6 Colo. Code Regs. § 1011-1-5-8

Current through Register Vol. 47, No. 11, June 10, 2024

Section 6 CCR 1011-1-5-8 - MEDICAL CARE SERVICES

8.1 PRACTITIONER CARE

Each facility resident shall be admitted to the facility under the care of a physician. The facility shall develop written policies that are approved by the medical director to coordinate and designate responsibility when more than one practitioner is treating a resident. The facility may, at its discretion, allow practitioners to utilize telehealth for the performance of any task required by these regulations except those tasks which specifically require a face to face evaluation.

A) The facility shall ensure that all residents, within seven days of admission, receive a face to face evaluation by a practitioner who provides the facility with sufficient information to validate the admission.

1) If the resident was thoroughly assessed in the 24 hours immediately prior to the resident's admission to the facility by a practitioner (or his/her associate) who will be involved in the resident's continuing care, and documentation of that evaluation accompanies the resident upon admission, that evaluation satisfies the criteria required in section 8.1(A).

B) The facility shall ensure that all residents receive a face to face comprehensive medical evaluation by a practitioner, as specified below, within 30 days of admission and on a yearly basis thereafter. Such evaluation shall include obtaining a thorough medical history; conducting a physical examination; conducting a review of routine, prn and other medications and supplements along with indications of continued necessary use; and developing or updating a detailed medical plan of care.

1) In a skilled nursing care facility that is certified to provide Medicare services, the initial comprehensive medical evaluation shall only be performed by a physician, as required by federal law.

2) In a nursing care facility that is not certified to provide Medicare services, the comprehensive medical evaluation may be performed by either a physician or a non-physician practitioner who is not a facility employee.

C) The facility shall ensure that all residents are seen by a practitioner every 30 days for the first 90 days after admission and at least once every 60 days thereafter.

D) The facility shall ensure that there is 24-hour practitioner coverage available to promptly assess any significant changes of condition.

E) The facility shall ensure that the only persons allowed to accept a verbal or electronically transmitted order to the facility are a practitioner, licensed nurse or other appropriate discipline as authorized by their professional licensure. All such orders shall be signed within 14 days and entered in the health information record within 30 days.

F) The facility shall ensure that at the time of visit, the practitioner documents the date of the visit along with a relevant discussion of any urgent issues, pertinent findings and updated plans. The complete note, along with signature and credentials, shall be available in the health information record within seven days.

G) The facility shall ensure that all medications and therapies ordered by the practitioner are supported by diagnoses and that there is documentation of attempts to discuss with the resident or resident representative the intended benefits and risks of those medications and therapies.

8.2 MEDICAL DIRECTOR

The facility shall retain by written agreement a physician to serve as medical director to the facility and require that the medical director visit the facility in person at least once every three months.

A) The medical director is responsible for overall coordination of medical care in the facility and for systematic review of the quality of the health care provided by the facility and the medical services provided by the practitioners in the facility. The medical director shall collaborate with the administrator, staff and other practitioners and consultants to help develop policies and procedures for medical care and for the physicians admitting residents to the facility.

B) The medical director is responsible for:

1) Acting as a liaison between the facility and admitting physicians on matters related to physician services, prompt writing of orders and responding to requests by facility staff;

2) Consulting on the development and implementation of resident care policies;

3) Establishing standards governing the conduct of physicians admitting residents to the facility;

4) Consulting on the development and implementation of a procedure to provide care in emergencies when a resident's practitioner is unavailable;

5) Reviewing accidents and hazards;

6) Participating in pharmaceutical advisory committee deliberations;

7) Participating in the psychotropic medication review committee; and

8) Chairing or co-chairing the quality management committee required by section 3.3 of this chapter.

C) The medical director may utilize telehealth for the performance of any task required by these regulations except those tasks where the regulations specifically require a face to face evaluation or personal visit.

6 CCR 1011-1-5-8