42 CFR 484.105 — Condition of Participation: Organization and Administration of Services

What this rule requires your agency to do

• 1The HHA must develop, implement, and annually review a patient acceptance-to-service policy applied consistently to each prospective patient (addressing anticipated needs, case load/mix, staffing levels, and staff skills/competencies), and must make available to the public accurate information on services offered and limitations, reviewed no less often than annually (subd. i).(42 CFR 484.105 — Condition of Participation: Organization and Administration of Services)
• 2The HHA must have a written agreement for any services furnished under arrangement, maintain overall responsibility for those services, and ensure the contracted entity/individual has not been denied Medicare/Medicaid enrollment, excluded or terminated from a federal health care program, had billing privileges revoked, or been debarred from a government program (subd. e).(42 CFR 484.105 — Condition of Participation: Organization and Administration of Services)
• 3The HHA must make available skilled nursing and at least one other therapeutic service on a visiting basis, provide at least one service directly, and provide all services in accordance with current clinical practice guidelines and accepted professional standards of practice (subd. f).(42 CFR 484.105 — Condition of Participation: Organization and Administration of Services)
• 4The HHA must organize, manage, and administer its resources to attain the highest practicable functional capacity for each patient, must not delegate administrative and supervisory functions to another agency, must monitor and control all services not furnished directly, and must set forth in writing its organizational structure, lines of authority, and services furnished (introductory paragraph).(42 CFR 484.105 — Condition of Participation: Organization and Administration of Services)
• 5One or more qualified clinical managers must provide oversight of all patient care services and personnel, including making patient/personnel assignments, coordinating patient care and referrals, assuring patient needs are continually assessed, and assuring development, implementation, and updates of the individualized plan of care (subd. c).(42 CFR 484.105 — Condition of Participation: Organization and Administration of Services)
• 6The parent HHA must report all branch locations to the state survey agency at initial certification, at each survey, and when adding or deleting a branch, and must provide direct support and administrative control of its branches (subd. d).(42 CFR 484.105 — Condition of Participation: Organization and Administration of Services)
• 7A governing body (or designated persons so functioning) must assume full legal authority and responsibility for the agency's overall management and operation, provision of all home health services, fiscal operations, review of the budget and operational plans, and the quality assessment and performance improvement program (subd. a).(42 CFR 484.105 — Condition of Participation: Organization and Administration of Services)
• 8The administrator must be appointed by and report to the governing body, be responsible for day-to-day operations, ensure a clinical manager is available during all operating hours, and ensure the HHA employs qualified personnel; when unavailable, a pre-designated person authorized in writing assumes the same responsibilities, and the administrator or pre-designated person is available during all operating hours (subd. b).(42 CFR 484.105 — Condition of Participation: Organization and Administration of Services)