DAR File No. 27372

Health, Health Systems Improvement, Licensing

R432-150-16

Physician Services

NOTICE OF PROPOSED RULE

DAR File No.: 27372
Filed: 08/27/2004, 11:25
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The rule amendment eliminates a requirement that a physician see a patient within five days if the patient has been admitted to a nursing facility by a physician assistant or nurse practitioner.

Summary of the rule or change:

Subsection R432-150-16(4)(b) is deleted which requires a physician to to see a patient admitted to a nursing facility by a physician assistant or nurse practitioner.

State statutory or constitutional authorization for this rule:

Title 26, Chapter 21

Anticipated cost or savings to:

the state budget:

There is no impact to State budget, since there are no nursing facilities operated by the State.

local governments:

Local governments that pay for the physician visit out of nursing home funds will experience a savings. However, limited research indicates that nursing homes are not paying physicians for the service. There is no anticipated impact to local government budgets.

other persons:

Limited research indicates that nursing homes, insurance providers, and private-pay patients have not paid physicians for this service. Physicians who have been providing this service without reimbursement will no longer provide the service without compensation. However, it is not possible to calculate to what extent physicians may be benefitted financially.

Compliance costs for affected persons:

This rule change removes a requirement and will have no compliance costs.

Comments by the department head on the fiscal impact the rule may have on businesses:

This rule change eliminates a requirement on regulated businesses and should have a positive fiscal impact. Scott D. Williams, MD

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Direct questions regarding this rule to:

Debra Wynkoop at the above address, by phone at 801-538-6152, by FAX at 801-538-6325, or by Internet E-mail at debwynkoop@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

10/15/2004

This rule may become effective on:

10/16/2004

Authorized by:

Scott D. Williams, Executive Director

RULE TEXT

R432. Health, Health Systems Improvement, Licensing.

R432-150. Nursing Care Facility.

R432-150-16. Physician Services.

(1) A physician must personally approve in writing a recommendation that an individual be admitted to a nursing care facility.

(a) Each resident must remain under the care of a physician licensed in Utah to deliver the scope of services required by the resident.

(b) Nurse practitioners or physician assistants, working under the direction of a licensed physician may initiate admission to a nursing care facility pending personal review by the physician.

(2) The facility must provide supervision to ensure that the medical care of each resident is supervised by a physician. When a resident's attending physician is unavailable, another qualified physician must supervise the medical care of the resident.

(3) The physician must:

(a) review the resident's total program of care, including medications and treatments, at each visit;

(b) write, sign, and date progress notes at each visit;

(c) indicate, in writing, direction and supervision of health care provided to residents by nurse practitioners or physician assistants; and

(d) sign all orders.

(4) Physician visits must conform to the following:

(a) The physician shall notify the facility of the name of the nurse practitioner or physician assistant who is providing care to the resident at the facility.

(b) [Each resident must be seen by the physician within five days of admission to a facility when admission is initiated by a nurse practitioner or physician assistant working under the direction of the physician.

(c) ]Each resident must be seen by a physician at least once every 30 days for the first 90 days after admission, and at least every 60 days thereafter.

([d]c) Physician visits must be completed within ten days of the date the visit is required.

([e]d) Except as required by R432-150-16(4)(f), all required physician visits must be made by the physician.

([f]e) At the option of the physician, required visits after the initial visit may alternate between personal visits by the physician and visits by a physician assistant or nurse practitioner.

(5) The facility must provide or arrange for the provision of physician services 24 hours a day in case of an emergency.

KEY: health facilities

[December 1, 1999]2004

Notice of Continuation October 9, 2002

26-21-5

26-21-16

ADDITIONAL INFORMATION

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For questions regarding the content or application of this rule, please contact Debra Wynkoop at the above address, by phone at 801-538-6152, by FAX at 801-538-6325, or by Internet E-mail at debwynkoop@utah.gov

For questions about the rulemaking process, please contact the Division of Administrative Rules (801-538-3764). Please Note: The Division of Administrative Rules is NOT able to answer questions about the content or application of these administrative rules.