Oregon Oregon Health Authority, Public Health Division
Administration of Home Health Agency
An agency shall clearly set forth in writing the organization, services provided, administrative control, and lines of authority for the delegation of responsibility to the patient care level. An agency shall not delegate administrative and supervisory functions to another agency, individual, or organization.(1) The primary agency shall monitor and control all services provided through contractual agreements between the primary agency and any patient service provider.(2) An agency shall maintain appropriate administrative records for each of its offices. If an agency has any branch offices, it shall ensure that each branch office is part of the agency and shares administration, supervision, and services on a daily basis.(3) If an agency chooses to provide professional students with a practicum in home health, the governing body must ensure that:(a) A contract between the agency and the accredited educational institution is in effect and it includes at a minimum, a description of:(A) Program objectives;(B) Program coordination;(C) Student supervision;(D) Adherence to agency policy; and(E) Conformance with applicable professional practice laws, rules, and regulations.(b) The agency maintains documentation of each practicum and the student’s activities, supervision and the evaluation of these activities.(c) The agency maintains documentation of patient care services provided by the student.(4) An agency’s governing body, or its designee, shall assume full legal and fiscal responsibility for the agency’s operation. The agency’s governing body shall provide for effective communication with administration of the agency and the owner of the agency.(5) An agency’s governing body shall:(a) Employ a qualified administrator, unless exempted under ORS 443.025 (Hospitals exempt from certain requirements if standards are met), who may also serve as Director of Professional Services;(b) Regularly monitor the performance of the administrator;(c) Appoint a professional policy-making committee;(d) Adopt and annually review its written by-laws or acceptable equivalent; and(e) Document all decisions affecting home health services.(6) The Administrator shall have the following qualifications:(a) A physician or registered nurse, currently licensed in Oregon, who has education, experience, and knowledge in community health service systems appropriate to the fulfillment of his/her responsibilities; or(b) An individual who has education, experience, and knowledge in a related community health service systems and at least one year overall administrative experience in home health care or related community health program appropriate to the fulfillment of his/her responsibilities.(7) The Administrator shall:(a) Have authority and responsibility for the agency’s overall management and operation;(b) Organize and direct the agency’s ongoing functions;(c) Maintain ongoing communication between agency’s governing body, professional policy-making committee, and staff;(d) Employ qualified personnel and ensure the provision of adequate staff education and the completion of performance evaluations;(e) Involve the Director of Professional Services in health care decisions;(f) Ensure the accuracy of information provided to the public regarding the agency and its services;(g) Implement an effective budgeting and accounting system;(h) Designate, in writing, an individual qualified to serve as acting administrator in the administrator’s absence; and(i) Ensure that adequate and appropriate staff resources are available and used to meet the care needs of the agency’s patients as identified in the plans of treatment.(8) The agency shall employ a Director of Professional Services who must be a physician or registered nurse. The agency shall ensure that the Director of Professional Services or a similarly qualified alternate, designated in writing, is available for consultation at all times during operating hours of the agency. The Director of Professional Services or designee shall have written authority, responsibility, and accountability for:(a) Functions, activities, and evaluations of all health care personnel;(b) The quality of home health services;(c) Orientation and in-service education for all agency health care personnel;(d) Coordination of home health services;(e) Development and documentation of all written material related to agency services, including policies, procedures, and standards;(f) Participation and involvement in employment decisions affecting home health care personnel;(g) Assignment of adequate and appropriate staff resources to meet the home health care needs of the agency’s patients; and(h) Designating, in writing, a person qualified to serve as acting Director of Professional Services in the Director’s absence.(9)(a) The agency shall develop personnel policies which must be appropriate to the agency, be documented, and include:(A) Hours of work;(B) Orientation that is appropriate to the classification of the employee. The following portions of the orientation shall be completed within two weeks of employment; and shall include at a minimum: policies and procedures of the agency; job description and responsibility; role as team member providing services in the home setting; and information regarding other community agencies, infection control, ethics and confidentiality.(C) An inservice program that provides ongoing education to ensure that staff skills are maintained for the responsibilities assigned and ensures that staff are educated in their responsibility in infection control;(D) Work performance evaluations;(E) Employee health program;(F) A tuberculosis infection control plan that includes provisions for employee assessment and screening for protecting patient and employees from tuberculosis in accordance with OAR 333-019-0041 (Other Disease Specific Provisions: Tuberculosis); and(G) Provisions for the completion of criminal records checks in accordance with ORS 443.004 (Criminal records check required for employees and volunteers providing direct care) and OAR 333-027-0064 (Criminal Records Check).(b) Personnel records shall include job descriptions, personnel qualifications, evidence of any required licensure or certification, evidence of orientation and performance evaluations, evidence of a completed criminal records check and fitness determination.(c) An agency may provide services by agency personnel working out of their individual homes within a portion of the geographic area served by an agency. The individual homes are not construed to be a branch. These services must be controlled, supervised, and evaluated by the agency, in accordance with all written agency policies. Such policies shall, at a minimum require documentation of:(A) A meeting at least every two weeks of the supervisor and the individual to review the plan(s) of treatment;(B) A telephone conference on at least a weekly basis between meetings;(C) Supervisor participation in the development of each plan of treatment; and(D) Procedures for submitting clinical and progress notes, summary reports, schedule of visits and periodic evaluations.(10) An agency contracting with individual personnel or public or private entities for home health care services shall maintain written contracts and shall clearly designate:(a) That patients are accepted for care only by the primary agency;(b) The services to be provided;(c) The rights and responsibilities of the contracting individual or entity in the coordination, supervision, and evaluation of the care or service provided;(d) The obligation to comply with all applicable agency policies;(e) The party with responsibility for development and revisions of the plan of treatment, patient assessment, progress reports, and patient care conferences, scheduling of visits or hours, and discharge planning;(f) Appropriate documentation of services provided on record forms provided by the agency; and(g) The terms of the agreement and basis for renewal or termination.(11) An agency, under the direction of the governing body, shall prepare and document an overall program plan and annual operating budget. The agency’s operating budget shall include all anticipated income and expenses related to items that would, under generally accepted accounting principles, be considered income and expense items. The agency’s overall program plan and budget shall be reviewed and updated at least annually by a committee consisting of representatives of the governing body, the administrative staff, and the professional staff of the agency.(12) An agency’s governing body shall appoint a professional policy-making committee composed of professional personnel associated with the agency.(a) The committee shall include one or more physicians and one or more registered nurses, at least two of whom are neither owners nor employees of the agency, and two consumers.(b) The committee shall establish in writing and review annually, the agency’s policies governing scope of services, admission and discharge policies, medical supervision, plans of treatment, emergency care, clinical records, personnel qualifications, and program evaluation.(c) The committee shall meet as needed to advise the agency on other professional issues.(d) The committee members shall participate with the agency staff in the annual evaluation of the agency’s program.(e) The agency shall document the committee’s systematic involvement and effective communication with the governing body and the management of the agency.