906 Kar 1:070. Networks

Link to law: http://www.lrc.ky.gov/kar/906/001/070.htm
Published: 2015

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      906 KAR 1:070.








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


      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


      (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


      (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


      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


      (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.)