(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(4) Rescinded,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
