6 Colo. Code Regs. § 1011-3-8

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

Section 6 CCR 1011-3-8 - PERMISSIBLE CIHCS AGENCY SERVICES

8.1Purpose

The activities of licensed CIHCS Agencies are directed towards integrating the services of a community-based team of qualified CIHCS providers, based on local need, to address gaps in a community's primary and public health care systems, to assess and treat consumers outside of the hospital setting for the purpose of preventing or improving a particular medical condition, and to reduce the burden of patients with non-emergent conditions who access the larger health care system through the emergency medical services system. CIHCS Agency services are intended to address the unmet needs of individuals who are experiencing intermittent health care issues and to prevent duplication of out-of-hospital medical care and services.

8.2Standards Governing CIHCS Agency Evaluation and Treatment Services for Single Visits

8.2.1 A CIHCS Agency, under medical direction and within the applicable scope of the provider's practice, may utilize its appropriate personnel to assess, provide, and/or coordinate out-of-hospital medical services during single visits.

8.2.2 A CIHCS Agency that is also an emergency medical services agency or that has contracted with an emergency medical services agency may utilize its appropriate personnel to:

A) Treat and release consumers with non-emergent conditions instead of transporting the consumer to a hospital or emergency department;

B) Treat and transport, as authorized by law, consumers with non-emergent conditions to appropriate destinations other than a hospital or an emergency department;

C) Treat and refer consumers with non-emergent conditions to a primary care or urgent care facility; or

D) Assess the consumer with a non-emergent condition and communicate with a care provider to determine an appropriate course of action.

8.3Standards Governing Recurrent CIHCS Agency Services

8.3.1 If the eligible consumer's care provider, as defined in Section 2.6 of these rules, orders a CIHCS Agency to provide services specific to the consumer's needs in a series of visits, the CIHCS Agency shall approve a service plan before providing services to the consumer. For purposes of these rules, "approval" of the service plan means, at minimum, that the Agency must review the service plan and, pursuant to these rules and the Agency's policies and procedures, confirm that its providers can supply the ordered services within their scopes of practice.

8.3.2 If the Agency determines the consumer lacks adequate resources to obtain or access necessary out-of-hospital medical services, the CIHCS Agency may provide the consumer with such necessary services through a series of visits established in the consumer service plan that the CIHCS medical director shall approve.

8.3.3 The Agency will provide the services in accordance with the consumer's service plan within the scope of services of the Agency, and will ensure continuous oversight of the consumer's care up to and until the consumer's discharge.

8.3.4 Evaluations of the consumer's progress based on the goals established in the service plan shall be conducted as set forth in Sections 8.4.2 and 8.5.2 and documented in the consumer's service records. CIHCS providers shall notify the Agency and/or the care provider regarding any changes that suggest a need to alter the service plan.

8.3.5 Each consumer service plan shall incorporate a defined discharge summary, as required in Sections 8.5.1(H) and 8.6 of these rules.

8.4Standards Governing Initial and Subsequent Assessments

8.4.1 Initial Consumer Assessment

A) The CIHCS Agency shall ensure a qualified CIHCS provider conducts an assessment of the consumer's immediate needs at the initial encounter.

B) The CIHCS Agency assessment shall:

i) Evaluate the consumer's physical and psychological status, if applicable, including but not limited to the consumer's special needs, communication or language barriers, capabilities, limitations, and short-term and long-term goals;

ii) Evaluate or screen the consumer for medical, therapeutic, social, nursing, and dietary service needs;

iii) Obtain a list of the consumer's current medications and medication schedules;

iv) Identify social support systems, evaluate environment and discuss any transportation accessibility issues and barriers; and

v) Assess, obtain and identify other systems, situations, and information as deemed appropriate to improve the consumer's life and/or health related outcomes.

8.4.2 Subsequent Assessments

A) CIHCS providers shall document and submit an individualized subsequent assessment that:

i) Accurately reflects the consumer's current health status, goals, and timeframes for meeting the goals;

ii) Includes information that may be used to demonstrate the consumer's progress toward achievement of the desired outcomes; and

iii) Identifies whether the consumer requires continuing CIHCS services or may be discharged.

B) Subsequent assessments shall occur when there is a significant change of condition.

C) Each subsequent assessment shall be submitted to the Agency for evaluation and use during the Agency's preparation of periodic service plan reviews, as required in Section 8.5.2 of these rules.

8.5Standards Governing CIHCS Agency Service Plans for Recurrent Services

8.5.1 This Section shall not apply to single visits described in Section 8.2 of these rules. Based on the initial assessment described in Section 8.4.1 of these rules, the CIHCS Agency shall ensure that a written service plan is developed or amended as needed to address the consumer's pertinent diagnoses and needs. The service plan must include at minimum information on:

A) The consumer's physical and mental status;

B) The consumer's short and long-term health care needs and any goals, and time-frames for meeting those needs and goals;

C) A description of the out-of-hospital medical service[s] needed to address and satisfy the consumer's health-care needs and any non-medical goals;

D) The frequency of visits along with the projected number of visits that may be required to address the consumer's health care needs and any non-medical goals;

E) Identification of and written documentation setting forth the CIHCS Agency's coordination of services provided to the consumer, including non-medical related goal outcomes;

F) A description of any equipment needed;

G) Limitations on the consumer's activities; and

H) A goal for the consumer's discharge.

8.5.2 For recurrent services provided pursuant to Sections 8.3 and 8.5 of these rules the CIHCS Agency shall ensure that either the Agency medical director or the consumer's care provider evaluates the subsequent assessments submitted by the CIHCS providers pursuant to Section 8.4.2 of these rules, and shall re-review the service plan when there is a significant change of condition.

8.6Standards Governing Discharge

8.6.1 The Agency shall establish and follow a discharge planning process as set forth in Section 8.3.5 of these rules.

8.6.2 The CIHCS Agency shall develop a discharge summary for each consumer.

8.6.3 The discharge summary shall be discussed with the consumer or designated representative prior to discharge and shall include:

A) An evaluation of the post-CIHCS care needs and goals as outlined in the service plan, and a summary of the services the consumer received.

B) Contact information for the consumer to call in case the consumer has questions after discharge.

C) Written instructions about self-care, follow-up care, modified diet, medications, and signs and symptoms to be reported to the consumer's care provider(s).

6 CCR 1011-3-8

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