The operator must provide or arrange for services
appropriate to each registrant in accordance with the comprehensive assessment
conducted and comprehensive care plan developed by the adult day health care
program or by the managed care organization or care coordination model that
referred the registrant to the adult day health care program. The following
registrant services shall be provided on-site, as appropriate, to each registrant
in accordance with the individual's multidisciplinary assessment of needs and
comprehensive care plan:
(a) medical
services provided by the operator, which, without limiting its responsibility for
the operation and management of the program, must:
(1) assign to the operator's medical board,
medical advisory committee, medical director or consulting practitioner the
following responsibilities regarding registrants of the program:
(i) developing and amending clinical
policies;
(ii) supervising medical
services;
(iii) advising the operator
regarding medical and medically related problems;
(iv) establishing procedures for emergency
practitioner coverage, records and consultants; and
(v) establishing professional relationships
with other institutions and agencies, such as general hospitals, rehabilitation
centers, residential health care facilities, home health agencies, hospital
outpatient departments, clinics and laboratories;
(2) ensure that medical services, including
arranging for necessary consultation services, are provided to registrants of the
program in accordance with the registrant's managed care organization or care
coordination model;
(3) provide or
arrange for the personnel, staff or other designated practitioner to obtain a
medical history and a physical examination of each registrant, including
diagnostic laboratory and x-ray services, as medically indicated, within six
weeks before or seven days after admission to the program;
(4) ensure that the practitioner record, date
and authenticate significant findings of the medical history, physical
examination, diagnostic services, diagnoses and orders for treatment in the
registrant's clinical records;
(5)
ensure that orders for treatment include orders for medication, diet, permitted
level of physical activity and, when indicated, special orders or recommendations
for rehabilitative therapy services and other adult day health care
services;
(b) case
management services;
(c) food and
nutrition services provided by the operator, which must:
(1) provide meals and nutritional supplements,
including modified diets when medically prescribed, to registrants who are on the
premises at scheduled meal times and, where appropriate, to registrants in their
homes in accordance with the identified needs included in registrant
comprehensive care plans;
(2) ensure
that nutrition services are under the direction of a qualified dietitian;
(i) A qualified dietician is one who is
qualified based on:
(a) registration by the
Commission on Dietetic Registration of the American Diabetes
Association;
(b) education, training,
and experience in identification of dietary needs, planning, and implementation
of dietary program; or
(c)
certification as a certified dietician or certified nutritionist in accordance
with Article 157 of the Education Law;
(3) ensure that dietary service records for the
adult day health care service are maintained;
(d) social services provided by the operator
must:
(1) be under the supervision and direction
of a licensed clinical social worker;
(2) be provided through the use of a full or
part-time licensed mental health professional in conformance with the approved
application for operation and regular access may be directly with a master's
prepared or licensed mental health professional;
(3) either directly or through the managed care
organization or care coordination model that referred the registrant to the adult
day health care program, ensure that psychosocial needs are assessed, evaluated
and recorded, and that services are provided to meet the identified needs of the
registrant as part of the comprehensive care plan; and
(4) ensure that staff members arrange for the
use of and/or access to other community resources as needed and coordinate the
needs of the registrants with services provided by the adult day health care
program and other health care providers, community social agencies and other
resources; provided, however, with respect to registrants referred to the adult
day health care program by a managed care organization or care coordination
model, this shall be the responsibility of the managed care organization or care
coordination model.
(e)
assistance and/or supervision with activities of daily living, such as toileting,
feeding, ambulation, bathing including routine skin care, care of hair and nails,
and oral hygiene, and supervision and monitoring of personal safety, restorative
rehabilitative and maintenance therapy services, and instrumental activities of
daily living;
(f) rehabilitation
therapy services provided or arranged by the operator, either directly or through
the managed care organization or care coordination model that referred the
registrant to the adult day health care program, in conformance with the
registrant's needs identified during the comprehensive assessment;
(g) an activities program, provided by the
operator either directly or through the managed care organization or care
coordination model that referred the registrant to the adult day health care
program, which must involve community, interpersonal and self-care functions
appropriate and sufficient in scope to the needs and interests of each registrant
to sustain physical and psychosocial functioning and must:
(1) ensure that activities are an integral part
of the program and reflect the registrants' individual interests and cultural
backgrounds;
(2) ensure that
activities are designed to enhance registrant participation in the program, home
life and the community;
(3) involve
appropriate volunteers and volunteer groups in the program, unless prohibited by
law;
(4) provide sufficient equipment
and supplies for the operation of the activity program;
(5) provide or arrange for transportation to
and from community events and outings; and
(6) ensure that activities are included as part
of each registrant's comprehensive care plan;
(h) nursing services, provided by the operator,
directly or through the managed care organization or care coordination model that
referred the registrant to the adult day health care program, must be based on
the care needs of the registrant as specified in the comprehensive care plan and
be provided by a registered professional nurse. A licensed practical nurse,
acting within his or her lawful scope of practice under Title VIII of the
Education Law, may provide the on-site services when a registered professional
nurse is available at the sponsoring licensed facility to provide immediate
direction or consultation;
(1) in addition to
providing nursing services as specified in the registrant comprehensive care
plan, the operator must ensure that a registered professional nurse is available
to conduct sick call triage assessments to registrants presenting with new
problems or symptoms that result in consultation with the registrant's primary
care physician or the managed care organization in which the registrant is
enrolled or, as necessary, immediate transfer to an emergency
department;
(i) pastoral
counseling, either provided directly or arranged for by the operator;
(j) counseling for HIV risk
reduction;
(k) pharmaceutical
services;
(l) substance abuse
services;
(m) mental health and
psychiatric services;
(n) ancillary
services commensurate with the level of care delivered on-site; and
(o) referrals for dental services and
sub-specialty care that are in conformance with the needs identified during the
comprehensive assessment.