906 KAR 1:070.
Networks.
RELATES TO: KRS
216.900-216.915
STATUTORY
AUTHORITY: KRS 216.915
NECESSITY,
FUNCTION, AND CONFORMITY: KRS 216.915 mandates that the Cabinet for Human
Resources promulgate administrative regulations necessary to implement health
care delivery networks. This administrative regulation responds to provisions
of KRS 216.905 which requires obtaining a license from the cabinet before
operating or maintaining a network.
Section 1.
Licensing Issuance. (1) The network shall be licensed in accordance with 902
KAR 20:008.
(2) The network
shall designate a specific address to which the license shall be issued which
shall be the primary location. The licensee may also designate one (1)
extension per physician employed by the network to be included as a part of the
network's license.
Section 2.
Administration. (1) Policies. The network shall establish and follow written
administrative policies covering all aspects of operation, including:
(a) A
description of organizational structure, staffing and allocation of
responsibility and accountability;
(b) A
description of linkages with inpatient facilities and other providers;
(c) A written
program narrative describing in detail the service(s) offered, methods and
protocols for service delivery, qualifications of personnel involved in the
delivery of the services, and goals of the service(s);
(d) Procedures
to be followed relating to the storage, handling and administration of drugs
and biologicals;
(e) A
description of the process utilized by the network to evaluate the health care
needs of its community and the network's response to these needs; and
(f) A
description of how the network will assure twenty-four (24) hour seven (7) day
per week access to health care for its patients.
(2) Personnel.
(a) Medical
director. The network shall have a medical director who is a licensed physician
responsible for all medical aspects of the network.
(b) Staffing
requirements.
1. The number of
personnel required shall be based on: the number of patients, amount and type
of care provided, program needed to meet the needs of patients as determined by
the definitions of care and services required by this administrative regulation
and the statutes relating to networks.
2. There shall
be written personnel policies which are made available to all employees.
(c) There shall
be a written job description for each position which shall be reviewed and
revised as necessary.
(d) Current
personnel records shall be maintained for each employee which include the following:
1. Name, address
and Social Security number;
2. Evidence of
current registration, certification or licensure of personnel;
3. Records of
training and experience; and
4. Records of
performance evaluation.
(3) In-service
training. All personnel shall participate in ongoing in-service training
programs relating to their respective job activities. Training shall include a
thorough job orientation for new employees.
(4) Medical
records.
(a) The network
shall maintain medical records in the problem-oriented format and shall contain
the following:
1. Medical or
social history relevant to the services provided including data obtainable from
other providers;
2. Name of
referring physician, and any orders for special diagnostic services;
3. Description
of each medical visit or contact, to include condition or reason necessitating
visit or contact, assessment, diagnosis, services provided, medications and
treatments prescribed, medical personnel involved and disposition made;
4. Reports of
all physical examinations, laboratory and other test findings relevant to the
services provided; and
5. Documentation
of all referrals made, including reason for referral, to whom patient was
referred, and any information obtained from referral source.
(b) Confidentiality
of all patient records shall be maintained at all times.
(c) Transfer of
records. The network shall establish systematic procedures to assist in
continuity of care where the patient moves to another source of care, and the
network shall, upon proper release, transfer medical records or an abstract
thereof when requested.
(d) Retention of
records. After patient's death or discharge the completed medical record shall
be placed in an inactive file and retained for five (5) years or in case of a
minor, three (3) years after the patient reaches the age of majority under
state law, whichever is longer.
(e) A specific
location shall be designated by the network for the storage and maintenance of
medical records.
(f) Provision
shall be made for written designation of a specific location for the storage of
medical records in the event the network ceases to operate. The licensee shall
safeguard the record and its content against loss, defacement and tampering.
Section 3.
Provision of Services. (1) Equipment used for direct patient care by a network
shall comply with the following:
(a) The licensee
shall establish and follow a written preventive maintenance program to ensure
that equipment shall be operative and properly calibrated;
(b) All
personnel engaged in the operation of diagnostic equipment shall have adequate
training and be currently licensed, registered or certified in accordance with
applicable state statutes and administrative regulations; and
(c) There shall
be a written training plan for the adequate training of personnel in the safe
and proper usage of the equipment.
(2) Diagnostic
services shall be performed in accordance with the network's protocol, and
developed by the medical director. Examination services shall be provided in a
manner which ensures the greatest amount of safety and security for the
patient.
(3) Treatment
services shall be performed in accordance with the network's protocols.
(a) The work
shall have a written description of the services the network provides directly
and those provided through agreement;
(b) The network
shall develop and maintain written protocols (i.e. standing orders, rules of
practice, and medical directives) which apply to services provided by the
network and which explicitly direct the step-by-step collection of subjective
and objective data from the patient. The protocols shall further direct data
analysis, direct explicit medical action depending upon the data collected, and
include rationale for each decision made.
(c) If the
network dispenses medication, each dose of medication given, and the name and
qualifications of the personnel who gave the medication, shall be recorded in
the patient's record.
(4) Quality
assurance and annual evaluation.
(a) The network
shall carry out, or arrange for an annual evaluation of its total program,
shall consider the findings of the evaluation, and take corrective action, if
necessary. The evaluation shall include:
1. The
utilization of network's services including at least the number of patients
served and the volume of services;
2. A
representative sample of both active and closed clinical records; and
3. The networks
health care policies.
(b) Quality
assurance program. The network shall have a written quality assurance plan
designed to ensure that there is an ongoing quality assurance program that
includes effective mechanisms for reviewing and evaluating patient care, and
that provides for appropriate response to findings. The written quality
assurance plan shall be approved by the board and the licensee and shall:
1. Assign
responsibility for the monitoring and evaluation activities;
2. Delineate
scope of care provided by the network;
3. Identify the
aspects of care that the network provides;
4. Identify
indicators (and appropriate clinical criteria) that can be used to monitor
these aspects of care;
5. Establish
thresholds for the indicators at which further evaluation of the care is
triggered;
6. Collect and
organize the date for each indicator;
7. Evaluate the
care when the thresholds are reached in order to identify problems or
opportunities to improve care;
8. Take actions
to correct identified problems or to improve care;
9. Assess the
effectiveness of the actions and document the improvement in care; and
10. Communicate
relevant information to other individuals, departments, or services as to the
network wide quality assurance program.
Section 4.
Housekeeping and Maintenance Services. (1) Housekeeping. The clinic shall
maintain a clean and safe facility free of unpleasant odors. Odors shall be
eliminated at their source by prompt and thorough cleaning of commodes,
urinals, bedpans and other sources.
(2) Maintenance.
The premises shall be well kept and in good repair. Requirements shall include:
(a) The network
shall insure that the grounds are well kept and the exterior of the building,
including the sidewalks, steps, porches, ramps, and fences are in good repair;
(b) The interior
of the building including walls, ceilings, floors, windows, window coverings,
doors, plumbing and electrical fixtures shall be in good repair. Windows and
doors which can be opened for ventilation shall be screened;
(c) Garbage and
trash shall be removed from the premises regularly. Containers shall be cleaned
regularly;
(d) A pest
control program shall be in operation in the clinic. Pest control services
shall be provided by maintenance personnel of the facility or by contract with
a pest control company. The compounds shall be stored under lock. (17 Ky.R.
2130; eff. 1-23-91.)
