Tenn. Comp. R. & Regs. 0720-30-.01 - DEFINITIONS

(1) Abuse. The willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish.

(2) Administrator. A person who:

(a) Is a licensed physician with at least one (1) year of supervisory or administrative experience in home health care, hospice care or related health programs; or

(b) Is a registered nurse with at least one (1) year of supervisory or administrative experience in home health care, hospice care or related health programs; or

(c) Has training and experience in health service administration and at least one (1) year of supervisory or administrative experience in home health care, hospice care or related health programs.

(3) Advance Directive. A written statement such as a living will, a durable power of attorney for health care or a do not resuscitate order relating to the provision of health care when the individual is incapacitated.

(4) Agency. A home care organization providing home medical equipment.

(5) Assistive Technology Practitioner (ATP). Service providers primarily involved in evaluating the consumer's needs and training in the use of a prescribed wheeled mobility device.

(6) Assistive Technology Supplier (ATS). Service providers involved in the sale and service of commercially available wheeled mobility devices.

(7) Board. The Tennessee Board for Licensing Health Care Facilities.

(8) Cardiopulmonary Resuscitation (CPR). The administering of any means or device to support cardiopulmonary functions in a patient, whether by mechanical devices, chest compressions, mouth-to-mouth resuscitation, cardiac massage, tracheal intubation, manual or mechanical ventilations or respirations, defibrillation, the administration of drugs and/or chemical agents intended to restore cardiac and/or respiratory functions in a patient where cardiac or respiratory arrest has occurred or is believed to be imminent.

(9) Clinical Note. A written and dated notation containing a patient assessment, responses to medications, treatments, services, any changes in condition and signed by a health team member who made contact with the patient.

(10) Commissioner. The Commissioner of the Tennessee Department of Health or his or her authorized representative.

(11) Competent. For the purpose of this chapter only, a patient who has decision-making capacity.

(12) Contact Person. The individual selected by the agency who will serve as the point-of-contact to communicate with the Health Facilities Commission. The agency must provide a name, title, telephone number, and electronic mail address of the contact person on the appropriate form.

(13) Decision-making Capacity. Decision-making capacity is shown by the fact that the person is able to understand the proposed procedure, its risks and benefits, and the available alternative procedures.

(14) Department. The Tennessee Department of Health.

(15) Do-Not-Resuscitate Order (DNR). A written order, other than a POST, not to resuscitate a patient in cardiac or respiratory arrest in accordance with accepted medical practices.

(16) Evaluation. The determination and documentation of the physiological and functional factors that impact the selection of an appropriate seating and wheeled mobility device.

(17) Hazardous Waste. Materials whose handling, use, storage and disposal are governed by local, state or federal regulations.

(18) Health Care Decision. A decision made by an individual or the individual's health care decision-maker, regarding the individual's health care including but not limited to:

(a) The selection and discharge of health care providers and institutions;

(b) Approval or disapproval of diagnostic tests, surgical procedures, programs of administration of medication, and orders not to resuscitate;

(c) Directions to provide, withhold or withdraw artificial nutrition and hydration and all other forms of health care; and

(d) Transfer to other health care facilities.

(19) Health Care Decision-maker. In the case of an incompetent patient, or a patient who lacks decision-making capacity, the patient's health care decision-maker is one of the following: the patient's health care agent as specified in an advance directive, the patient's court-appointed legal guardian or conservator with health care decision-making authority, or the patient's surrogate as determined pursuant to Rule 0720-30-.13 or T.C.A. § 33-3-220.

(20) Home Care Organization. As defined by T.C.A. § 68-11-201, a "home care organization" provides home health services, home medical equipment services or hospice services to patients on an outpatient basis in either their regular or temporary place of residence.

(21) Home Medical Equipment.

(a) Medical equipment intended for use by the consumer including, but not limited to the following:

1. A device, instrument, apparatus, machine, or other similar article whose label bears the statement: "Caution: Federal law requires dispensing by or on the order of a physician.";

2. Ambulating assistance equipment;

3. Mobility equipment;

4. Rehabilitation seating;

5. Oxygen care equipment and oxygen delivery systems;

6. Respiratory care equipment and respiratory disease management devices;

7. Rehabilitation environmental control equipment;

8. Ventilators;

9. Apnea monitors;

10. Diagnostic equipment;

11. Feeding pumps;

12. A bed prescribed by a physician to treat or alleviate a medical condition;

13. Transcutaneous electrical nerve stimulator;

14. Sequential compression devices; and

15. Neonatal home phototherapy devices.

(b) Home medical equipment does not include:

1. Medical equipment used or dispensed in the normal course of treating patients by hospitals and nursing facilities as defined in this part, other than medical equipment delivered or dispensed by a separate unit or subsidiary corporation of a hospital or nursing facility or agency that is in the business of delivering home medical equipment to an individual's residence;

2. Upper and lower extremity prosthetics and related orthotics;

3. Canes, crutches, walkers, and bathtub grab bars;

4. Medical equipment provided through a physician's office incident to a physician's service;

5. Equipment provided by a pharmacist which is used to administer drugs or medicine that can be dispensed only by a pharmacist; or

6. Enteral and parenteral equipment provided by a pharmacist.

(22) Home Medical Equipment Provider. Any agency which provides home medical equipment services.

(a) Providers may fall into the following categories:

1. In-state providers who have a physical location;

2. In-state providers who have no physical location;

3. Out-of-state providers who do not have a physical location; or

4. Mail order companies.

(b) Providers who do not have a physical location must comply with survey requirements and provide access and documentation to surveyors necessary to conduct a survey.

(c) Designation on whether or not an agency has a physical location shall be located on the agency's wall certificate.

(23) Home Medical Equipment Services. A service provided by any person who sells or rents home medical equipment for delivery to the consumer's place of residence in this state, regardless of the location of the home medical equipment provider.

(24) Incompetent. A patient who has been adjudicated incompetent by a court of competent jurisdiction and has not been restored to legal capacity.

(25) Infectious Waste. Solid or liquid wastes which contain pathogens with sufficient virulence and quantity such that exposure to the waste by a susceptible host could result in an infectious disease.

(26) Lacks Decision-making Capacity. Lacks Decision-making Capacity means the factual demonstration by the attending physician and the medical director, or the attending physician and another physician that an individual is unable to understand:

(a) A proposed health care procedure(s), treatment(s), intervention(s), or interaction(s);

(b) The risks and benefits of such procedure(s), treatment(s), intervention(s) or interaction(s); and

(c) The risks and benefits of any available alternative(s) to the proposed procedure(s), treatment(s), intervention(s) or interaction(s).

(27) Legal Conservator. Any person authorized to act for the patient pursuant to any provision of T.C.A. Title 34, Chapters 5 and 11 through 13.

(28) Legal Guardian. Any person authorized to act for the resident pursuant to any provision of T.C.A. §§ 34-5-102(4) or 34-11-101, or any successor statute thereto.

(29) Licensee. The person or entity to whom the license is issued. The licensee is held responsible for compliance with all rules and regulations.

(30) Licensed Practical Nurse. A person currently licensed as such by the Tennessee Board of Nursing.

(31) Life Threatening or Serious Injury. Injury requiring the patient to undergo significant additional diagnostic or treatment measures.

(32) Mail Order Company. A company which lists its products for consumers to buy, rent or lease via telephone, mailed check with order form, or Internet order and delivers such products directly to the consumer via a postal service, such as the U.S. Postal Service (USPS), UPS, FedEx or another courier service; provided, however, that a company that supplies respiratory care and oxygen equipment or any other home medical equipment necessary to avert an immediate threat to a consumer's health or safety, without which a consumer might be required to seek emergency medical treatment, shall not be considered to be a mail order company for purposes of this rule.

(33) Medical Record. Information that pertains to confinement or services rendered to patients, including one or more of the following:

(a) Medical histories;

(b) Records;

(c) Reports;

(d) Clinical notes;

(e) Summaries; or

(f) Orders.

If the patient does not require any clinical services from the home medical equipment company, the medical record will consist of the physician order only.

(34) Medical Futile Treatment. Resuscitation efforts that cannot be expected either to restore cardiac or respiratory function to the patient or to achieve the expressed goals of the informed patient. In the case of the incompetent patient, the surrogate expresses the goals of the patient.

(35) Misappropriation of Patient/Resident Property. The deliberate misplacement, exploitation or wrongful, temporary or permanent use of an individual's belongings or money without the individual's consent.

(36) Neglect. The failure to provide goods and services necessary to avoid physical harm, mental anguish or mental illness; however, the withholding of authorization for or provision of medical care to any terminally ill person who has executed an irrevocable living will in accordance with the Tennessee Right to Natural Death Law, or other applicable state law, if the provision of such medical care would conflict with the terms of the living will, shall not be deemed "neglect" for purposes of these rules.

(37) Patient. Includes but is not limited to any person who is suffering from an acute or chronic illness or injury or who is crippled, convalescent or infirm, or who is in need of obstetrical, surgical, medical, nursing or supervisory care.

(38) Physician. A person currently licensed as such by the Tennessee Board of Medical Examiners or currently licensed by the Tennessee Board of Osteopathic Examination. For the purpose of this chapter only, a physician who is licensed to practice medicine or osteopathy in a state contiguous to Tennessee, who has previously provided treatment to the patient and has an ongoing physician-patient relationship with the patient for whom a referral is to be made, may refer a patient residing in this state to a home care organization providing hospice services duly licensed under this chapter. This shall not be construed as authorizing an unlicensed physician to practice medicine in violation of T.C.A. §§ 63-6-201 or 63-9-104.

(39) Physician Assistant. A person who has graduated from a physician assistant educational program accredited by the Accreditation Review Commission on Education for the Physician Assistant, has passed the Physician Assistant National Certifying Examination, and is currently licensed in Tennessee as a physician assistant under Title 63, Chapter 19.

(40) Qualified Rehabilitation Professional. A health care professional within the professional's scope of practice licensed under Title 63; or an individual who has appropriately obtained the designation of ATS or ATP, meeting all requirements thereof, as established by the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA).

(41) Registered Nurse. A person currently licensed as such by the Tennessee Board of Nursing.

(42) Shall or Must. Compliance is mandatory.

(43) Supervision. Authoritative procedural guidance by a qualified person for the accomplishment of a function or activity with initial direction and periodic inspection of the actual act of accomplishing the function or activity. Periodic supervision must be provided if the person is not a licensed or certified assistant, unless otherwise provided in accordance with these rules.

(44) Surrogate. The patient's conservator, or if none, a competent adult most likely to know the wishes of the patient with respect to the possible withholding of resuscitative services or withdrawal of resuscitative services.

(45) Survey Material. Survey material is any material stored in electronic or physical format that may be necessary to conduct a survey. The survey material includes, but is not limited to, personnel files, patient medical records, policies and procedures, data, background checks, abuse registry checks, facility reported incidents, litigation and bankruptcy history, current licensure status, copies of investigations, discipline records in any other state in which the provider is licensed, and video records or files, if available.

(46) Wheeled Mobility Device. A wheelchair or wheelchair and seated positioning system prescribed by a physician and required for use by the patient for a period of six (6) months or more. The following Medicare wheelchairs base codes are exempt: K0001, K0002, K0003, K0004, K0006, and K0007 as long as the consumer weighs less than three hundred (300) pounds.

Notes

Tenn. Comp. R. & Regs. 0720-30-.01

Original rule filed August 24, 2000; effective November 7, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Amendment filed April 28, 2003; effective July 12, 2003. Amendment filed May 27, 2004; effective August 10, 2004. Amendment filed June 25, 2007; effective September 8, 2007. Amendment filed October 11, 2007; effective December 25, 2007. Amendments filed December 23, 2009; effective March 23, 2010. Amendment filed January 3, 2012; effective April 2, 2012. Amendment filed March 27, 2015; effective June 25, 2015. Amendments filed January 7, 2019; to have become effective April 7, 2019. However, the Government Operations Committee filed a 60-day stay of the effective date of the rules; new effective date June 6, 2019. Transferred from chapter 1200-08-29 pursuant to Public Chapter 1119 of 2022 effective July 1, 2022. Emergency rules filed June 26, 2023; effective through December 23, 2023. Emergency rules expired effective December 24, 2023, and the rules reverted to their previous statuses. Amendments filed March 4, 2024; effective 6/2/2024.

Authority: T.C.A. §§ 4-5-202, 4-5-204, 68-11-201, 68-11-202, 68-11-204, 68-11-207, 68-11-209, 68-11-210, 68-11-211, 68-11-213, 68-11-224, 68-11-226, 68-11-268, and 68-11-303.