6 Colo. Code Regs. § 1011-1 Chapter 26, pt. 2

Current through Register Vol. 47, No. 20, October 25, 2024

Part 2 - DEFINITIONS

2.1 "Authorized representative" means an individual responsible for the private payment of home care services or an individual who possesses written authorization from the consumer to represent their interests regarding care, treatment, and services provided by the home care agency. The authorized representative shall not be the home care consumer's service provider except as allowed by state Medicaid programs.

2.2 "Branch office" means a location or site from which a home care agency provides services within a portion of the total geographic area served by the parent agency. The branch office is part of the home care agency and is located close to share administration, supervision, personnel, and services in a manner that renders it unnecessary for the branch to independently meet the requirements of this chapter.

2.3 "Bylaws" means a set of rules adopted by a home care agency for governing the agency's operation. For purposes of this Chapter 26, "governing documents" is synonymous with "bylaws".

2.4 "Certified home care agency" means an agency that is certified by either the federal Centers for Medicare and Medicaid Services (CMS) or the state Department of Health Care Policy and Financing (HCPF) to provide skilled home health or personal care services.

2.5 "Clinical note" means a written notation of a healthcare contact with a consumer that is signed, with date and time, by personnel of the home care agency that describes signs and symptoms; treatment; education; drugs administered and the consumer's reaction; and any changes in physical or emotional condition.

2.6 "Community Centered Board" means a community-centered board, as defined in Section 25.5-10-202, C.R.S., that is designated pursuant to Section 25.5-10-209, C.R.S., by the Department of Health Care Policy and Financing.

2.7 "Department" means the Colorado Department of Public Health and Environment.

2.8 "Geographic area" means an area of land for which the agency shall be licensed surrounding the home care agency's primary location. There is no restriction as to the number of agencies that may provide services in a particular geographic area.

2.9 "Governing body" means the board of trustees, directors, or other governing entity in whom the ultimate authority and responsibility for the conduct of the home care agency is vested.

2.10 "Home care agency" means any sole proprietorship, partnership, association, corporation, government, or governmental subdivision or agency subject to the restrictions in Section 25-1.5-103(1)(a)(II), C.R.S., not-for-profit agency, or any other legal or commercial entity that manages and offers, directly or by contract, skilled home health services or personal care services to a home care consumer in the home care consumer's temporary or permanent home or place of residence. Home care agency is also referred to in this chapter as "HCA" or "agency."

(A) A residential facility that delivers skilled home health or personal care services that the facility is not licensed to otherwise provide shall either be licensed as a home care agency or require the skilled home health or personal care services to be delivered by a licensed home care agency.

(B) "Home care agency" does not include:

(1) Organizations that provide only housekeeping services;

(2) Community and rural health networks that furnish home visits for the purpose of public health monitoring and disease tracking;

(3) An individual who is not employed by or affiliated with a home care agency and who acts alone, without employees or contractors;

(4) Outpatient rehabilitation agencies and comprehensive outpatient rehabilitation facilities certified pursuant to Title 18 or 19 of the "Social Security Act," as amended;

(5) Consumer-directed attendant programs administered by the Colorado Department of Health Care Policy and Financing;

(6) Licensed dialysis centers that provide in-home dialysis services, supplies, and equipment;

(7) Subject to the requirements of Section 25-27.5-103(3), C.R.S., a facility otherwise licensed by the Department;

(8) A home care placement agency as defined in this part;

(9) Services provided by a qualified early intervention service provider and overseen jointly by the Department of Education and the Department of Human Services; or

(10) A program of all-inclusive care for the elderly (PACE), established in Section 25.5-5-412, C.R.S., and regulated by the Department of Health Care Policy and Financing and the CMS, except that PACE home care services are subject to regulation in accordance with Section 25-27.5-104(4).

2.11 "Home care consumer" means a person who receives skilled home health services or personal care services in their temporary or permanent home or place of residence from a home care agency or from a provider referred by a home care placement agency. A home care consumer is also referred to in this chapter as "consumer".

2.12 "Home care placement agency" means an organization that, for a fee, provides only referrals of providers to home care consumers seeking services. A home care placement agency does not provide skilled home health services or personal care services, directly or by contract, to a home care consumer in the home care consumer's temporary or permanent home or place of residence. Such organizations shall follow the requirements of Section 25-27.5-101, et seq., C.R.S., that pertain to home care placement agencies and Part 3 of this chapter.

2.13 "Informal caregiver" means a person who provides care to the consumer without payment and who is not an employee of the agency.

2.14 "Licensed independent practitioner" means an individual permitted by law and the HCA to independently diagnose, initiate, alter, or terminate health care treatment within the scope of their license, and includes Advanced Practice Registered Nurses (APRN) and Physician Assistants.

2.15 "Manager" or "administrator" means any person who is responsible for and supervises or offers or attempts to oversee and supervise the day-to-day operations of a home care agency or home care placement agency.

2.16 "Nurse aide" means a nurse aide certified by the Colorado Department of Regulatory Agencies (DORA) or a nurse aide who has completed the requisite training and is within four (4) months of achieving certification.

2.17 "Owner" means a shareholder in a for-profit or nonprofit corporation, a partner in a partnership or limited partnership, a member in a limited liability company, a sole proprietor, or a person with a similar interest in an entity, who has at least a fifty-percent (50%) ownership interest in the business entity.

2.18 "PACE home care services" means skilled home health services or personal care services:

(A) Offered as part of a comprehensive set of medical and nonmedical benefits, including primary care, day services, and interdisciplinary team care planning and management by PACE providers to an enrolled participant in the program of all-inclusive care for the elderly established in Section 25.5-5-412, C.R.S. and regulated by the Department of Health Care Policy and Financing and the CMS; and

(B) Provided in the enrolled participant's temporary or permanent place of residence.

2.19 "Parent agency" means the agency that develops and maintains administrative control of branch offices.

2.20 "Personal care services" means assistance with activities of daily living, including but not limited to: bathing, dressing, eating, transferring, walking or mobility, toileting, continence care, housekeeping, personal laundry, medication reminders, and companionship services, furnished to a home care consumer in the home care consumer's temporary or permanent home or place of residence, and those normal daily routines that the home care consumer could perform for themselves were they physically capable, which are intended to enable that individual to remain safely and comfortably in the home care consumer's temporary or permanent home or place of residence.

2.21 "Personnel" means individuals employed by and/or providing services under the direction of the HCA, including but not limited to: managers, administrators, staff, employees, contractors, students, interns, or volunteers.

2.22 "Plan of care" means a plan developed in consultation with the licensed independent practitioner and agency staff that covers all pertinent diagnoses, including mental status, types of services and equipment required, frequency of visits, prognosis, rehabilitation potential, functional limitations, activities permitted, instructions for timely discharge or referral, and any other appropriate items.

2.23 "Plan of correction" means a written plan prepared by the home care agency or home care placement agency and submitted to the Department for approval that specifies the measures the agency shall take to correct all cited deficiencies.

2.24 "Pseudo-patient" means a person trained to participate in a role-play situation or a computer-based mannequin device. A pseudo-patient must be capable of responding to and interacting with the nurse aide and must demonstrate the general characteristics of the primary consumer population served by the HCA in key areas such as age, frailty, functional status, and cognitive status.

2.25 "Qualified Early Intervention Service Provider" has the same meaning set forth in Section 27-10.5-702, C.R.S.

2.26 "Respite care" means services provided to a consumer who is unable to care for themselves on a short term basis because of the absence or need for relief of those persons normally providing care.

2.27 "Service Agency" means a service agency, as defined in Section 25.5-10-202, C.R.S., that has received certification from the Department of Health Care Policy and Financing as a developmental disabilities service agency under rules promulgated by the medical service board and is providing services pursuant to the supported living services waiver or the children's extensive service support waiver or the home and community-based services waivers administered by the Department of Health Care Policy and Financing under Part 4 of Article 6 of Title 25.5, C.R.S.

2.28 "Service note" means a written notation that is signed, with date and time, by personnel of the home care agency furnishing the non-medical services.

2.29 "Skilled home health services" means health and medical services furnished in the consumer's temporary or permanent home or place of residence that include: wound care services; use of medical supplies including drugs and biologicals prescribed by a physician; in-home infusion services; nursing services; certified nurse aide services that require the supervision of a licensed or certified health care professional acting within the scope of their license or certificate; occupational therapy; physical therapy; respiratory care services; dietetics and nutrition counseling services; medication administration; medical social services; and speech-language pathology services. "Skilled home health services" does not include the delivery of either durable medical equipment or medical supplies.

2.30 "Subdivision" means a component of a multi-function health agency, such as the home care department of a hospital or the nursing division of a health department, which independently meets the licensure requirements for HCAs. A subdivision that has branch offices is considered a parent agency.

2.31 "Summary report" means the compilation of the pertinent factors of a home care consumer's clinical notes that is submitted to the consumer's physician by the skilled home healthcare agency.

2.32 "Supervision" means authoritative procedural guidance by a qualified person for the accomplishment of a function or activity.

2.33 "Workstation" means a location separate from the parent agency that operates solely for the convenience of direct care staff. Any non-medical, medical, state, or federally certified agency may establish a workstation within the agency's geographic service area. The site may provide a place to work so that direct care staff can decrease travel. Consumer charts are not to be kept at a workstation, but the site may contain phones, faxes, office supplies, wound care supplies, policies, procedures, forms, etc. The workstation shall not be used to accept referrals; conduct marketing, administrative activities, or personnel training; or store consumer records. The workstation shall not be staffed to serve the public and signage at the workstation shall not be posted to invite the public inside to conduct business.

6 CCR 1011-1 Chapter 26, pt. 2