42 CFR § 484.75

§ 484.75 Condition of participation: Skilled professional services.

This regulation establishes conditions of participation for skilled professional services provided by Home Health Agencies (HHAs), covering skilled nursing, physical therapy, speech-language pathology, occupational therapy, physician/practitioner services, and medical social work. Skilled professionals must be appropriately qualified, authorized, and supervised, and must fulfill responsibilities including patient assessment, care plan development, clinical documentation, and participation in QAPI and in-service training. Supervision requirements are specified for nursing assistants, rehabilitative therapy assistants, and medical social service staff.

§ 484.75 Condition of participation: Skilled professional services.

Skilled professional services include skilled nursing services, physical therapy, speech-language pathology services, and occupational therapy, as specified in § 409.44 of this chapter, and physician or allowed practitioner and medical social work services as specified in § 409.45 of this chapter. Skilled professionals who provide services to HHA patients directly or under arrangement must participate in the coordination of care.

(a) 
Standard: Provision of services by skilled professionals.
 Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under § 484.115 and who practice according to the HHA's policies and procedures.

(b) 
Standard: Responsibilities of skilled professionals.
 Skilled professionals must assume responsibility for, but not be restricted to, the following:

(1) Ongoing interdisciplinary assessment of the patient;

(2) Development and evaluation of the plan of care in partnership with the patient, representative (if any), and caregiver(s);

(3) Providing services that are ordered by the physician or allowed practitioner as indicated in the plan of care;

(4) Patient, caregiver, and family counseling;

(5) Patient and caregiver education;

(6) Preparing clinical notes;

(7) Communication with all physicians involved in the plan of care and other health care practitioners (as appropriate) related to the current plan of care;

(8) Participation in the HHA's QAPI program; and

(9) Participation in HHA-sponsored in-service training.

(c) 
Supervision of skilled professional assistants.
 (1) Nursing services are provided under the supervision of a registered nurse that meets the requirements of § 484.115(k).

(2) Rehabilitative therapy services are provided under the supervision of an occupational therapist or physical therapist that meets the requirements of § 484.115(f) or (h), respectively.

(3) Medical social services are provided under the supervision of a social worker that meets the requirements of § 484.115(m).

[82 FR 4578, Jan. 13, 2017, as amended at 85 FR 27628, May 8, 2020]