As a condition of enrollment in adult day health care program, a participant must obtain a written physician order for enrollment. Each participant must remain under the care of a physician.
(a)Physician supervision. The program management must ensure that—
(1) The medical care of each participant is supervised by a primary care physician;
(2) Each participant's medical record must contain the name of the participant's primary physician; and
(3) Another physician is available to supervise the medical care of participants when their primary physician is unavailable.
(b)Frequency of physician reviews.
(1) The participant must be seen by the primary physician at least annually and as indicated by a change of condition.
(2) The program management must have a policy to help ensure that adequate medical services are provided to the participant.
(3) At the option of the primary physician, required reviews in the program after the initial review may alternate between personal physician reviews and reviews by a physician assistant, nurse practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section.
(c)Availability of acute care. The program management must provide or arrange for the provision of acute care when it is indicated.
(d)Availability of physicians for emergency care. In case of an emergency, the program management must provide or arrange for the provision of physician services when the program has participants under its care.
(e)Physician delegation of tasks.
(1) A primary physician may delegate tasks to:
(i) A certified physician assistant or a certified nurse practitioner, or
(ii) A clinical nurse specialist who—
(A) Is acting within the scope of practice as defined by State law; and
(B) Is under the supervision of the physician.
(2) The primary physician may not delegate a task when the provisions of this part specify that the primary physician must perform it personally, or when the delegation is prohibited under State law or by the facility's own policies.