6 Colo. Code Regs. § 1011-3-5

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

Section 6 CCR 1011-3-5 - ADMINISTRATOR, MEDICAL DIRECTOR AND OTHER STAFF

5.1Administrator

5.1.1 Minimum Qualifications

A) The administrator shall:

i) Be at least 21 years of age and of good moral character;

ii) Be qualified by education, knowledge and experience to oversee the community integrated health care services provided; and

iii) Have at least two (2) years health care, emergency medical service agency or health service administration experience with at least one (1) year of supervisory experience in home care, emergency medical services, or a closely related health program.

B) Responsibilities

The administrator shall assume authority for the CIHCS Agency's business operations including, but not limited to:

i) Managing the business affairs and the overall operation of the CIHCS Agency;

ii) Organizing and directing the Agency's ongoing functions;

iii) Overseeing a budgeting and accounting system;

iv) Designating in writing a qualified back up administrator to act in the administrator's absence;

v) Maintaining availability of a qualified administrator at all hours employees are providing services;

vi) Ensuring the Agency's community integrated health care services are in compliance with all applicable federal, state and local laws;

vii) Ensuring the completion, maintenance and submission of such reports and records as required by the Department;

viii) Providing ongoing liaison with the CIHCS providers, Agency staff members and the community;

ix) Establishing a current organizational chart to show lines of authority down to the consumer level;

x) Maintaining appropriate personnel records, financial and administrative records, and all policies and procedures of the Agency;

xi) Ensuring that marketing, advertising and promotional information accurately represents the CIHCS Agency, and addresses the care, treatment and services that the Agency can provide directly or through contractual arrangement; and

xii) Hiring and employing or contracting with sufficient qualified personnel to operate the Agency's services in accordance with:

a) Written job descriptions;

b) Applicable licensing, certification or registration requirements in compliance with state laws and regulations;

c) Each CIHCS provider's scope of practice, if applicable; and d) The provisions of Sections 26-3.1-111(6), C.R.S., on or after January 1, 2019. Prior to hiring or contracting with a person who will provide direct care to an at-risk adult as defined in Section 2.3 of these rules, the administrator shall ensure that it has required each prospective Agency employee and contractor to submit to a CAPS Check, as defined in Section 26-3.1-101 (1.8), C.R.S.

C) The administrator shall, in collaboration with the Agency's medical director:

i) Ensure appropriate education, supervision and evaluation of Agency staff;

ii) Designate through policy a backup for medical direction when the Agency medical director is unavailable in accordance with the requirements of Section 5.2.3(A)(vii) of these rules; and

iii) Develop and implement a quality management program for the Agency and CIHCS provider services.

5.2Medical Director's Qualifications, Duties and Training

5.2.1 Nothing in these rules prohibits a CIHCS Agency from employing or contracting with an APN and physician medical director to serve as co-medical directors for the Agency. The Agency shall clearly delineate and document those CIHCS providers over whom each co-medical director retains supervisory and medical direction oversight as defined in Section 2.18 of these rules.

5.2.2 Qualifications. A CIHCS Agency's medical director, as defined in Section 2.7 of these rules, must possess the following minimum qualifications:

A) Physician medical directors must:

i) Be a physician currently licensed in good standing to practice medicine in the State of Colorado;

ii) Possess authority under their licensure to perform all medical acts to which they extend their authority to CIHCS providers; and

iii) Satisfy all requirements mandated in 6 CCR 1015-3, Chapter Two if the medical director also serves as an EMS Agency medical director.

B) Advanced Practice Registered Nurse (APN) medical directors:

i) Must be currently licensed in good standing to practice advanced practice nursing in the State of Colorado;

ii) Must possess authority under their licensure to perform all nursing functions and delegated medical functions in accordance with accepted practice standards for which they extend their authority to non-Community Paramedic-endorsed CIHCS providers;

iii) Must not be a medical director for any Community Paramedic-endorsed provider delivering medical services; and

iv) May only issue standing orders and protocols as authorized by law.

5.2.3 Responsibilities

A) A CIHCS Agency shall ensure that all CIHCS Agency medical directors perform the following responsibilities and duties:

i) Be actively involved in the provision of community integrated health care services within the community served by the CIHCS Agency. Involvement does not require that a physician or APN have such community involvement prior to becoming a medical director, but does require active involvement as the medical director. Community involvement could include, by way of example and not limitation, those inherent, reasonable and appropriate responsibilities of a medical director to interact, and, as necessary, collaborate with the community served by the CIHCS Agency, the hospital community, the public safety agencies, home care, hospice, and the medical community, and should include other aspects of liaison oversight and communication expected in the supervision of CIHCS providers;

ii) Be actively involved on a regular basis with the CIHCS Agency providers. Such involvement shall include, at minimum, overseeing continuing education, provider supervision, care and service audits, developing protocols and/or treatment policies and procedures;

iii) In collaboration with the administrator, develop a quality management program for the Agency and CIHCS provider services;

iv) In accordance with Agency policy, participate in the supervision and evaluation of the performance of CIHCS providers. This includes ensuring that CIHCS providers have adequate clinical knowledge of, and are competent in performing medical skills and acts performed on behalf of the CIHCS Agency within the CIHCS provider's scope of practice and in accordance with state licensure, certification or registration requirements as applicable;

v) In collaboration with the administrator, oversee training and education programs for CIHCS Agency personnel regarding the provision of out-of-hospital medical services;

vi) Notify the Department within fourteen (14) business days of changes to the medical director's position, including cessation of duties as the Agency's medical director;

vii) In collaboration with the Agency administrator, designate through policy a backup for medical direction in accordance with the requirements of Section 3.2.2 of these rules for when the agency medical director is unavailable;

viii) Establish standards governing the CIHCS Agency services that can be provided to consumers during a single visit, pursuant to Section 8.2 of these rules;

ix) In conjunction with the CIHCS consumer's care provider, if applicable, develop, monitor, and evaluate service plans as required by Section 8.5.1 of these rules;

x) When implementing the consumer service plan, ensure that consumer chart reviews are performed in compliance with the quality management plan to determine if appropriate assessments, referrals, documentations, and communications are occurring between the care provider(s), CIHCS providers, and the consumer; and

xi) In conjunction with the consumer's care provider(s), if applicable, and CIHCS provider(s), develop and implement discharge summaries as part of each consumer's service plan.

5.2.4 Additional physician medical director responsibilities for Community Paramedic oversight.

A) In addition to the responsibilities set forth in Section 5.2.3 of these rules, all physician medical directors shall:

i) Develop protocols and standing orders which are appropriate for the care and services offered by the Agency and conform to the certification, skill level and scope of practice of each CIHCS provider type;

ii) Conduct a review of the protocols and standing orders on an annual basis; and

iii) Retain ultimate authority for establishing all protocols and standing orders pertaining to community integrated health care services provided by Community Paramedics.

B) In addition to the responsibilities set forth in Section 5.2.3 of these rules, a physician medical director who oversees Community Paramedics shall:

i) Oversee the training, knowledge and competency of endorsed Community Paramedics under his or her supervision and ensure that Community Paramedics are appropriately trained and demonstrate ongoing competency in all skills, procedures and medication administration and management as authorized in accordance with Section 6 CCR 1015-3, Chapter 2;

ii) Ensure that appropriate additional education and training is provided to supervised Community Paramedics and understand that certain skills, procedures and medications authorized in accordance with Section 6 CCR 1015-3, Chapter 2 (and as identified by the Department) may not be included in the education and training of Community Paramedics; and

iii) Retain ultimate authority and responsibility for monitoring, supervising, evaluating and ensuring the competency of Community Paramedics in the delivery of care and services and the performance of authorized medical acts.

5.3Staff and CIHCS Providers

5.3.1 General Requirements

A) The Agency shall ensure that each employee or contracted staff possesses the education, good moral character and experience to provide services in the homes of consumers in accordance with Agency policy, these regulatory requirements, state practice acts, and professional standards of practice.

B) The Agency shall ensure its providers and other relevant staff receive appropriate training.

i) The CIHCS Agency shall develop and implement a provider training policy that requires its CIHCS providers to undergo a minimum amount of annual training specific to the CIHCS Agency services provided to the community and the equipment used.

ii) The CIHCS Agency shall establish by policy the minimum annual amount of continuing education required of each CIHCS provider and, as applicable, administrative staff.

a) The minimum amount of required continuing education shall not be less than twelve (12) hours or twelve (12) educational sessions per year.

b) Continuing education requirements that CIHCS providers complete to maintain certification, license, or registration may apply to satisfy the annual minimum twelve (12) hour mandatory continuing education requirement.

C) All training and continuing education records shall be documented and retained by the Agency.

5.3.2 Responsibilities of all CIHCS Providers

A) CIHCS providers, acting within the scope of their relevant certification, license or registration, shall:

i) Participate as part of a community based team to provide integrated out- of-hospital medical services to address a consumer's particular nonurgent medical condition; and

ii) Provide information to CIHCS Agency consumers about relevant local community resources and other collaborative services.

B) As required by these regulations and in accordance with Agency policy and procedures, the duties of a CIHCS provider shall at a minimum include:

i) Preparing clinical notes;

ii) Coordinating services;

iii) Communicating appropriate medical status and treatment information to the consumer and/or designated representative and, if applicable, the consumer's care provider; and

iv) Comply with all Agency reporting requirements set forth in Agency policy and these rules.

5.3.3 Requirements Applicable To Specific CIHCS Providers

A) CIHCS providers who are not regulated under DORA shall, at a minimum, meet the following requirements:

i) A registered dietician shall have successfully completed a program of formal training in nutrition with successful completion of the registration examination for dieticians.

ii) An X-ray technician:

a) Shall meet the requirements of 6 CCR 1007-1, Part Two (Appendix 2D-X-ray System Operator Adequate Radiation Safety Training And Experience, Including Limited Scope X-ray Machine Operator); or

b) Who operates an X-ray machine for dental, podiatric, and chiropractic diagnosis purposes must meet the minimum standard for qualifications, education, and training under Sections 12-32-201 and 202, C.R.S. (podiatrist X-ray technician); Sections 12-33-201 and 202, C.R.S. (chiropractic X-ray technician); or Sections 12-35-201 and 202, C.R.S. (dental X-ray technicians).

iii) A phlebotomist shall:

a) Have successfully completed an approved phlebotomy training course or have equivalent experience through previous employment; and

b) Have two (2) years of verifiable phlebotomy experience.

5.3.4 CIHCS Agency Provider Scopes of Practice

A) Community Paramedic scope of practice when providing out-of-hospital medical services on behalf of a CIHCS Agency.

i) Under the supervision and direction of the Agency's physician medical director, an endorsed Community Paramedic may, in addition to performing his or her other authorized activities within the paramedic scope of practice, perform the following medical tasks and procedures:

a) An initial assessment of the consumer and any subsequent assessments, as needed, within the rules as promulgated in 6 CCR 1015-3, Chapter Two;

b) Medical interventions that are deemed permissible tasks and procedures as promulgated in 6 CCR 1015-3, Chapter Two, and are conducted within the rules set forth therein;

c) Care coordination;

d) Resource navigation;

e) Patient education;

f) Inventory, compliance, and administration of medications conducted within the rules promulgated in 6 CCR 1015-3, Chapter Two;

g) Gathering of laboratory and diagnostic data conducted within the rules promulgated in 6 CCR 1015-3, Chapter Two; and

h) Other community paramedic tasks and procedures as promulgated within the rules of 6 CCR 1015-3, Chapter Two.

B) Any services provided must not exceed the scope of practice of the Community Paramedic.

C) EMS Providers who are not endorsed Community Paramedics are prohibited from providing out-of-hospital medical services to a consumer when employed by or contracting with a CIHCS Agency; except that, in their capacity as CIHCS Agency providers, unendorsed EMS providers may perform:

i) Ancillary non-medical services with respect to non-emergent conditions i.e. driving); and

ii) Any of the services that may be provided through a CARES Program as set forth in Section 25-3.5-1203(3), C.R.S.

5.3.5 Other CIHCS Agency Providers When Performing Out-Of-Hospital Medical Services On Behalf Of a CIHCS Agency.

A) Under the supervision and direction of the Agency's medical director, a CIHCS Agency provider who holds a license, registration or certificate to practice a profession in good standing may perform the authorized activities and skills listed for the provider's license, registration, or certificate level on behalf of a CIHCS Agency within the applicable scope of practice as described in statute and rule.

6 CCR 1011-3-5

40 CR 21, November 10, 2017, effective 1/1/2018