory visit to the recipient's home at least every month (within 30 days), and documentation of the supervisory visit shall be incorporated into the clinical record.

4223.8 Each provider of personal care aide services shall discontinue personal care aide services when the services are no longer required or have been determined inadequate to meet a recipient's needs.

4223.9 Each provider of personal care aide services shall notify the MAA and the recipient or recipient's representative, in writing, no less than thirty (30) calendar days prior to discharge or referral. The thirty (30) day written notice shall not be required, and oral notice may be given, if the discharge or referral is the result of:

1. (a) A medical emergency;
2. (b) A physician's order to admit the recipient to an in-patient facility;
3. (c) A determination by the home care agency that the discharge or referral is necessary to protect the health, safety, or welfare of agency staff; or
4. (d) A determination by a physician that the condition that necessitated the provision of services no longer exists.

4223.10 A provider of personal care aide services shall assist a recipient in selecting a new provider, if the recipient seeks a change in providers, and cannot abandon the recipient until the new provider has been successfully obtained.

4223.11 Each provider of personal care aide services shall immediately terminate the services of a personal care aide and instruct the personal care aide to discontinue all services to the recipient, in any case where the provider believes that the recipient's physical or mental well-being is endangered by the care or lack of care provided by the aide or that the recipient's property is at risk.

4223.12 Each provider of personal care aide services shall develop contingency staffing plans to provide coverage for each recipient in the event the assigned personal care aide cannot provide the services or is terminated.

4223.13 Each provider of personal care aide services that contracts with a personnel staffing agency for personal care aides shall be responsible for ensuring that that the personal care aides meet the requirements set forth in these rules.

SOURCE: Final Rulemaking published at 50 DCR 9025 (October 24, 2003).