(1) Each
resident in a nursing facility shall designate a licensed physician who may be
called when needed. Professional management of a resident's care shall be the
responsibility of the hospice program when:
a.
The resident is terminally ill, and
b. The resident has elected to receive
hospice services under the federal Medicare program from a Medicare-certified
hospice program, and
c. The
facility and the hospice program have entered into a written agreement under
which the hospice program takes full responsibility for the professional
management of hospice care.
(2) Each resident admitted to a nursing
facility shall have had a physical examination prior to admission. If the
resident is admitted directly from a hospital, a copy of the hospital admission
physical and discharge summary may be made part of the record in lieu of an
additional physical examination. A record of the examination, signed by the
physician or other qualifying health care practitioner, shall be a part of the
resident's record. (III)
(3)
Arrangements shall be made to have a physician available to furnish medical
care in case of emergency. (II, III)
(4) Rescinded, effective 7/14/82.
(5) The person in charge shall immediately
notify the physician of any accident, injury, or adverse change in the
resident's condition. (I, II, III)
(6) A schedule listing the names and
telephone numbers of the physicians shall be readily available to nursing
staff. (III)
(7) Residents shall be
admitted to a nursing facility only on a written order signed by a physician
certifying that the individual being admitted requires no greater degree of
nursing care than the facility is licensed to provide. (III)
(8) Physician delegation of tasks. Each
resident, including private pay residents, shall be visited by or shall visit
the resident's physician at least twice a year. The year period shall be
measured from the date of admission and is not to include preadmission
physicals.
a. For a skilled nursing patient,
the resident must be seen by a physician for the initial comprehensive visit.
Additional visits are required at least once every 30 days for 90 days after
admission and at least once every 60 days thereafter. After the initial
comprehensive visit, alternate required visits may be performed by an advanced
registered nurse practitioner, clinical nurse specialist or physician assistant
who is working in collaboration with a physician, as outlined in Table 1.
(III)
b. Notwithstanding the
provisions of 42 CFR
483.40, any required physician task or visit
in a nursing facility may also be performed by an advanced registered nurse
practitioner, clinical nurse specialist, or physician assistant who is working
in collaboration with a physician, as outlined in Table 1. (III)
c. In dually certified skilled
nursing/nursing facilities, the advanced registered nurse practitioner,
clinical nurse specialist, and physician assistant must follow the skilled
nursing facility requirements for services for skilled nursing facility stays.
For nursing facility stays in skilled nursing/nursing facilities, any required
physician task or visit may be performed by an advanced registered nurse
practitioner, clinical nurse specialist, or physician assistant working in
collaboration with the physician. (III)
d. Nurse practitioners, clinical nurse
specialists, and physician assistants may perform other tasks that are not
reserved to the physician such as visits outside the normal schedule needed to
address new symptoms or other changes in medical status. (III)
Table 1: Authority for non-physician practitioners to perform
visits, sign orders, and sign certifications/recertifications when permitted by
state law*
|
Initial Comprehensive
Visit/Orders
|
Other Required
Visits1
|
Other Medically Necessary Visits and
Orders2
|
Certification/ Recertification
|
Skilled Nursing Facilities
|
Physician assistant, nurse practitioner and clinical
nurse specialist employed by the facility
|
May not perform/May not sign
|
May perform alternate visits
|
May perform and sign
|
May not sign
|
Physician assistant, nurse practitioner and clinical
nurse specialist not a facility employee
|
May not perform/May not sign
|
May perform alternate visits
|
May perform and sign
|
May sign subject to state requirements
|
|
Initial Comprehensive
Visit/Orders
|
Other Required
Visits1
|
Other Medically Necessary Visits and
Orders2
|
Certification/ Recertification
|
Nursing Facilities
|
Nurse practitioner, clinical nurse specialist, and
physician assistant employed by the facility
|
May not perform/May not sign
|
May not perform
|
May perform and sign
|
Not applicable+
|
Nurse practitioner, clinical nurse specialist, and
physician assistant not a facility employee
|
May perform/May sign
|
May perform
|
May perform and sign
|
Not applicable+
|
*As permitted by state law governing the scope and practice
of nurse practitioners, clinical nurse specialists, and physician
assistants.
1Other required visits include the
skilled nursing resident monthly visits that may be alternated between
physician and advanced registered nurse practitioners, clinical nurse
specialists, or physician assistants after the initial comprehensive visit is
completed.
2Medically necessary visits may be
performed prior to the initial comprehensive visit.
+This requirement relates
specifically to coverage of Part A Medicare stays, which can take place only in
a Medicare-certified skilled nursing facility.
Notes
Iowa Admin. Code
r. 481-58.14
ARC 1048C, IAB 10/2/2013,
effective 11/6/2013; ARC 1398C, IAB 4/2/2014, effective 5/7/2014
Amended by
IAB
May 31, 2023/Volume XLV, Number 24, effective
7/5/2023