§ 442.498 Staff and facilities.

(a) The ICF/MR must have available enough qualified staff and support personnel to carry out the various speech pathology and audiology services, in accordance with stated goals and objectives.

(b) Staff who assume independent responsibilities for clinical services must meet the qualification requirements of § 405.1101 of this chapter.

(c) The ICF/MR must provide adequate, direct, and continuing supervision to personnel, volunteers, or support personnel used in providing clinical services.

(d) The ICF/MR must have enough space, equipment, and supplies to provide efficient and effective speech pathology and audiology services.

RECORDS

§ 442.499 Maintenance of resident records. (a) The ICF/MR must maintain a record for each resident that is adequate for

(1) Planning and continuous evaluation of the resident's habilitation program;

(2) Furnishing documentary evidence of each resident's progress and response to his habilitation program; and

(3) Protecting the legal rights of the residents, the ICF/MR, and the staff. (b) Any individual who makes an entry in a resident's record must make it legibly, date it, and sign it.

(c) The ICF/MR must provide a legend to explain any symbol or abbreviation used in a resident's record.

§ 442.500 Admission records.

At the time a resident is admitted, the ICF/MR must enter in the individual's record the following information:

(a) Name, date of admission, birth date and place, citizenship status, marital status, and social security number.

(b) Father's name and birthplace, mother's maiden name and birthplace, and parents' marital status.

(c) Name and address of parents, legal guardian, and next of kin if needed.

(d) Sex, race, height, weight, color of hair, color of eyes, identifying marks, and recent photograph.

(e) Reason for admission or referral problem.

(f) Type and legal status of admission.

(g) Legal competency status.

(h) Language spoken or understood. (i) Sources of support, including social security, veterans' benefits, and insurance.

(j) Religious affiliation, if any.

(k) Reports of the preadmission evaluations.

(1) Reports of previous histories and evaluations, if any.

§ 442.501 Record entries during residence.

(a) Within 1 month after the admission of each resident, the ICF/MR must enter in the resident's record

(1) A report of the review and updating of the preadmission evaluation; (2) A prognosis that can be used for programing and placement; and

(3) A comprehensive evaluation and individual program plan, designed by an interdisciplinary team.

(b) the ICF/MR must enter the following information in a resident's record during his residence:

(1) Reports of accidents, seizures, illnesses, and treatments for these conditions.

(2) Records of immunizations.

(3) Records of all periods that restraints were used, with justification and authorization for each.

(4) Reports of regular, at least annual, review and evaluation of the program, developmental progress, and status of each resident.

(5) Enough observations of the resident's response to his program to enable evaluation of its effectiveness. (6) Records of significant behavior incidents.

(7) Records of family visits and contacts.

(8) Records of attendance and ab

sences.

(9) Correspondence pertaining to the resident.

(10) Periodic updates of the information recorded at the time of admission. (11) Appropriate authorizations and consents.

(c) The ICF/MR must enter a discharge summary in the resident's record at the time he is discharged.

§ 442.502 Confidentiality.

(a) The ICF/MR must keep confidential all information contained in a resident's records, including information contained in an automated data bank.

(b) The record is the property of the ICF/MR which must protect it from loss, damage, tampering, or use by unauthorized individuals.

(c) The ICF/MR must have written policies governing access to, duplication of, and release of information from the record.

(d) The ICF/MR must obtain written consent of the resident, if competent, or his guardian before it releases information to individuals not otherwise authorized to receive it.

§ 442.503 Central record service.

The ICF/MR must

(a) Maintain an organized central record service for the collection and release of resident information;

(b) Make records readily accessible to authorized personnel if a centralized system is used;

(c) Have appropriate records available in the resident living units;

(d) Have a master alphabetical index of all residents admitted to the ICF/ MR; and

(e) Retain records for a period consistent with HEW regulations and the statute of limitations of the State in which the ICF/MR is located.

§ 442.504 Staff and facilities.

The ICF/MR must have

(a) Enough qualified staff and support personnel to accurately process, check, index, file, and retrieve records and record data promptly; and

(b) Adequate space, equipment, and supplies to provide efficient and effective record services.

SAFETY AND SANITATION

§ 442.505 Emergency plan and procedures. (a) The ICF/MR must have a written staff organization plan and detailed written procedures to meet all potential emergencies and disasters such as fire, severe weather, and missing residents.

(b) The ICF/MR must

(1) Clearly communicate and periodically review the plan and procedures with the staff; and

(2) Post the plan and procedures at suitable locations through the facility.

§ 442.506 Evacuation drills.

(a) The ICF/MR must hold evacuation drills at least quarterly for each shift of personnel and under varied conditions to

(1) Insure that all personnel on all shifts are trained to perform assigned tasks;

(2) Insure that all personnel on all shifts are familiar with the use of the ICF/MR's firefighting equipment; and

(3) Evaluate the effectiveness of emergency and disaster plans and procedures.

(b) The ICF/MR must

(1) Actually evacuate residents to safe areas during at least one evacuation drill each year, on each shift;

(2) Make special provisions for the evacuation of the physically handicapped, such as fire chutes and mattressloops with poles;

(3) Write and file a report and evaluation of each evacuation drill; and

(4) Investigate all accidents and take corrective action to prevent similar accidents in the future.

§ 442.507 Fire protection.

(a) Except as provided in §§ 442.508, 442.509, and paragraph (b) of this section, the ICF/MR must meet the provisions of the Life Safety Code of the National Fire Protection Association, 1967 edition, that apply to institutional occupancies.

(b) If the Secretary finds that the State has a fire and safety code imposed by State law that adequately

protects residents in ICF's/MR, the State survey agency may apply the State code for purposes of medicaid certification instead of the Life Safety Code.

§ 442.508 Fire protection exceptions for smaller ICF's/MR.

The State survey agency may apply the lodgings or rooming houses section of the residential occupancy requirements of the Life Safety Code of the National Fire Protection Association, 1967 edition, instead of the institutional occupancy provisions required by § 442.507, to an ICF/MR that has 15 beds or less if a physician or psychologist who meets the definition of qualified mental retardation professional under § 442.401 certifies that each resident is

(a) Ambulatory;

(b) Receiving active treatment; and (c) Capable of following directions and taking appropriate action for selfpreservation under emergency conditions.

§ 442.509 Fire protection waivers.

(a) The State survey agency may waive specific provisions of the Life Safety Code required by § 442.507, for as long as it considers appropriate, if— (1) The waiver would not adversely affect the health and safety of the residents;

(2) Rigid application of specific provisions would result in unreasonable hardship for the ICF/MR as determined under guidelines contained in the HCFA long-term care manual; and

(3) The waiver is granted in accordance with criteria contained in the long-term care manual.

(b) If a State agency waives provisions of the Code for an existing building of two or more stories that is not built of at least 2-hour fire-resistive construction, the ICF/MR may not house a blind, nonambulatory, or physically handicapped resident above the street-level floor unless it is built of

(1) One-hour protected, noncumbustible construction as defined in National Association Fire Protection Standard No. 220;

(2) Full sprinklered, 1-hour protected, ordinary construction;

(3) Full sprinklered, 1-hour protected, wood frame construction.

§ 442.510 Paint.

The ICF/MR must

(a) Use lead-free paint inside the facility; and

(b) Remove or cover old paint or plaster containing lead so that it is not accessible to residents.

§ 442.511 Building accessibility and use. (a) The ICF/MR must

(1) Be accessible to and usable by all residents, personnel, and the public, including individuals with disabilities; and

(2) Meet the requirements of American National Standards Institute (ANSI) Standard No. A117.1 (1961) American Standard Specifications for Making Buildings and Facilities Accessible to and Usable by the Physically Handicapped.

(b) The State survey agency may waive, for as long as it considers appropriate, specific provisions of ANSI Standard No. A117.1 (1961) if—

(1) The construction plans for the ICF/MR or a part of it were approved and stamped by the responsible State agency before March 18, 1974;

(2) The provision would result in unreasonable hardship on the ICF/MR if strictly enforced; and

(3) The waiver does not adversely affect the health and safety of the residents.

§ 442.512 Sanitation records and reports. The ICF/MR must keep

(a) Records that document compliance with the sanitation, health, and environmental safety codes of the State or local authorities having primary jurisdiction over the ICF/MR; and

(b) Written reports of inspections by State or local health authorities, and records of action taken on their recommendations.

ADMINISTRATIVE SERVICES

§ 442.513 Support services.

(a) The ICF/MR must provide adequate, modern administative support to efficiently meet the needs of resi

Sec.

RURAL HEalth CliniCS

447.371 Services furnished by rural health clinics.

AUTHORITY: Sec. 1102 of the Social Security Act, 49 Stat. 647 (42 U.S.C. 1302). SOURCE: 43 FR 45253, Sept. 29, 1978, unless otherwise noted.

Subpart A-Payments: General Provisions

§ 447.1 Purpose.

This subpart prescribes State plan requirements, FFP limitations and procedures concerning payments made by State medicaid agencies for medicaid services.

§ 447.10 Prohibition against reassignment of provider claims.

(a) Basis and purpose. This section implements sec. 1902(a)(32) of the Act which prohibits State payments for medicaid services to anyone other than a provider or recipient, except in specified circumstances.

(b) Definitions. For purposes of this section:

"Facility" means an institution that furnishes health care services to inpatients.

"Factor" means an individual or an organization, such as a collection agency or service bureau, that advances money to a provider for accounts receivable that the provider has assigned, sold or transferred to the individual organization for an added fee or a deduction of a portion of the accounts receivable. Factor does not include a business representative as described in paragraph (f) of this section.

"Organized health care delivery system" means a public or private organization for delivering health services. It includes, but is not limited to, a clinic, a group practice prepaid capitation plan, and a health maintenance organization.

(c) State plan requirements. A State plan must provide that the requirements of paragraphs (d) through (h) are met.

(d) Who may receive payment. Payment may be made only— (1) To the provider; or