Administrative Code

Virginia Administrative Code
1/27/2023

Part III. Skilled Services

12VAC5-381-300. Skilled services.

A. The organization shall provide a program of home health services that shall include one or more of the following:

1. Nursing services;

2. Physical therapy services;

3. Occupational therapy services;

4. Speech therapy services;

5. Respiratory therapy services; or

6. Medical social services.

B. All skilled services delivered shall be prescribed in a medical plan of care that contains at least the following information:

1. Diagnosis and prognosis;

2. Functional limitations;

3. Orders for all skilled services, including: (i) specific procedures, (ii) treatment modalities, and (iii) frequency and duration of the services ordered;

4. Orders for medications, when applicable; and

5. Orders for special dietary or nutritional needs, when applicable.

The medical plan of care shall be approved and signed by the client's primary care physician.

C. Verbal orders shall be documented within 24 consecutive hours in the client's record by the health care professional receiving the order and shall be countersigned by the prescribing person.

D. The primary care physician shall be notified immediately of any changes in the client's condition that indicates a need to alter the medical plan of care.

E. The medical plan of care shall be reviewed, approved, and signed by the primary care physician at least every 60 days.

F. There shall be a director of skilled services, who shall be a physician licensed by the Virginia Board of Medicine or a registered nurse, responsible for the overall direction and management of skilled services including the availability of services, the quality of services and appropriate staffing. The individual shall have the appropriate experience for the scope of services provided by the organization.

G. The organization shall develop and implement policies and procedures for the handling of drugs and biologicals, including procurement, storage, administration, self-administration, and disposal of drugs and shall allow clients to procure their medications from a pharmacy of their choice.

H. All prescription drugs shall be prescribed and properly dispensed to clients according to the provisions of Chapters 33 (§ 54.1-3300 et seq.) and 34 (§ 54.1-3400 et seq.) of Title 54.1 of the Code of Virginia and the regulations of the Virginia Board of Pharmacy, except for prescription drugs authorized by § 54.1-3408 of the Drug Control Act, such as epinephrine for emergency administration, normal saline and heparin flushes for the maintenance of IV lines, and adult immunizations, which may be given by a nurse pursuant to established protocol.

Statutory Authority

§§ 32.1-12 and 32.1-162.12 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 22, Issue 3, eff. January 1, 2006.

12VAC5-381-310. Nursing services.

A. All nursing services shall be directly provided by an appropriately qualified registered nurse or licensed practical nurse, except for those nursing tasks that may be delegated by a registered nurse according to 18VAC90-20-420 through 18VAC90-20-460 of the regulations of the Virginia Board of Nursing and with a plan developed and implemented by the organization.

B. Supervision of services shall be provided as often as necessary as determined by the client's needs, the assessment by the registered nurse, and the organization's written policies not to exceed 90 days.

Statutory Authority

§§ 32.1-12 and 32.1-162.12 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 22, Issue 3, eff. January 1, 2006.

12VAC5-381-320. Therapy services.

A. Physical therapy, occupational therapy, speech therapy, or respiratory therapy services shall be provided according to the medical plan of care by or under the direction of an appropriately qualified therapist currently licensed in Virginia and may include, but are not limited to:

1. Assessing client needs or admission for service as appropriate;

2. Implementing a medical plan of care and revising as necessary;

3. Initiating appropriate preventive, therapeutic, and rehabilitative techniques according to the medical plan of care;

4. Educating the client and family regarding treatment modalities and use of equipment and devices;

5. Providing consultation to other health care professionals;

6. Communicating with the physician and other health care professionals regarding changes in the client's needs;

7. Supervising therapy assistants and home attendants as appropriate; and

8. Preparing clinical notes.

B. Therapy assistants may be used to provide therapy services.

1. The occupational therapy assistant shall be currently certified by the National Board for Certification in Occupational Therapy and shall practice under the supervision of a licensed occupational therapist.

2. The physical therapy assistant shall be currently licensed by the Virginia Board of Physical Therapy and shall practice under the supervision of a licensed physical therapist.

C. Duties of therapy assistants shall be within their scope of practice and may include, but are not limited to:

1. Performing services planned, delegated, and supervised by the appropriately licensed therapist; and

2. Preparing clinical notes.

D. Supervision of services shall be provided as often as necessary as determined by the client's needs, the assessment of the licensed therapist, and the organization's written policies not to exceed 90 days.

Statutory Authority

§§ 32.1-12 and 32.1-162.12 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 22, Issue 3, eff. January 1, 2006.

12VAC5-381-330. Home attendants assisting with skilled services.

A. Home attendants assisting with providing skilled services may:

1. Assist clients with (i) activities of daily living, (ii) ambulation and prescribed exercise, and (iii) other special duties with appropriate training and demonstrated competency;

2. Administer normally self-administered drugs as allowed by § 54.1-3408 of the Virginia Drug Control Act (Chapter 34 (§ 54.1-3400 et seq.) of Title 54.1 of the Code of Virginia);

3. Measure and record fluid intake and output;

4. Take and record blood pressure, pulse and respiration;

5. Record and report to the appropriate health care professional changes in the client's condition;

6. Document services and observations in the client's record; and

7. Perform any other duties that the attendant is qualified to do by additional training and demonstrated competency as allowed by state or federal guidelines.

B. Prior to the initial delivery of services, the home attendant shall receive specific written instructions for the client's care from the appropriate health care professional responsible for the care.

C. Home attendants shall work under the supervision of the appropriate health care professional responsible for the client's care.

D. Relevant in-service education or training for home attendants shall consist of at least 12 hours annually. In-service training may be in conjunction with on-site supervision.

Statutory Authority

§§ 32.1-12 and 32.1-162.12 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 22, Issue 3, eff. January 1, 2006; amended, Virginia Register Volume 27, Issue 26, eff. September 29, 2011.

12VAC5-381-340. Medical social services.

A. Medical social services shall be provided according to the medical plan of care by or under the direction of a qualified social worker who holds, at a minimum, a bachelor's degree with major studies in social work, sociology, or psychology from a four-year college or university accredited by the Council on Social Work Education and has at least two years experience in case work or counseling in a health care or social services delivery system.

The organization shall have one year from January 1, 2006, to ensure the designated individual meets the qualifications of this standard.

B. The duties of a social worker may include, but are not limited to:

1. Assessing the client's psychological status;

2. Implementing a medical plan of care and revising, as necessary;

3. Providing social work services including (i) short-term individual counseling, (ii) community resource planning, and (iii) crisis intervention;

4. Providing consultation with the primary care physician and other health care professionals regarding changes in the client's needs;

5. Preparing notes on the care or services provided; and

6. Participating in discharge planning.

Statutory Authority

§§ 32.1-12 and 32.1-162.12 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 22, Issue 3, eff. January 1, 2006.

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