Section 150.005 - Physician Services(A) Facilities providing Level I, II or III care shall establish a medical director who shall be responsible for the implementation of resident care policies and the coordination of medical care in the facility. (1) Supervisory and advisory functions shall include: advice on the development of medical and resident care policies concerning resident admissions and discharge, medical records, responsibilities of primary care providers, supportive and preventive services, emergency medical care, and the review of the facility's overall program of resident care.(2) Staff physicians or the medical director shall spend at least four hours per month in the facility devoted to supervisory and advisory functions.(3) A SNCFC shall appoint a pediatrician with experience in developmental disabilities who shall participate in the development of resident care policies, familiarize himself or herself with the condition, needs and care of each resident, and participate in periodic staff conferences.(4) In a SNCFC, services of a neurologist, orthopod, psychiatrist, psychologist or any other consultant services shall be provided as needed to those individuals requiring such services.(B) Every resident shall have a primary care provider who is responsible for his or her continuing medical care and periodic reevaluation. (1) Each resident or resident's guardian shall on admission designate a primary care provider. If the resident does not have a primary care provider, the facility shall designate a primary care provider with the approval of the resident or the resident's guardian.(2) The addresses and telephone numbers of the resident's primary care provider shall be recorded in the resident's record and be readily available to personnel on duty in case of emergencies.(C) All facilities shall have written arrangements for emergency physician services when the resident's own primary care provider is not immediately available. (1) A list of the names and telephone numbers of emergency physicians.(2) If medical orders for the immediate care of a resident are not available at the time of admission, the emergency physician or medical director shall be contacted to provide temporary orders until the primary care provider assumes responsibility.(3) Facilities shall establish and follow procedures covering immediate care of the resident, persons to be notified and reports to be prepared in the case of emergencies.(4) The date, time and circumstances surrounding each call to an emergency physician and his or her findings, treatment, and recommendations shall be recorded in the resident's clinical record. The facility shall notify the resident's primary care provider and record such notification in the clinical record.(D) All medical, psychiatric and other consultations shall be recorded in the resident's clinical record and dated and signed by the consulting practitioner.(E) Every resident shall have a complete admission physical exam and medical evaluation. Based on this information, the resident's primary care provider shall develop a medical care plan that shall include such information as the following:(1)Primary Diagnosis. (a)Other Diagnoses or Associated Conditions.1. Pertinent findings of physical exam (including vital signs and weight, if ambulatory);2. Weight shall be included for non-ambulatory patients in a SNCFC;3. Significant past history;4. Significant special conditions, disabilities or limitations;6. Assessment of physical capability (ambulation, feeding assistance bowel and bladder control);7. Assessment of mental capacity.(b)Treatment Plan Including. Medications;
Special treatments or procedures;
Rehabilitation services;
Dietary needs;
Order of ambulation and activities;
Special requirements necessary for the individual's health or safety;
Preventive or maintenance measures;
Short and long term goals;
Estimated length of stay;
Documented advance directives, if available.
The care plan for residents in a SNCFC shall include in addition to the above, a developmental history, including evaluation of the patient's physical, emotional and social growth and development, immunization status, and assessments of hearing, speech and vision. Each resident's medical care plan shall include a schedule of appropriate immunizations as recommended by the American Academy of Pediatrics.
(2) The medical care plan shall be completed and recorded in the resident's clinical record as follows: (a) Level I or II, within five days prior to admission, up to 48 hours following admission.(b) Level III or IV, within 14 days prior to admission, up to 72 hours following admission.(3) If the care plan is completed within the specified time limits prior to admission by the provider who will continue as the the resident's primary care provider, a repeat examination and evaluation following admission to the facility is not required.(F) Each resident shall be re-examined and re-evaluated, and his or her care plan reviewed and revised, if indicated, by the primary care provider to ensure appropriate medical services and resident placement. Reviews shall be recorded in the clinical record at least as often as follows:(1)Level II, Every 30 Days. If after 90 days following admission in the opinion of the primary care provider it is deemed unnecessary to see the resident with such frequency, an alternate schedule not to exceed 60 days between visits may be adopted providing the justification is documented in the resident's medical record.(2)Level III, Every 60 Days. If after 90 days following admission in the opinion of the primary care provider it is deemed unnecessary to see the resident with such frequency, an alternate schedule not to exceed 90 days between visits may be adopted providing the justification is documented in the resident's medical record.(3) Level IV, every six months unless the primary care provider documents fewer visits are necessary.Amended by Mass Register Issue 1361, eff. 3/23/2018.