This regulation establishes licensing and operating standards for home health agencies in Alaska, covering governance, administration, staffing, clinical services (skilled nursing, therapy, home health aide, medical social work, nutrition, infusion therapy), quality improvement, patient rights, clinical records, and abuse/neglect prevention. Home health agencies must provide skilled nursing plus at least one additional therapeutic service, develop individualized plans of care, and maintain comprehensive clinical records. Agencies are subject to annual surveys and must exclude patients residing in hospitals or nursing facilities.
View official source7 AAC 12.500. Scope. A public or private entity that is primarily engaged in the provision of skilled nursing care and therapeutic services, but not the treatment of mental illness, in a patient's home is a home health agency, and must comply with 7 AAC 12.500 - 7 AAC 12.590 . 7 AAC 12.503. Surveys. (a) The department will survey each home health agency and each subunit of a home health agency at least annually to determine compliance with 7 AAC 12.500 - 7 AAC 12.590 . (b) All records of a home health agency and its subunits must be available for inspection during regular business hours to representatives of the department without prior notice of the inspection. (c) The department will review complaints made against a home health agency. 7 AAC 12.505. Home health agency services. (a) A home health agency must provide skilled nursing services and at least one of the following additional services: (1) physical therapy; (2) occupational therapy; (3) speech therapy; or (4) home health aide services. (b) A home health agency may provide additional services designed to maintain, improve, or restore a physical or mental condition. Additional services must be provided in accordance with generally accepted professional standards and identified in a plan of care established under 7 AAC 12.513 . Additional services may include (1) nursing care under the supervision of a registered nurse; (2) physical, occupational, speech, or respiratory therapy; (3) medical social services; (4) nutrition counseling; (5) home health aide services; (6) personal care services; and (7) medical supplies, other than drugs and biologicals, and the use of medical appliances. 7 AAC 12.507. Governing body. (a) A home health agency must be organized under a governing body that assumes full legal authority and fiscal responsibility for the conduct of the agency. (b) The governing body shall (1) appoint a qualified administrator and regularly monitor the performance of the administrator; (2) appoint a professional advisory committee as required under 7 AAC 12.508 ; (3) adopt written by-laws, policies, and procedures; (4) provide adequate staff, equipment, and supplies for the agency; (5) cooperate in establishing a system by which to coordinate and provide continuity of care within the community; and (6) ensure an annual program evaluation and act upon the evaluation findings. (c) The governing body shall provide for systematic and effective communication between the governing body and the administrator of the home health agency. 7 AAC 12.508. Professional advisory committee. (a) The governing body of a home health agency shall appoint a professional advisory committee that meets as frequently as needed to advise and monitor the agency and report its findings to the governing body. The committee must consist of (1) the agency administrator; (2) a physician; (3) a registered nurse; (4) a consumer who is not an owner or employee of the agency; and (5) at least one representative from one of the patient care services provided by the agency. (b) At least annually the professional advisory committee shall conduct an overall program evaluation of the agency and forward the results of that evaluation in writing to the governing body of the home health agency. The program evaluation must include a review of the (1) agency's policies and procedures governing the scope of services offered, including (A) acceptance and discharge; (B) medical supervision; (C) plans of care; (D) emergency care; (E) clinical records; (F) personnel qualifications; (G) agency administrative practices; (H) the quality improvement program; and (I) other relevant professional issues; and (2) results of quality improvement activities conducted under 7 AAC 12.512 , including clinical record reviews. (c) The home health agency shall document the professional advisory committee's involvement and communication with the governing body and the administrator of the home health agency. (d) The professional advisory committee shall maintain each agency review as a separate administrative record. 7 AAC 12.510. Home health agency administration. (a) A home health agency shall describe in writing the services provided by the agency, who has administrative control over those services, and the lines of authority for the delegation of responsibility to the patient care level. Administrative and supervisory functions may not be delegated to another agency, individual, or organization. (b) All services provided through contractual arrangements must be monitored and controlled by the agency. (c) The administrator must be an individual who has education, experience, and knowledge related to home health service and at least one year overall administrative experience in home health care or a related home health program appropriate to the fulfillment of the position's responsibilities. (d) The administrator shall (1) have authority and responsibility for the management of the business affairs and overall operation of the agency; (2) organize and direct the agency's ongoing functions; (3) maintain liaison between the governing body, the professional advisory committee, and the staff; (4) report to the governing body at least annually on agency operations; (5) employ qualified personnel and ensure adequate continuing education and evaluation of that staff; (6) designate a director of clinical services; (7) ensure the involvement of the director of clinical services in all decisions regarding employees and contract staff; (8) designate, in writing, a qualified person to act in the absence of the administrator; (9) evaluate the recommendations of agency committees and consultants; and (10) ensure the home health agency has an institutional budget plan that includes and annual operating budget and a capital expenditure plan for a prospective three-year period. 7 AAC 12.512. Quality improvement. (a) A home health agency shall have a quality improvement program to assess the extent to which the agency's program is appropriate, effective, and efficient. The quality improvement program must include an analysis of: (1) a quarterly clinical record review; (2) quality indicator data derived from patient assessments; (3) current clinical practice guidelines and professional practice standards applicable to patients in the home; (4) utilization data; (5) measures of staff performance; (6) medical and other professional evaluation of the home health agency's care giving system; (7) patient satisfaction surveys; and (8) patient complaints and the resolution process. (b) The quality improvement program must include problem identification, corrective action, and follow-up monitoring of identified problems. (c) A home health agency shall review a patient's clinical record for each 62-day period that a patient receives home health services to determine adequacy of the plan of care and appropriateness of continued care. (d) The quarterly clinical review required by (a) of this section must be conducted by a multidisciplinary team of health professionals representing the services provided by the agency. The review must consist of at least 10 percent of both active and closed records in that quarter to determine if state and federal laws and agency policies are followed in providing services by employees or contractors of the agency. (e) A home health agency shall take whatever corrective action is necessary in response to the findings of the quality improvement program. 7 AAC 12.513. Plan of care. (a) A home health agency shall, in consultation with the patient and the patient's attending physician, advanced practice registered nurse, or physician assistant, develop a plan of care for each patient accepted by the agency. The plan of care must (1) be reviewed, as often as the patient's condition requires but at least every 62 days, by (A) the attending physician, advanced practice registered nurse, or physician assistant; and (B) the professional staff of the agency; (2) be signed by the attending physician, advanced practice registered nurse, or physician assistant and included in the patient's clinical record not later than 21 days after the start of care or the recertification date of the agency; (3) identify long and short term goals of patient care that provide measurable indices of performance; (4) address all pertinent diagnoses, rehabilitation potential, functional limitations, activities permitted, nutritional requirements, medications and treatments, safety measures to protect against injury, planning for discharge, instructions for timely discharge or referral, and any other factors relevant to the care of that patient. (b) The agency shall promptly alert the attending physician, advanced practice registered nurse, or physician assistant of conditions that may require a change to the plan of care. The attending physician, advanced practice registered nurse, or physician assistant must approve any changes to the plan of care. (c) The agency shall discuss the following information with the patient and document the discussion in the patient's clinical record: (1) the plan of care; (2) the services that the agency will provide; (3) alternate services available when the agency is unable to meet identified needs of the patient. 7 AAC 12.514. Acceptance of patients. A home health agency may accept a patient for treatment only if there is a reasonable expectation that the patient's needs will be met adequately by the home health agency in the patient's place of residence. A home health agency may not accept a patient for treatment if that patient's place of residence is a hospital or nursing facility. The agency must consider the following factors before accepting a patient for home health services: (1) adequacy and suitability of staff and resources of the agency to provide needed services; (2) assessments of medical, nursing, and social needs of the patient as they relate to the benefits derived from home health care; (3) attitudes of the patient and family members; (4) degree of patient and family awareness of their rights and responsibilities; (5) management of medical emergencies; (6) availability, ability, and willingness of others to participate in the care of the patient; and (7) assurance that services can be effectively coordinated through liaison with organizations and individuals also providing care to the patient. 7 AAC 12.515. Agency staff. Repealed. 7 AAC 12.516. Director of clinical services. The home health agency administrator shall designate a physician or registered nurse to serve as that agency's director of clinical services. The director of clinical services shall (1) supervise the agency's professional service providers; (2) be available at all times for consultation during regular office hours or have a qualified designee if the director is on authorized leave status; (3) participate in the development of job descriptions and employment decisions affecting home health personnel who provide direct services; (4) ensure that the agency has a sufficient number of staff to meet patient needs; (5) have authority over and responsibility for the (A) functions, activities, and evaluation of all professional and ancillary staff to assure that they conform to applicable state and federal laws, agency policies and procedures, and applicable professional standards; (B) quality of home health services, implementation and coordination of each plan of care, appropriateness of each plan of care to meet the patient's needs, and implementation of patient care policies and procedures; (C) orientation and inservice training for all professional staff and ancillary personnel, including those under contract; and (D) development and documentation of all written material related to home health services, including policies, procedures, and standards for home health services. 7 AAC 12.517. Nursing services. (a) A home health agency shall furnish nursing services in accordance with a plan of care by or under the supervision of a registered nurse licensed under AS 08.68 . A registered nurse employed by a home health agency shall (1) assure that patient care is coordinated between services and that all of the patient's needs identified by the assessments are addressed; (2) conduct initial evaluation visits and re-evaluate nursing needs on an ongoing basis; (3) conduct in-depth and comprehensive assessments of a patient at acceptance and when significant changes occur in the patient's condition; (4) initiate a plan of care and make necessary revisions; (5) provide services requiring substantial and specialized nursing skill; (6) initiate appropriate preventive and rehabilitative nursing procedures; (7) implement patient teaching based on the patient's needs consistent with agency policies and procedures, including demonstration, supervision, and evaluation; (8) prepare clinical and progress notes; (9) prepare summaries of care; (10) inform the attending physician, advanced practice registered nurse, or physician assistant and inform other personnel of changes in the patient's condition and needs; (11) counsel each patient and the patient's family on how to meet the patient's nursing and related needs; (12) prepare a written summary of care and services in the event of patient transfer to another agency, hospital, or other health care setting; (13) supervise other nursing personnel; (14) participate in inservice training; and (15) if a patient is receiving care by a licensed practical nurse, review the plan of care and the nursing services every two weeks and document the review in the patient's clinical record. (b) A licensed practical nurse licensed under AS 08.68 employed by a home health agency shall (1) furnish services in accordance with applicable state and federal law, agency policies and procedures, and the plan of care; (2) assist the physician and registered nurse in performing specialized procedures; (3) prepare equipment and materials for treatments observing required aseptic technique; (4) assist the patient in learning appropriate self-care; (5) consult the registered nurse in making judgments and decisions regarding care and services rendered; and (6) prepare clinical progress notes. 7 AAC 12.519. Home health aide services. (a) If a home health agency provides home health aide services, those services must be provided (1) by a home health aide who (A) is a nurse aide certified by the Board of Nursing under AS 08.68.331 - 08.68.336; (B) does not appear in the registry of certified nurse aides under AS 08.68.333 as having committed abuse, neglect, or misappropriation of property in connection with employment as a nurse aide; (C) has a valid criminal history check under AS 47.05.300 - 47.05.390 and 7 AAC 10.900 - 7 AAC 10.990 , unless a variance is granted under 7 AAC 10.935 ; and (D) meets home health requirements and has completed the competency evaluation requirements in (f) of this section; (2) in accordance with a plan of care; and (3) in accordance with written instructions prepared by a registered nurse, or appropriate therapist providing therapy under 7 AAC 12.521 , that specify each task to be completed during a home visit. (b) A home health aide employed by a home health agency shall (1) follow a current written plan of care; (2) perform simple procedures as an extension of therapy services; (3) provide personal care, including bathing, hair care, oral hygiene, skin care, and hand and foot care; (4) assist the patient with ambulation and exercise; (5) assist with the nutritional needs of the patient; (6) assist with patient administered, non-prescription and prescription medications, by handing the patient the medication bottle or medications prepared under the supervision of a registered nurse or a physician; (7) report changes in the patient's condition and needs, and complete appropriate records; and (8) take and record vital signs. (c) A home health agency shall provide and document orientation of a home health aide within the two weeks immediately following that aide's employment. Orientation must include information on the following matters: (1) applicable state and federal law and the policies and procedures of the agency; (2) duties of the home health aide; (3) functions of other health personnel employed by the agency and how they relate to each other in the care of the patient; (4) coordination of services within the agency and community services; and (5) ethics and confidentiality. (d) A registered nurse, or therapist providing service under 7 AAC 12.521 , shall make a supervisory visit to the patient's residence at least once every two weeks, either to observe and assist when the aide is present, or to assess relationships and determine whether goals identified in the plan of care are being met. The registered nurse or therapist must directly observe the in-home performance of each home health aide at least once every three months. (e) A home health agency shall provide a home health aide with 12 hours of inservice training each calendar year based on the training needs identified through supervisory visits and the needs of patients being served by the home health agency. A home health agency shall provide training for all care duties not included in the basic competency skills identified in (f) of this section. (f) A home health agency shall maintain sufficient documentation to demonstrate that an individual who furnishes home health aide services is competent in the skills identified in this subsection. Before providing services to patients, a home health aide shall be evaluated for competency in each of the following areas: (1) communication; (2) observation, reporting, and documentation of the patient care provided; (3) maintenance of a clean, safe, and healthy environment; (4) provision of basic infection control procedures; (5) knowledge of basic nutrition and fluid intake, including food preparation techniques as appropriate; (6) reading and recording temperature, pulse, and respiration; (7) knowledge and observation of basic elements of body functioning and changes in body function that must be reported to an aide's supervisor; (8) recognition of emergencies and knowledge of emergency procedures; (9) recognition of the physical, emotional, and developmental needs of, and ways to work with, the clients served by the home health agency, including respect for the patient, the patient's privacy, and the patient's property; (10) use of appropriate and safe techniques of personal hygiene and grooming, including (A) a bed bath; (B) a sponge, tub, or shower bath; (C) sink, tub, or bed shampooing; (D) nail and skin care; (E) oral hygiene; and (F) toileting and elimination; (11) safe transfer techniques and ambulation; (12) normal range of motion and positioning; (13) any other task that the home health agency may assign to the home health aide. 7 AAC 12.520. Nursing service. Repealed. 7 AAC 12.521. Therapy services. (a) Physical therapy services offered by a home health agency must be provided in accordance with a plan of care by or under the supervision of a physical therapist licensed under AS 08.84 . A physical therapist employed by or on contract with a home health agency shall (1) evaluate a patient; (2) establish or modify a physical therapy treatment plan upon written or verbal orders from a physician, advanced practice registered nurse, or physician assistant; (3) prepare clinical progress notes; (4) prepare summaries of care; (5) plan, supervise, and delegate services to a physical therapy assistant licensed under AS 08.84 ; and (6) makes supervisory visits to the patient's residence every two weeks to evaluate the effectiveness of the services furnished by the physical therapy assistant and to document the patient's condition in the clinical record. (b) Occupational therapy services offered by a home health agency must be provided in accordance with a plan of care by an occupational therapist licensed under AS 08.84 . An occupational therapist employed by or on contract with a home health agency shall (1) evaluate a patient; (2) establish or modify an occupational therapy treatment plan upon written or verbal orders from a physician, advanced practice registered nurse, or physician assistant; (3) prepare clinical progress notes; (4) prepare summaries of care; (5) plan, supervise, and delegate services to an occupational therapy assistant licensed under AS 08.84 ; and (6) make supervisory visits to the patient's residence every two weeks to evaluate the effectiveness of the services furnished by the occupational therapy assistant and document the patient's condition in the clinical record. (c) A physical therapy assistant and occupational therapy assistant shall (1) assist in preparing clinical progress notes; and (2) participate in educating the patient, family, and staff. (d) Speech therapy services offered by a home health agency must be provided in accordance with a plan of care by a speech therapist who has a current certificate of clinical competence in speech pathology granted by the American Speech-Language-Hearing Association. A speech pathologist employed by or under contract to a home health agency shall (1) evaluate a patient; (2) establish or modify a speech therapy treatment plan upon written or verbal instructions from the treating physician, advanced practice registered nurse, or physician assistant; (3) prepare clinical progress notes; and (4) prepare summaries of care. 7 AAC 12.523. Medical social work service. (a) If a home health agency offers medical social services, the services must be delivered in accordance with the patient's plan of care by, or under the supervision of, a social worker who has (1) a master's degree from a school of social work accredited by the National Council on Social Work Education; (2) one year of social work experience in a health care setting; and (3) if required to be licensed under AS 08.95 , a valid license. (b) A social worker employed by a home health agency shall (1) assist the treating physician, advanced practice registered nurse, or physician assistant, the team members, and the family in understanding the social and emotional factors related to health problems of the patient; (2) participate in the development of a plan of care; (3) prepare clinical and progress notes; (4) participate in inservice training; (5) refer the patient and family members to appropriate community resources and consult with other agency personnel; (6) accept, in relation to social services issues, the orders of a physician, advanced practice registered nurse, or physician assistant; (7) participate in discharge planning; and (8) plan, supervise, and delegate services furnished by a social work assistant. (c) A social work assistant must have a baccalaureate degree in social work or in a human service field, including sociology, special education, rehabilitation counseling, psychology, or another field related to social work, and at least one year of social work experience in a health care setting. A social work assistant shall (1) perform delegated services in accordance with the plan of care; (2) assist in preparing clinical progress notes; and (3) participate in inservice training. 7 AAC 12.524. Nutrition services. If a plan of care requires the consultation or direct services of a dietitian, the home health agency must ensure that those services are provided by a dietitian registered by the Commission on Dietetic Registration of the American Dietetic Association. A dietitian providing services for a home health agency shall (1) review the dietary assessment of a patient with special dietary needs, and monitor the management of any special diet requirements; (2) participate in developing a plan of care regarding a patient's dietary needs, including dietary goals, objectives, and interventions; (3) provide written directions to family and staff for meal planning for a special diet; (4) participate in patient care conferences; (5) participate in educating the patient and family about the patient's dietary needs and management; (6) participate in agency inservice training; (7) prepare clinical progress notes; (8) prepare summaries of care; (9) provide the agency with an assessment and consultation if hyperalimentation services are being provided; and (10) maintain liaison with the treating physician, advanced practice registered nurse, or physician assistant and with the agency staff to ensure that their efforts are coordinated effectively and support the objectives outlined in a plan of care. 7 AAC 12.525. Central supply. (a) A home health agency shall maintain a separate area for processing, decontamination, if necessary, and storage of sterile supplies and materials. (b) A home health agency shall develop and implement policies and procedures for (1) the cleaning, antimicrobial processing, and storage of nondisposable supplies and equipment to prevent their contamination and the transmission of infection through their use; (2) identifying potentially infectious materials that must be treated before disposal; and (3) the handling, packaging, and disposal of materials and sharp instruments contaminated by pathological or infectious waste. 7 AAC 12.526. Infusion therapy. (a) If a home health agency provides parenteral or hyperalimentation services, the agency shall (1) describe the scope of the services to be provided, including the population to be served; (2) develop a plan for emergency services to meet the scope of the services provided; and (3) administer treatments only upon the order of a physician, advanced practice registered nurse, or physician assistant. (b) A home health agency shall develop and implement policies and procedures for (1) preparing and administering parenteral solution, medications, and admixtures; (2) infection control, including (A) preparing, assessing, rotating, and labeling the site; (B) necessary and appropriate flushing procedures; and (C) using sterile equipment according to manufacturer's guidelines; (3) using dietitian services when a patient requires enteral or parenteral nutrition; (4) identifying preparations that can be administered at home; (5) using and controlling parenterally administered experimental drugs; (6) using drugs that cause tissue necrosis upon extravasation; (7) handling and disposing of biohazardous material, antineoplastic agents, and infectious materials; (8) using precision volume chambers, electronic infusion devices, and flow control devices; (9) assuring a product is free of particulate matter and cloudiness; (10) administering blood and blood products to assure (A) viability, temperature stability, and prevention of contamination; and (B) registered nurse or physician attendance; and (11) providing care for pediatric patients that describe the (A) amount and specifications of parenteral fluid or medication to be administered, as determined by age, body surface, weight, intake, and output; and (B) type and use of control devices. (c) The home health agency shall ensure that employees, including contract personnel, who administer enteral medication or blood products have (1) any license required under AS 08 and are authorized to penetrate the skin and insert intravenous devices and administer medications; (2) documented training and skills in (A) intravenous insertion techniques; (B) parenteral administration; (C) line and site management; and (D) use of equipment. (d) The home health agency shall document the following information in each patient's clinical record: (1) administration of solutions and medications, including amount, rate, and route; (2) insertion and removal of a cannula, catheter, or needle, and the patient's condition at time of removal; (3) management of tubing and dressing; (4) use of electronic infusion devices, volumetric pumps, or flow control devices; and (5) education of patient or family members on infusion therapy; (e) If a home health agency contracts for infusion therapy services, the agency must define the responsibilities of the contractor and the agency in writing, including (1) the specific services, consultants, and equipment to be provided; (2) reimbursement procedures; and (3) staff assignments for monitoring and assisting patients during all hours of infusion therapy administration. 7 AAC 12.530. Medical records. Repealed. 7 AAC 12.531. Agency policies and procedures. (a) A home health agency shall establish, implement, and make available to all personnel, written policies and procedures appropriate to the services offered by the agency. These policies and procedures must be reviewed at least annually and revised as necessary. (b) A home health agency shall establish policies and procedures covering (1) the scope of services and geographic service area; (2) conditions for acceptance, transfer, discharge, and continuing care of patients; (3) treatments and procedures performed in the home by each of the services; (4) infection control policies and practices; (5) coordination of services; (6) clinical records; (7) patient teaching; (8) intravenous infusion and aseptic technique; (9) patient safety assessment; (10) emergency care; (11) personnel qualifications, responsibilities, and job descriptions; (12) program evaluation; (13) the administration, supervision, coordination, and evaluation of services provided through subunits and branch offices of the agency; (14) patient care equipment and preventive maintenance; (15) the process for investigation, documentation, and resolution of a complaint made by a patient or the patient's family or guardian; (16) an advance declaration relating to the use of life-sustaining procedures; and (17) abuse, neglect, or mistreatment. 7 AAC 12.534. Patients' rights. (a) The governing body of a home health agency shall protect and promote the rights of its home health patients, by assuring that (1) before services are provided, the patient and the patient's family are informed orally and in writing, in a language the patient and family understand, of the rights and obligations of the agency and the patient; the agency shall document the patient's and the patient's family's receipt of these rights and obligations; and (2) appropriate and professional quality home health care services are provided without discrimination based on race, creed, color, religion, sex, national origin, sexual preference, age, or diagnosis, but an agency may limit its practice to the provision of care or services for patients with a specific disease or diagnosis without violating this paragraph. (b) A patient receiving home health services has the right to (1) courteous and respectful treatment of person and property; (2) be free from physical and mental abuse, neglect, or mistreatment; (3) receive care or services from employees or contractors properly trained to perform assigned tasks, and to be given proper identification by name and title of an employee or contractor who provides home health care to that patient; (4) be given the following information in advance of care or services: (A) the care and services to be provided; (B) any changes in the care to be provided; (C) the type of services to be provided; (D) the frequency of proposed visits for care or services; (E) the agency's expectation of the patient's responsibilities to participate in the patient's own care; and (F) the name of the person supervising the care and how to contact that person; (5) confidentiality with regard to information about the patient's health, social, and financial circumstances and about activities at the patient's home; (6) expect that the patient's medical history be released only as required by law or authorized by the patient or the patient's legal representative; (7) access information in the patient's medical record upon written request within two working days of the agency; (8) be informed, orally and in writing, before a service is initiated, of the expected source of payment for the care or services; (9) raise a grievance about the service or lack of service provided by the agency, its employees, or its contractors; (10) be informed of the reason for impending discharge, transfer to another agency, change in the level of care, ongoing care requirements, and other available services and options, if needed; and (11) participate in development of the patient's plan of care and changes in care or treatment. 7 AAC 12.535. Drugs. Repealed. 7 AAC 12.537. Advance directives. (a) Before initiating care or services, a home health agency must provide each patient, 18 years of age or older, or their legal representatives, with forms and information on (1) the right of the individual to make health care decisions, including the right to (A) accept or refuse medical or surgical treatment; and (B) execute an advance directive and power of attorney for health care; (2) the policies of the home health agency with respect to the implementation of the rights of the individual to make health care decisions; (3) living wills and do-not-resuscitate orders; (4) persons who can provide additional information concerning advance directives and powers of attorney for health care. (b) A home health agency may not condition the provision of care or otherwise discriminate against a patient based on whether the patient has executed an advance directive. If the agency cannot comply with a patient's advance directive as a matter of conscience, the agency must assist the patient in transferring to an agency that will comply. 7 AAC 12.540. Therapeutic treatment. Repealed. 7 AAC 12.541. Abuse, neglect, and mistreatment. (a) A home health agency shall develop and implement written policies and procedures that prohibit abuse, neglect, and mistreatment of patients. (b) An agency shall (1) screen a potential employee or contractor to prevent the employment of an individual who has been convicted of abuse, neglect, or mistreatment of another individual, or misappropriation of the property of a patient under the individual's care; (2) contact the appropriate licensing authority to verify the employment background of potential employees or contractors who are required to hold a license to practice; (3) report to the appropriate licensing authority any knowledge it has of an action by a court or other government agency against an individual that would indicate unfitness for holding a professional or occupational license; (4) report within 24 hours any suspected abuse, neglect, or mistreatment of a patient or misappropriation of a patient's property to state officials in accordance with AS 47.17.010 , 47.17.020, and AS 47.24.010 and to the department in its capacity as the state survey agency; (5) review and document alleged incidents of abuse, neglect, or mistreatment; (6) take any necessary action to remove the potential for further abuse, neglect, or mistreatment of a patient or misappropriation of a patient's property while the investigation is in progress; (7) document the results of the investigation and the corrective action taken; and (8) assure that an employee or contractor does not obtain a patient's power of attorney in violation of AS 13.26.358 . 7 AAC 12.545. Agency policies and procedures. Repealed. 7 AAC 12.550. Patient evaluation. Repealed. 7 AAC 12.551. Drugs. (a) If ordered by the patient's physician, advanced practice registered nurse, or physician assistant, a drug may be administered to a patient by an employee or a contractor of the home health agency who is authorized to administer drugs by law. (b) An employee or a contractor of a home health agency who administers a drug or injection shall immediately record the name and strength of the drug or injection and sign the patient's clinical record. (c) The agency shall document all drugs a patient may be taking, including a drug not prescribed by the attending physician, advanced practice registered nurse, or physician assistant. 7 AAC 12.555. Treatment plan. Repealed. 7 AAC 12.558. Whole blood glucose monitoring. If a home health agency uses its own equipment to monitor a patient's whole blood glucose levels, the agency must test and calibrate the machine according to the manufacturer's recommendations. If a patient has whole blood glucose equipment, the home health agency must teach the patient the proper use of the equipment. 7 AAC 12.560. Review of records. Repealed. 7 AAC 12.561. Clinical records. (a) A home health agency shall maintain a clinical record for each patient. The clinical record must be legible and maintained in accordance with accepted professional or occupational standards. The clinical record must be readily available upon the request of the (1) attending physician, advanced practice registered nurse, or physician assistant; (2) the department; (3) the patient; (4) the patient's representative; or (5) if authorized by the patient, another health care provider. (b) A clinical record must include the following items: (1) appropriate identifying information; (2) assessments by appropriate personnel; (3) the plans of care; (4) name of the attending physician, advanced practice registered nurse, or physician assistant; (5) signed and dated clinical progress notes; (6) copies of summary reports sent to the attending physician, advanced practice registered nurse, or physician assistant; (7) a signed patient release or consent forms, if indicated; (8) documentation of informed consent regarding the initiation of care and treatment, and changes in the plan of care; (9) evidence the patient received the patients' rights under 7 AAC 12.534 and advance directive information under 7 AAC 12.537 ; (10) copies of transfer information sent with the patient; and (11) a discharge summary. (c) Clinical progress notes must be written or dictated on the day that care or service is rendered. The clinical progress notes must be incorporated into the patient's clinical record within seven days. Summaries of the care or service reported must be submitted to the attending physician, advanced practice registered nurse, or physician assistant at least every 62 days. (d) A home health agency shall have written policies and procedures to provide that clinical records are (1) legibly written in ink or typed, suitable for photocopying; (2) readily available to authorized personnel during operating hours of the agency; (3) protected from damage; (4) if computerized, have a security mechanism in place to ensure confidentiality; (5) retained for five years after the date of discharge, or, in the case of a minor, three years after the patient turns 21 years of age; agency policy and procedures must provide for record retention even if the home health agency discontinues operation; (6) disposed of using a method that will prevent retrieval and subsequent use of information; and (7) transferred with the patient if the patient transfers to another agency or health facility; the transferred record may be a copy or an abstract and a summary report. 7 AAC 12.563. Contracts. (a) A home health agency may contract with another facility or agent to perform services or provide resources to the agency. The services provided under contract that are regulated under 7 AAC 12.500 - 7 AAC 12.590 must meet the requirements of this chapter. (b) A home health agency's contract with another facility or agent to provide home health care or services must (1) be in writing; (2) be signed and dated by the agency and the contractor; (3) specify the respective functions and responsibilities of the contractor and the agency, including the frequency of services to be provided by the contractor; (4) include, if applicable, the current license or registration number of the contractor; (5) provide that patients are accepted for care or services only by the contracting home health agency; (6) identify the type and frequency of services to be furnished; (7) require the contractor to conform to all applicable agency policies, including personnel qualifications; (8) specify the contractor's responsibility for participating in developing a plan of care; (9) specify the manner in which the care or services will be controlled, coordinated, and evaluated by the contracting home health agency; (10) identify the procedures for (A) submitting clinical progress notes; (B) scheduling of visits; (C) performing periodic patient evaluation; and (11) identify the procedures for payment for services furnished under the contract. 7 AAC 12.565. Risk management. (a) A home health agency shall have a risk management program that includes a procedure to investigate, analyze, and respond to patient grievances related to patient care. (b) A home health agency shall conduct, in each service area, an orientation program for each new employee and annual inservice training that covers the following topics: (1) agency policies and procedures; (2) employee job responsibilities and the skills necessary to meet those responsibilities; (3) recognition and response to potential fire, emergency, and home safety hazards; (4) principles and techniques of infection control; and (5) ethics and confidentiality. (c) A home health agency shall require cardiopulmonary resuscitation training every two years for each employee working directly with patients. (d) A home health agency shall establish personnel policies requiring an annual evaluation of each employee's performance. 7 AAC 12.566. Infection control. (a) A home health agency shall develop and implement written policies and procedures applicable to all agency staff that (1) minimize the risk of transmitting infection in all patient care or services; and (2) provide for the safe handling and disposal of biohazardous and infectious materials. (b) At least every two years, a home health agency shall verify that its employees, contractors, and volunteers who provide patient care receive training on universal precautions and the prevention, transmission, and treatment of (1) human immunodeficiency virus (HIV); (2) acquired immunodeficiency virus (AIDS); (3) hepatitis; and (4) tuberculosis, in accordance with 7 AAC 12.650 (a)(1). 7 AAC 12.570. Physical plant. Repealed. 7 AAC 12.571. Employee health program. A home health agency shall have an employee health program that meets the requirements of 7 AAC 12.650 . 7 AAC 12.590. Definitions. In 7 AAC 12.500 - 7 AAC 12.590 , unless the context requires otherwise, (1) "abuse" means the infliction of physical pain or injury, the infliction of mental anguish that requires medical attention, or the deprivation by a caretaker of services that are necessary to maintain the physical and mental health of an individual; (2) "administrator" means the individual appointed by the governing body to manage the home health agency; (3) "admixture" means a preparation of a dosage form for administration when a drug is altered, diluted, or compounded by the addition of a diluent or another drug; (4) "agency" has the same meaning given "home health agency" in this chapter; (5) "branch" means a location from which a home health agency provides services within a portion of the total geographic area served by the parent home health agency; (6) "clinical progress note" means a written, signed, and dated notation by an employee or contractor of the home health agency of a contact with a patient that contains a description of care or services rendered, patient signs and symptoms, treatments, drugs given, the patient's reaction, changes in physical or emotional condition, and any other pertinent information; (7) "department" means the Department of Health and Social Services; (8) "governing body" means the designated persons or group having full legal authority and fiscal responsibility for the conduct and operation of the home health agency; (9) "home health agency" means an entity that is primarily engaged in providing skilled nursing and at least one other service identified at 7 AAC 12.505 ; (10) "neglect" means the failure by the caretaker of an individual to provide services necessary to maintain the physical and mental health of the individual; (11) "nutrition services" means nutritional assessment and counseling, dietary teaching, and the monitoring and management of special diets and hyperalimentation provided by a registered dietitian; (12) "occupational therapy assistant" means a person licensed under AS 08.84 by the State Physical Therapy and Occupational Therapy Board to assist in the practice of occupational therapy under the supervision of an occupational therapist; (13) "parent home health agency" means a licensed home health agency; a "parent home health agency" may have branches or subunits; (14) "personal care services" means services of a non-technical medical nature provided to a patient whose medical needs would otherwise require placement in a hospital or nursing home that enables the patient to remain safely in their own home; "personal care services" are ordered by a physician and are designed to improve or delay deterioration of a patient's health; "personal care services" include assistance with activities of daily living, bathing, dressing, meal preparation, light housekeeping, and shopping assistance; (15) "physical therapy assistant" means a person licensed under AS 08.84 by the State Physical Therapy and Occupational Therapy Board to assist in the practice of physical therapy under the supervision of a physical therapist; (16) "plan of care" means a written plan of treatment based on an attending physician's orders, established by a registered nurse or physical or occupational therapist, and periodically reviewed by a physician; (17) "primary home health agency" means the licensed home health agency that accepts the patient for the rendering of curative, restorative, or preventive services in the patient's home by an employee of the home health agency; when services are provided through contracts with other organizations or individuals, the contracting home health agency is considered the primary home health agency and is responsible for the plan of treatment signed by the referring physician; (18) "skilled nursing services" means the curative, restorative, or preventive aspects of patient care services performed by or under the supervision of a registered nurse emphasizing a high level of nursing direction, observation, and skill; (19) "state survey agency" means the health facilities licensing and certification unit in the division of medical assistance that determines compliance with licensure requirements, certifies home health agencies, and investigates complaints against licensed health facilities; (20) "subunit" means a location or site from which a home health agency provides services at a distance from the parent home health agency; (21) "summary report" means a compilation of the pertinent facts from clinical notes at least every 62 days; (22) "survey" means an on-site review by the department to determine compliance with state and federal law.