5003 ADMINISTRATION AND STAFFING

5003.1 NPI numbers for Providers, staffing agencies and all personnel delivering personal care services shall be included in all Medicaid billings.5003.2 Each Provider shall have a current organizational chart that clearly describes the organizational structure, management responsibilities, staff responsibilities, and lines of authority.5003.3 Each Provider shall maintain current copies of all fully executed contracts in the Provider's home health agency office and make them available to DHCF, CMS, or their agents when requested.5003.4 A Provider shall be prohibited from waiving liability or assigning contract authority to any other entity for covered services provided to Medicaid beneficiaries.5003.5 Each Provider shall provide to all employees and contractors (such as, staffing agencies) a current policy manual which sets forth all of its policies and procedures.5003.6 Each policy manual shall include, but not be limited to, the following information:- (a) A description of the services to be provided;

- (b) Procedures for beneficiary care;

- (c) The reimbursement methodology or fee schedules;

- (d) Operational schedules;

- (e) Quality assurance standards;

- (f) A statement of beneficiary rights and responsibilities;

- (g) Financial and record-keeping requirements;

- (h) Procedures for emergency care, infection control and reporting of unusual incidents;

- (i) A description of staff positions and personnel policies, which

shall be reviewed annually, revised as necessary, and dated at time of review;

(j) Policies and procedures for employee hiring, assessments, grievances, and in-service training;

(k) An up-to-date listing of professional staff licensure and registration information;

(l) Policies, procedures, and presentation materials for owners, managers, and employees for in-service education on the following subject matters:

(1) Compliance with federal and local False Claims Acts;

(2) Preventing, detecting, and reporting fraud, waste, and abuse; and

(3) Rights of employees to be protected as whistleblowers.

5003.7 Each Provider shall be staffed with individuals who are qualified to perform the following functions:

(a) Verify and document each beneficiary's Medicaid eligibility;

(b) Provide quality services in accordance with the plan of care, including the proper assignment and supervision of personal care aides; and

(c) Coordinate the provision of personal care services with home health services, as appropriate.

5003.8 Each Provider shall employ a registered nurse who is responsible for the following:

(a) Performing the initial assessment of the beneficiary and regularly reassessing the beneficiary's needs;

(b) Developing and reviewing the plan of care and preparing clinical and progress notes;

(c) Monitoring the quality of the personal care services on a regular basis;

(d) Supervising the personal care aides which shall include on-site supervision at least once every sixty-two (62) days;

(e) Coordinating services and communicating with primary care physicians and advanced registered practice nurses regarding changes in the beneficiary's condition and needs;

(f) Gathering information regarding the beneficiary's condition and the need for continued care; and

(g) Counseling the beneficiary and the beneficiary's family regarding nursing and related needs.

5003.9 The registered nurse shall visit each beneficiary within forty-eight (48) hours of initiating personal care services to monitor the quality of services, and no less than every sixty-two (62) days thereafter for assessment of the beneficiary and update of the plan of care.

5003.10 The registered nurse may provide an additional supervisory visit to each beneficiary if the situation warrants an additional visit, such as the assignment of a new personal care aide or change in the beneficiary's health status.

5003.11 Each Provider shall discontinue personal care services when such services are no longer required.

5003.12 Each Provider shall notify DHCF and the beneficiary or beneficiary's representative, in writing, no less than fifteen (15) calendar days prior to any termination or reduction of services, discharge or referral consistent with the requirements set forth in District and Federal law. The beneficiary's record shall contain documentation of the date the notice was mailed to the beneficiary and a copy of the notice to the beneficiary. An oral notice may be provided in lieu of the fifteen (15) day written notice if:

(a) The discharge or referral is the result of one (1) of the following:

(1) A medical emergency;

(2) A primary care physician's order to admit the beneficiary to a facility;

(3) A determination by the home health agency that the

discharge or referral is necessary to protect the health, safety or welfare of agency staff; or

(4) A determination by a primary care physician that the beneficiary's condition, that required the delivery of personal care services, no longer exists; and

(b) Documentation indicating a reason to omit the fifteen (15) day notice is included in the beneficiary's record.

5003.13 If the beneficiary seeks to change his or her personal care services Provider, the Provider shall assist the beneficiary in selecting a new Provider. Until the beneficiary is transferred to a new personal care services Provider, the Home Health Provider shall continue providing personal care services to the beneficiary until the transfer has been completed successfully and the beneficiary is receiving personal care services from the new Provider.

5003.14 Each Provider shall immediately terminate the services of a personal care aide and instruct the personal care aide to discontinue all services to the beneficiary, in any case where the Provider believes that the beneficiary's physical or mental well-being is endangered by the care or lack of care provided by the aide, or that the beneficiary's property is at risk.

5003.15 Each Provider shall conduct a performance assessment of each personal care aide after the first three (3) months of employment and annually thereafter.

5003.16 Each Provider shall develop contingency staffing plans to provide coverage for each beneficiary in the event the assigned personal care aide cannot provide the services or is terminated.

SOURCE: Final Rulemaking published at 50 DCR 3957 (May 23, 2003); Notice of Final Rulemaking published at 59 DCR 1760, 1765 (March 2, 2012).