Section 759.8 - Registrant services

759.8 Registrant services. The operator must provide or arrange for services appropriate to each registrant in accordance with the comprehensive assessment conducted and comprehensive care plan developed by the adult day health care program or by the managed care organization or care coordination model that referred the registrant to the adult day health care program.  The following registrant services shall be provided on-site, as appropriate, to each registrant in accordance with the individual's multidisciplinary assessment of needs and comprehensive care plan:

(a) medical services provided by the operator, which, without limiting its responsibility for the operation and management of the program, must:

(1) assign to the operator's medical board, medical advisory committee, medical director or consulting practitioner the following responsibilities regarding registrants of the program:

(i) developing and amending clinical policies;

(ii) supervising medical services;

(iii) advising the operator regarding medical and medically related problems;

(iv) establishing procedures for emergency practitioner coverage, records and consultants; and

(v) establishing professional relationships with other institutions and agencies, such as general hospitals, rehabilitation centers, residential health care facilities, home health agencies, hospital outpatient departments, clinics and laboratories;

(2) ensure that medical services, including arranging for necessary consultation services, are provided to registrants of the program in accordance with the registrant’s managed care organization or care coordination model;

(3) provide or arrange for the personnel, staff or other designated practitioner to obtain a medical history and a physical examination of each registrant, including diagnostic laboratory and x-ray services, as medically indicated, within six weeks before or seven days after admission to the program;

(4) ensure that the practitioner record, date and authenticate significant findings of the medical history, physical examination, diagnostic services, diagnoses and orders for treatment in the registrant's clinical records;

(5) ensure that orders for treatment include orders for medication, diet, permitted level of physical activity and, when indicated, special orders or recommendations for rehabilitative therapy services and other adult day health care services;

(b) case management services;

(c) food and nutrition services provided by the operator, which must:

(1) provide meals and nutritional supplements, including modified diets when medically prescribed, to registrants who are on the premises at scheduled meal times and, where appropriate, to registrants in their homes in accordance with the identified needs included in registrant comprehensive care plans;

(2) ensure that nutrition services are under the direction of a qualified dietitian;

(i) A qualified dietician is one who is qualified based on:

(a) registration by the Commission on Dietetic Registration of the American Diabetes Association;

(b) education, training, and experience in identification of dietary needs, planning, and implementation of dietary program; or

(c) certification as a certified dietician or certified nutritionist in accordance with Article 157 of the Education Law;

(3) ensure that dietary service records for the adult day health care service are maintained;

(d) social services provided by the operator must:

(1) be under the supervision and direction of a licensed clinical social worker;

(2) be provided through the use of a full or part-time licensed mental health professional in conformance with the approved application for operation and regular access may be directly with a master’s prepared or licensed mental health professional;

(3) either directly or through the managed care organization or care coordination model that referred the registrant to the adult day health care program, ensure that psychosocial needs are assessed, evaluated and recorded, and that services are provided to meet the identified needs of the registrant as part of the comprehensive care plan; and

(4) ensure that staff members arrange for the use of and/or access to other community resources as needed and coordinate the needs of the registrants with services provided by the adult day health care program and other health care providers, community social agencies and other resources; provided, however, with respect to registrants referred to the adult day health care program by a managed care organization or care coordination model, this shall be the responsibility of the managed care organization or care coordination model.

(e) assistance and/or supervision with activities of daily living, such as toileting, feeding, ambulation, bathing including routine skin care, care of hair and nails, and oral hygiene, and supervision and monitoring of personal safety, restorative rehabilitative and maintenance therapy services, and instrumental activities of daily living;

(f) rehabilitation therapy services provided or arranged by the operator, either directly or through the managed care organization or care coordination model that referred the registrant to the adult day health care program, in conformance with the registrant’s needs identified during the comprehensive assessment;

(g) an activities program, provided by the operator either directly or through the managed care organization or care coordination model that referred the registrant to the adult day health care program, which must involve community, interpersonal and self-care functions appropriate and sufficient in scope to the needs and interests of each registrant to sustain physical and psychosocial functioning and must:

(1) ensure that activities are an integral part of the program and reflect the registrants' individual interests and cultural backgrounds;

(2) ensure that activities are designed to enhance registrant participation in the program, home life and the community;

(3) involve appropriate volunteers and volunteer groups in the program, unless prohibited by law;

(4) provide sufficient equipment and supplies for the operation of the activity program;

(5) provide or arrange for transportation to and from community events and outings; and

(6) ensure that activities are included as part of each registrant's comprehensive care plan;

(h) nursing services, provided by the operator, directly or through the managed care organization or care coordination model that referred the registrant to the adult day health care program, must be based on the care needs of the registrant as specified in the comprehensive care plan and be provided by a registered professional nurse.  A licensed practical nurse, acting within his or her lawful scope of practice under Title VIII of the Education Law, may provide the on-site services when a registered professional nurse is available at the sponsoring licensed facility to provide immediate direction or consultation;

(1) in addition to providing nursing services as specified in the registrant comprehensive care plan, the operator must ensure that a registered professional nurse is available to conduct sick call triage assessments to registrants presenting with new problems or symptoms that result in consultation with the registrant’s primary care physician or the managed care organization in which the registrant is enrolled or, as necessary, immediate transfer to an emergency department;

(i) pastoral counseling, either provided directly or arranged for by the operator;

(j) counseling for HIV risk reduction;

(k) pharmaceutical services;

(l) substance abuse services;

(m) mental health and psychiatric services;

(n) ancillary services, commensurate with the level of care delivered on-site; and

(o) referrals for dental services and sub-specialty care that are in conformance with the needs identified during the comprehensive assessment.

Effective Date: 
Wednesday, June 14, 2017
Doc Status: 
Complete