10.07.10.09

.09 Governing Authority.

A. The home health agency shall have a duly constituted governing body, or designated persons so functioning, with full legal authority, responsibility, and accountability for its operation.

B. Adoption of By-laws.

(1) The governing body shall adopt written by-laws, in accordance with applicable legal requirements, for the conduct of business by the home health agency.

(2) These by-laws shall include, at least the following:

(a) A statement of objectives; and

(b) An organizational structure by which agency policies and procedures are implemented.

(3) These by-laws shall be reviewed annually and revised as necessary.

C. The governing body shall appoint a home health agency administrator who shall be responsible for the overall management and fiscal operations of the agency.

D. The governing body shall designate a "professional advisory group" whose functions shall include, at least:

(1) To regularly review and advise on agency policies covering professional issues, including:

(a) Scope of services offered;

(b) Criteria for acceptance, discharge and/or rejection of patients;

(c) Appropriateness of medical supervision;

(d) Emergency care services to patients;

(e) Adequacy of system for maintaining clinical records;

(f) Adequacy of agency's review and evaluation program; and

(g) Mechanism for referrals and continuity of care with allied health care providers;

(2) To participate in the annual evaluation of the agency's programs.

E. The Professional Advisory Group shall meet at least three times each calendar year and shall keep documented minutes.

F. The governing body shall take appropriate actions on recommendations made by the professional advisory group. Complete documentation of recommendations made and actions taken shall be maintained.

G. The governing body shall assure that all services offered by the home health agency, whether directly or indirectly, are:

(1) Monitored and supervised by the parent agency; and

(2) When stipulated by a physician's order, provided to an individual within 24 hours after the physician refers the individual to the agency.

H. The home health agency shall establish a written contractual arrangement for the provision of all services which are not provided directly by the agency. At a minimum, the written contract shall:

(1) Designate the services which are to be provided, the setting and the geographical area served (services provided are to be within the scope and limitations set forth in the plan of treatment and may not be altered in type, amount, frequency, or duration, except in the case of adverse reaction, by the individual under contract);

(2) Describe how the contracted personnel are to be administratively or professionally supervised, or both;

(3) Describe how services will be controlled, coordinated, and evaluated by the parent agency;

(4) Describe the procedure for submitting clinical and progress notes, scheduling of visits, and periodic patient evaluations;

(5) Specify the charges for specific services provided under contract;

(6) Specify that only the parent agency shall bill for service and collect the applicable deductible or co-insurance payments;

(7) Specify the period of time that the contract shall be in effect and how frequently it shall be reviewed; the contract shall be reviewed at least annually and renewed when necessary;

(8) Insure that personnel and services contracted meet the requirements specified in these regulations for home health agency personnel and services, including licensure, personnel qualifications, physical examinations, functions, supervision, orientation, in-service education, and attendance at case conferences;

(9) Provide for the acceptance of patients for home health services only by the parent agency. Patients may not be admitted for home health service by a contracted individual without prior review of the case and acceptance of the patient by the home health agency in accordance with agency policies.