reglab/statecodes huggingface dataset:
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 2 - DEFINITIONS › Section 54127 - Nursing Service

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Nursing service means a service provided by the adult day
						health center which is organized, staffed and equipped to provide skilled
						nursing care to participants.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 2 - DEFINITIONS › Section 54129 - Occupational Therapy

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Occupational therapy as used in this Chapter means
						services rendered by an occupational therapist to train or strengthen muscles
						or nerve functions. Services shall include, but are not limited to,
						modification of the environment and training in self-help for activities of
						daily living.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 2 - DEFINITIONS › Section 54131 - Participant

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Participant means a Medi-Cal beneficiary who has been
						accepted by the adult day health center's Intake and Assessment Unit,
						voluntarily signs an Agreement of Participation, and whose application for
						participation in an adult day health center has been approved by the
						Department.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 2 - DEFINITIONS › Section 54133 - Psychiatric and Psychological Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Psychiatric services means services
					 performed by a physician trained or experienced in psychiatry.
(b) Psychology services means services
					 provided by a:
(1) Psychologist.
(2) Psychological assistant under the
					 direction and supervision of a psychologist or board certified
					 psychiatrist.
(3) A psychiatric
					 social worker who is a licensed clinical social worker working in consultation
					 with a psychologist or board certified psychiatrist.
(4) A psychiatric nurse who meets the
					 qualifications of Section
					 78337.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 2 - DEFINITIONS › Section 54135 - Service Area

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Service area means the geographic area in which the adult
						day health center is authorized to provide service. Unless otherwise specified,
						the service area shall be so limited that no participant will be in transit
						utilizing ground transportation more than one hour from his or her home to the
						center.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 2 - DEFINITIONS › Section 54137 - Staff Physician Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Staff physician services means those services provided by
						a physician employed by the adult day health care provider.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 2 - DEFINITIONS › Section 54139 - Subcontract

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Subcontract
					 means any agreement between the adult day health care provider and any of the
					 following:
(1) A provider of services, as
					 defined in Section
					 51051, and any other organization
					 that provides services to Medi-Cal beneficiaries in order to meet the
					 requirements of this Chapter.
(2)
					 An organization or person that performs administrative functions or services
					 for the operation of the program specifically related to meeting the
					 requirements of this Chapter.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 2 - DEFINITIONS › Section 54141 - Supervision

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Supervision
					 means the instruction and direction of an employee or subordinate in the
					 performance of assigned duties. Supervision does not necessarily require the
					 immediate presence of the supervisor.
(1)
					 Direct supervision means that the supervisor shall be present in the same
					 building as the person being supervised and available for consultation and
					 assistance.
(2) Immediate
					 supervision shall mean that the supervisor shall be physically present while
					 the task is being performed.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 3 - ELIGIBILITY, PARTICIPATION AND DISCHARGE › Section 54201 - Eligibility

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Adult day health care services may be provided to
						eligible Medi-Cal beneficiaries who have medical or psychiatric impairment, who
						meet the criteria stated in Section
						54209, and who are one of the
						following:
(a) Not inpatients in a
					 licensed health facility.
(b)
					 Inpatients in a licensed health facility who are provided transition visits in
					 accordance with Section
					 54504.
1.
						Amendment filed 2-11-83; effective thirtieth day thereafter (Register 83, No.
						7).
Note: Authority cited: Section
						  14570,
						  Welfare and Institutions Code. Reference: Section
						  14525,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 3 - ELIGIBILITY, PARTICIPATION AND DISCHARGE › Section 54203 - Participation

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Participation
					 by an eligible Medi-Cal beneficiary in adult day health care program shall
					 require:
(1) A written request from a
					 physician.
(2) A multidisciplinary
					 team assessment.
(3) An agreement
					 of participation signed by the participant or the participant's guardian or
					 conservator.
(4) Approval by the
					 Department.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 3 - ELIGIBILITY, PARTICIPATION AND DISCHARGE › Section 54205 - Physician Request

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Adult day health care services shall be requested in writing by a physician.
					 The request shall include:
(1) Principal and
					 significant diagnoses.
(2)
					 Prognosis.
(3) Specific type of
					 treatment and anticipated duration.
(4) Overall therapeutic goals for the
					 participant.
(5) Medications and
					 special diets.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 3 - ELIGIBILITY, PARTICIPATION AND DISCHARGE › Section 54207 - Multidisciplinary Team Assessment

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Each applicant shall be assessed by a
					 multidisciplinary team prior to acceptance into the program. The assessment
					 shall be conducted by the adult day health care provider in order to ascertain
					 the individual's pathological diagnosis, physical disabilities, functional
					 abilities, psychological status and social and physical environment. The
					 assessment shall include:
(1) Contact with
					 the applicant's physician to obtain the individual's medical history and a
					 statement indicating the applicant's restrictions and medications and absence
					 of infectious disease. If the applicant does not have a personal physician, the
					 center shall assist the individual in finding one. An initial physical
					 examination may be done by the staff physician or by a nurse practitioner under
					 the supervision of a physician to the extent allowed under state law.
(2) Assessment of the home environment based
					 on a home visit within the last 12 months. The assessment shall include:
(A) Living arrangements.
(B) Relationship with family or other
					 person.
(C) Facilities available
					 such as heat, bath, toilet, stove.
(D) Existence of environmental barriers such
					 as stairs or other features not negotiable by the impaired
					 individual.
(E) Access to
					 transportation, shopping, church or other needs of the
					 individual.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 3 - ELIGIBILITY, PARTICIPATION AND DISCHARGE › Section 54209 - Prior Authorization

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Adult day health care services except for
					 the initial assessment and reassessments shall require prior authorization by
					 the Medi-Cal Consultant. The request for authorization shall:
(1) Be initiated by the center and shall
					 include the results of an individual's multidisciplinary assessment conducted
					 by the center within the last 30 days and the participant's plan of
					 care.
(2) Be approved and signed by
					 a physician.
(3) Include a
					 statement describing the patient's progress toward achieving the therapeutic
					 goals.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 3 - ELIGIBILITY, PARTICIPATION AND DISCHARGE › Section 54211 - Multidisciplinary Team

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The
					 multidisciplinary team conducting the assessment pursuant to Section
					 54207 shall consist of at least a
					 physician, nurse, social worker, occupational therapist and physical therapist.
					 The physician may be either a salaried staff member of the adult day health
					 center or the participant's physician. When indicated by the needs of the
					 participant, a psychiatrist, psychologist, psychiatric social worker, speech
					 therapist and dietitian shall be included as members of the assessment team and
					 assist in the assessment.
(b) The
					 multidisciplinary assessment team shall:
(1)
					 Determine the medical, psychosocial and functional status of each
					 participant.
(2) Develop an
					 individualized plan of care including goals, objectives and services designed
					 to meet the needs of the person. The plan shall be signed by each member of the
					 team, except that the signature of only one physician member of the team shall
					 be required.
(A) The individualized plan of
					 care shall include:
1. Medical
					 diagnoses.
2. Prescribed
					 medications and frequency.
3.
					 Scheduled days of attendance.
4.
					 Specific type, number of units of service and frequency of individual services
					 to be given on a monthly basis.
5.
					 The specific elements of the services which need to be identified with
					 individual objectives, therapeutic goals and duration of treatment.
6. An individualized activity plan designed
					 to meet the needs of the participant for social and therapeutic recreational
					 activities.
7. Participation in
					 specific group activities.
8. A
					 plan to meet transportation needs.
9. Therapeutic diet requirements, dietary
					 counseling and education if indicated.
10. A plan for other needed services which
					 the adult day health center will coordinate.
11. Prognosis and prospective length of
					 stay.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 3 - ELIGIBILITY, PARTICIPATION AND DISCHARGE › Section 54213 - Discharge

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Participation
					 in an adult day health program shall be voluntary. The participant may
					 terminate participation at any time. However, if the assessment team has found
					 the participant's condition to be of such serious nature that continued
					 treatment is essential to prevent institutionalization, the participant shall
					 be informed in writing that termination is counter to the participant's best
					 interest. A copy of the letter shall be sent to the participant's personal
					 physician and the Department.
(b)
					 Discharge shall be mandatory when:
(1) The
					 participant notifies the adult day health care center either orally or in
					 writing of intent to discontinue participation. The date of discharge shall be
					 the date of notification or a later date designated by the
					 participant.
(2) The participant
					 leaves the service area permanently.
(3) The participant requests discharge from
					 the Department either orally or in writing. The date of discharge shall be as
					 in (1).
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 3 - ELIGIBILITY, PARTICIPATION AND DISCHARGE › Section 54215 - Reassessment

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Reassessment,
					 at least quarterly, shall include:
(1)
					 Progress achieved.
(2) Review and
					 revision of goals and objectives.
(3) Revision or continuation of the
					 individual plan of care.
(4)
					 Preparation of a reauthorization request for continuing
					 care.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 3 - ELIGIBILITY, PARTICIPATION AND DISCHARGE › Section 54217 - Beneficiary Agreement of Participation

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) When the initial assessment has been
					 completed and the individualized plan of care prepared, an agreement of
					 participation on forms furnished by the Department shall be prepared by the
					 adult day health care provider and discussed with the prospective participant
					 or the participant's guardian or conservator.
(b) If the terms of agreement are
					 satisfactory, the participant shall sign the statement. The statement shall be
					 sent to the Department with the initial Treatment Authorization Request. The
					 signing of the agreement of participation does not mandate participation and
					 the participant may end participation at any time.
(c) Statement that the participant
					 understands that services beyond the amounts included in each adult day health
					 center's staffing requirements as set forth in Section
					 54423(a) are
					 subject to prior authorization by a Medi-Cal consultant.
1.
						Amendment filed 9-19-79; effective thirtieth day thereafter (Register 79, No.
						38).
Note: Authority cited: Chapter 1066, Statutes of 1977.
						  Reference: Chapter 1066, Statutes of
						  1977.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 3 - ELIGIBILITY, PARTICIPATION AND DISCHARGE › Section 54221 - Hours of Operation

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Centers shall be open to participants for no less than 6 hours and no more than
					 12 hours during each calendar day of operation.
(b) Programs will operate at least five days
					 a week. Adjustment may be made in the hours or days of operation:
(1) To accommodate working relatives of
					 participants.
(2) In response to
					 other special circumstances.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 3 - ELIGIBILITY, PARTICIPATION AND DISCHARGE › Section 54223 - Attendance

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Attendance
					 shall be regular and planned. Treatment needs of the participant shall
					 determine the frequency and duration of attendance. The number of days
					 scheduled shall be governed by the least time needed to carry out an individual
					 plan of care related to the needs of the participant and his or her
					 family.
(b) Participants shall not
					 be encouraged to attend more frequently than necessary for achievement of
					 individual goals and objectives.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 4 - SERVICES AND STANDARDS › Section 54301 - Certification

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Each adult day
					 health center shall:
(1) Be licensed or have
					 a special permit pursuant to Chapter 3.5, commencing with Section
					 1570, Division 2, Health and
					 Safety Code, to provide adult day health care.
(2) Have appropriate licensed and allied
					 health personnel to provide services in accordance with the requirements of
					 this Chapter.
(3) Have a written
					 description of its philosophy, objectives and program for providing medical and
					 ancillary health related services available for public inspection.
(4) Demonstrate to the satisfaction of the
					 Department that staff and facilities are adequate to provide the planned
					 services described in its written program.
(5) Provide or arrange for, through written
					 agreement, nonroutine medical services which may become necessary.
(6) Execute a written agreement with each
					 participant which specifies but is not limited to, a list of basic services
					 which are to be furnished each visit or according to a specified
					 schedule.
(7) When serving a
					 substantial number of participants of a particular racial group, or whose
					 primary language is other than English, employ staff of that particular racial
					 or linguistic group at all times.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 4 - SERVICES AND STANDARDS › Section 54303 - Denial of Initial Certification

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The Director shall deny application for
					 certification if the applicant has:
(1) Not
					 been approved as a licensed adult day health care provider.
(2) Failed to meet the requirements of
					 Section 54301, or any other applicable
					 requirements of the statutes or regulations relating to the California Medical
					 Assistance Program.
(3) Previously
					 violated Department regulations and there is probability of noncompliance by
					 the applicant.
(4) Failed to
					 correct violations of regulations pertaining to licensure or Medi-Cal
					 certification.
(5) Failed to comply
					 with the approved adult day health care county plan.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 4 - SERVICES AND STANDARDS › Section 54305 - Termination or Suspension of Certification

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Certification shall be suspended or
					 revoked for any of the following:
(1)
					 Violation of any statute or regulation relating to the California Medical
					 Assistance Program.
(2) Aiding,
					 abetting or permitting the violation of applicable statutory provisions or
					 regulations of the Department.
(3)
					 Conduct in the operation or maintenance of an adult day health center which is
					 inimical to the health, morals, welfare or safety of either participant
					 receiving services from the center or the people of the State of
					 California.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 4 - SERVICES AND STANDARDS › Section 54307 - Denial of Renewal of Certification

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The Director shall deny an application
					 for renewal of certification as a provider of adult day health care services if
					 the applicant:
(1) Was party to an action
					 which resulted in denial, suspension or revocation of license as an adult day
					 health care provider.
(2) Is not
					 currently certified as a Medi-Cal provider because of suspension or disapproval
					 of an application for certification.
(3) Has previously violated Department
					 regulations and there is probability of noncompliance by the
					 applicant.
(4) Has failed to
					 correct violation of regulations pertaining to other licensure and Medi-Cal
					 certification.
(5) Is not in
					 compliance with the approved Adult Day Health County Plan.
(6) Would be denied certification under
					 Section 54303.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 4 - SERVICES AND STANDARDS › Section 54309 - Required Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Each adult day health center shall provide directly on the premises, at least
					 the following services:
(1) Rehabilitation
					 services, including:
(A) Physical therapy as
					 specified in Section
					 54313.
(B) Occupational therapy as specified in
					 Section 54315.
(C) Speech therapy as specified in Section
					 54317.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 4 - SERVICES AND STANDARDS › Section 54311 - Optional Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Each adult day health center may arrange for the following additional services.
					 These services shall be separately billed by the provider according to the
					 requirements of Article 7, Chapter 3, Division 3, Title 22, California
					 Administrative Code.
(1) Podiatric services
					 arranged for by the supervising physician.
(2) Visual care screening and advice for
					 low-vision cases by a licensed ophthalmologist or optometrist, following
					 referral and arrangement by the supervising physician.
(3) Dental screening for the purpose of
					 apprising the participant of the necessity of regular or emergency dental care,
					 which is arranged for by the supervising physician.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 4 - SERVICES AND STANDARDS › Section 54313 - Physical Therapy Service

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The
					 physical therapy service shall:
(1) Provide:
(A) Muscle, nerve joint and functional
					 ability tests.
(B) Treatment to
					 relieve pain, develop or restore function.
(C) Assistance to achieve and maintain
					 maximum performance using physical means such as exercise, massage, heat,
					 sound, water, light or electricity.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 4 - SERVICES AND STANDARDS › Section 54315 - Occupational Therapy Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Occupational therapy services shall:
(1) Reevaluate the participant as the
					 condition changes and modify treatment goals consistent with these
					 changes.
(2) Decrease or eliminate
					 disability during participant's initial phase of recovery following injury or
					 illness.
(3) Increase or maintain
					 the participant's capability for independence.
(4) Enhance the participant's physical,
					 emotional and social well-being.
(5) Develop function to a maximum
					 level.
(6) Guide participants in
					 the use of therapeutic, creative and self-care activities for improving
					 function.
(7) Require that
					 occupational therapists:
(A) Record
					 treatments, each day, in the participant's health record. Each entry shall be
					 signed.
(B) Record quarterly
					 progress notes. Each entry shall be signed and dated.
(C) Review and initial all evaluations and
					 the discharge summary.
(8) Develop personnel policies which define
					 the occupational therapy responsibilities and the duties assigned to the
					 occupational therapy assistant.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 4 - SERVICES AND STANDARDS › Section 54317 - Speech Therapy Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Speech therapy services shall:
(1) Evaluate
					 participants and develop necessary plans for appropriate speech and language
					 therapy.
(2) Instruct other health
					 team personnel and family members in methods of assisting the participant to
					 improve and correct speech disorders.
(3) Require that speech therapists:
(A) Record treatments, each day, in the
					 participant's health record. Each entry shall be signed.
(B) Record quarterly progress notes. Each
					 entry shall be signed and dated.
(C) Review and initial all evaluations and
					 the discharge summary.
(4) Develop personnel policies which define
					 the duties of the speech therapist and allied personnel.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 4 - SERVICES AND STANDARDS › Section 54319 - Staff Physician Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Staff physician services shall include consultation to staff and may include
					 the following limited direct services to the participant:
(1) Periodic physical examination as part of
					 the assessment process.
(2)
					 Consultation with the participant's physician.
(3) Minor, incidental or occasional
					 treatment.
(4) The development of
					 the medical component of the individual participant's plan of care, except when
					 this component is developed by the participant's physician who retains primary
					 responsibility for all medical care provided to the
					 participant.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 4 - SERVICES AND STANDARDS › Section 54321 - Personal Physician

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Close liaison shall be maintained with the participant's personal physician.
					 The personal physician shall retain primary responsibility for the medical care
					 of the participant.
(b) The
					 personal physician shall be:
(1) Requested to
					 provide the report of physical examination and medical history required for
					 initial evaluation.
(2) Requested
					 to sign the Medi-Cal treatment authorization request for prior authorization if
					 the adult day health center does not have a staff physician.
(3) Informed, on a regular basis, of the
					 participant's status and progress.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 4 - SERVICES AND STANDARDS › Section 54323 - Nursing Service

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The
					 nursing service shall, as a minimum:
(1)
					 Assess each participant to determine needs for personal care and assistance in
					 activities of daily living such as bathing, grooming, toileting and eating;
					 include these needs in the plan of care and supervise the provision of these
					 services.
(2) Specify short-term
					 and long-term nursing goals in each individualized plan of care.
(3) Document all skilled nursing care
					 provided on the day the service is given and include quarterly signed and dated
					 progress notes in each participant record.
(4) Provide health education and counseling
					 to the participant and family when indicated by the plan of care.
(5) Provide assistance to the participant in
					 obtaining medical services from providers other than adult day health
					 staff.
(6) Monitor, administer and
					 record prescribed medications as follows:
(A)
					 Medication shall be given only on the prescriber's order.
(B) Participants shall be identified prior to
					 the administration of a drug.
(C)
					 Medication shall be administered within one hour of the prescribed
					 time.
(D) Time and doses of each
					 drug administered must be recorded in the participant's record by the nurse who
					 gave the drug.
(7)
					 Provide training in self-administration of medications to
					 participants.
(8) Provide liaison
					 to the participant's personal physician.
(9) Develop the nursing component in the plan
					 of care for each participant capable of benefiting from a continence training
					 program.
(10) Provide observation
					 and monitoring of health status.
(11) Provide supportive and restorative
					 nursing as indicated by the treatment plan.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 4 - SERVICES AND STANDARDS › Section 54325 - Psychiatric and Psychological Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Each adult day health center shall have a
					 consultant psychiatrist, psychologist, psychiatric social worker or psychiatric
					 nurse who shall make assessments of participants when indicated, develop an
					 individualized plan of care, supervise the carrying out of these plans and do
					 reassessments. The consultant psychiatrist, psychologist, psychiatric social
					 worker or psychiatric nurse shall provide consultation services to center staff
					 at least three hours per month.
(b)
					 Consultant services are indicated when:
(1)
					 The participant's diagnoses or medical history indicate a mental, emotional or
					 behavioral problem.
(2) Information
					 from the participant's family indicates mental, emotional or behavioral
					 problems may exist.
(3) The
					 psychosocial assessment developed by the social worker indicates apparent
					 mental, emotional or behavioral problems that need further assessment by a
					 psychiatrist, psychologist, psychiatric social worker or psychiatric
					 nurse.
(4) Observation by center
					 staff indicates the need for psychiatric or psychological
					 assessment.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 4 - SERVICES AND STANDARDS › Section 54327 - Personal Psychiatrist and Psychologist Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The adult day health center shall
					 maintain close liaison with the attending psychologist or psychiatrist
					 providing services to a participant. The psychologist or psychiatrist shall
					 maintain primary responsibility for the psychological or psychiatric treatment
					 of the participant and shall be kept informed of the participant's health
					 status. Any psychologic or psychiatric services provided by the center shall be
					 coordinated with the attending psychiatrist or psychologist.
(b) The center shall assist the participant
					 in obtaining psychiatric or psychological services determined to be
					 necessary.
(c) An attending
					 psychiatrist or psychologist for an individual participant who is also the
					 consultant psychiatrist or psychologist for the adult day health center, may
					 not bill for services provided at the center for this participant in the manner
					 prescribed in Article 7, Chapter 3, Division 3, Title 22, California
					 Administrative Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 4 - SERVICES AND STANDARDS › Section 54329 - Medical Social Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Medical social services shall as a minimum:
(1) Interview and screen all referrals to
					 determine the general appropriateness of the prospective participant for the
					 full assessment process and adult day health care participation.
(2) Provide referral for persons not
					 appropriate for adult day health care.
(3) Provide a signed and dated documentation
					 for all service performed the day the service is provided and include signed
					 and dated quarterly progress reports in each participant record.
(4) Provide for periodic reevaluation and
					 revision of plan of care.
(5)
					 Provide counseling and referral to available community resources.
(6) Promote peer group relationship through
					 problem-centered discussion group and task oriented committees.
(7) Serve as liaison with the participant's
					 family and home.
(8) Serve as
					 liaison with other community agencies who may be providing services to a
					 participant and work with these agencies to coordinate all services delivered
					 to the participant to meet the participant's needs and avoid duplication.
					 Liaison shall include, but not be limited to the following agencies:
(A) In-Home Supportive Services in the county
					 welfare department.
(B) Home Health
					 Agency providers.
(9)
					 Provide discharge planning for all discharged participants.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 4 - SERVICES AND STANDARDS › Section 54331 - Nutrition Service

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The
					 nutrition service shall as a minimum:
(1) Be
					 staffed and equipped to assure that food provided to the participants is safe,
					 appetizing and provides for nutritional needs.
(2) Include dietary counseling and education
					 as part of the nutrition service.
(3) Provide at least one meal to each
					 participant who is present for four hours. The meal shall provide one-third of
					 the recommended dietary allowance of the Nutrition Board of the National
					 Research Council, National Academy of Science.
(4) Each participant who is in the center for
					 eight hours shall be served a meal and between meal nourishments that shall
					 supply at least one-half of the recommended dietary allowance of the Nutrition
					 Board of the National Research Council, National Academy of
					 Science.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 4 - SERVICES AND STANDARDS › Section 54333 - Transportation

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Transportation
					 shall be provided only if necessary. Persons who live within walking distance
					 of the center and who are sufficiently mobile shall be encouraged to walk to
					 the center.
(b) Family members
					 shall be encouraged to provide nonmedical transportation for the participant if
					 specially equipped vehicles are not needed. Volunteers may also be utilized to
					 provide transportation.
(c)
					 Transportation to and from participants' homes shall be scheduled to insure
					 that participant one-way transit time does not exceed one hour.
(d) Medical transportation shall be supplied
					 by either the center's own vehicles or by contract with other transportation
					 services to facilitate regular attendance and prompt arrival and departure. If
					 there is an existing transportation system in the area which is equipped to
					 handle handicapped persons and is capable of providing the level of service,
					 medical transportation service shall be purchased from that system. Vehicles
					 used for nonmedical transportation shall be in good condition. Vehicles used
					 for medical transportation shall meet the qualifications stated in Section
					 51151.
(e) Vehicle operators employed by the center
					 shall maintain good driving records and shall have an appropriate operator's
					 license. The vehicle operator shall be responsible for maintaining a schedule
					 of transportation to and from the center. The driver or the driver's assistant
					 shall assist the participant in and out of home and vehicle as
					 necessary.
(f) If a participant
					 does not appear for transportation or come to the center on a scheduled day of
					 attendance, prompt follow-up shall be made to determine the reason. Efforts
					 should be made to determine if the participant is helpless and unable to answer
					 the door or phone or has gone away for the day.
(g) Participants who know that they will not
					 attend on a scheduled day, shall notify the center.
(h) If the participant is ill, the adult day
					 health center shall determine by visit or by telephone call the extent of the
					 illness and make arrangements for proper treatment if indicated, such as
					 notifying the participant's physician, family or arranging for home health
					 services.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 4 - SERVICES AND STANDARDS › Section 54335 - Emergency Service

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Each adult day health center shall provide a readily available source of
					 emergency health services.
(1) The
					 participant, or the participant's sponsor shall sign an agreement granting the
					 center permission to transfer the participant to a hospital or other health
					 facility in case of emergency.
(2)
					 The center shall maintain written agreements for emergency medical care which
					 shall include:
(A) An on-call
					 physician.
(B) Hospital or
					 emergency room care.
(C) Medical
					 transportation.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 4 - SERVICES AND STANDARDS › Section 54337 - Program Aides

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Program aides may be full-time or part-time employees. Aides shall evidence
					 capacity for learning, the ability to comprehend the use of written and spoken
					 English and shall have personal qualities conducive to good interpersonal
					 relationships with demonstrated competence in helping others.
(b) Program aides, under the supervision of
					 the program director or of members of the multidisciplinary assessment team,
					 shall perform assigned tasks involving:
(1)
					 Support of major group activity and recreational programs.
(2) Transportation of participants to and
					 from the adult day health center.
(3) Arranging for appointments for
					 participants outside the center.
(4) Assistance in personal care under nursing
					 supervision.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 4 - SERVICES AND STANDARDS › Section 54339 - Activity Program

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The
					 activity program shall be staffed and equipped to meet the needs and interests
					 of each participant and shall encourage self-care and resumption of normal
					 activities. Participants shall be encouraged to participate in activities
					 suited to their individual needs. The activity program shall provide a planned
					 schedule of social and other purposeful independent or group activities.
					 Opportunities shall be provided for involvement, both individual and group, in
					 the planning and implementation of the activity programs.
(b) The primary objectives of activity
					 programs shall be to encourage the participant toward restoration to self-care
					 and the resumption of normal activities or for those who cannot realistically
					 resume normal activities, to prevent further mental or physical
					 deterioration.
(c) The individual
					 plan of care of each participant shall include an individual activity plan.
					 This plan shall be reviewed quarterly.
(d) Each adult day health center shall
					 designate an activity coordinator who shall be a full-time employee of the
					 center. The activity coordinator shall have the following duties:
(1) Assess the needs and interests of each
					 participant and develop an individualized activity plan as part of the
					 individualized plan of care developed by the assessment team.
(2) Record, date and sign quarterly progress
					 notes in each participant record.
(3) Provide or supervise the provision of
					 activities specified in the activity plan.
(4) Develop, implement and supervise the
					 activity program.
(5) Schedule and
					 post planned activities.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 5 - ADMINISTRATION › Section 54401 - Organization and Administration

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Each adult day health center shall be
					 organized and staffed to carry out the requirements of this Chapter. Staffing
					 and administrative requirements and capabilities shall include:
(1) An administrator.
(2) A program director with appropriate
					 qualifications.
(3) Sufficient
					 clerical supportive staff to conduct the center's daily business in an orderly
					 manner.
(4) A grievance
					 procedure.
(5) The ability to
					 provide data reports required by the Department.
(6) Financial records and books of account
					 fully disclosing the disposition of all funds received. Fiscal reports shall be
					 submitted quarterly to the Department in the format prescribed by the
					 Department.
(7) Appropriately
					 qualified staff in sufficient numbers to provide an adequate scope of services
					 and to meet the staffing requirements stated in Section
					 54423.
(8) Ethnic or linguistic staff as indicated
					 by participant characteristics.
(9)
					 Participant records maintained in a format approved by the
					 Department.
(10) Adequate personnel
					 records.
(11) Nondiscrimination by
					 and to participants and staff.
(12)
					 Confidentiality of data maintained as stated in Section
					 54439.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 5 - ADMINISTRATION › Section 54403 - Administrator

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Each center
					 shall have an administrator. The administrator shall have the responsibility
					 and authority to carry out the policies of the licenses. The licensee shall
					 notify the Department in writing within 14 working days following a change of
					 administrator. Notification shall include the new administrator's name, mailing
					 address, effective date of office, background, qualifications and Social
					 Security number.
(b) An
					 administrator shall have the following qualifications:
(1) Knowledge of supervision and care
					 appropriate to the participants receiving services.
(2) Ability to conform to the applicable
					 laws, rules and regulations.
(3)
					 Ability to maintain or supervise the maintenance of financial and other
					 records.
(4) Ability to direct the
					 work of others.
(5) Be of good
					 character and maintain a reputation of personal integrity.
(6) Graduation from an accredited college or
					 university, in a field related to the program, and either of the following:
(A) A master's degree plus one year of
					 successful experience in a responsible managerial, administrative or
					 supervisory position in a social or health service program or agency.
(B) A bachelor's degree plus three years of
					 successful experience in a responsible managerial, administrative or
					 supervisory position in a social or health service program or
					 agency.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 5 - ADULT DAY HEALTH CARE › Article 5 - ADMINISTRATION › Section 54405 - Program Director

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Each center shall have a full-time program director during hours of operation.
					 The administrator may serve in this capacity if the administrator meets the
					 qualifications. The program director shall be on the premises and available to
					 participants and their relatives and employees. When the program director is
					 temporarily absent, another adult on the staff shall be designated to serve as
					 the acting program director. When the program director is expected to be or has
					 been absent for more than one month, the acting program director shall meet the
					 qualifications of the program director.
(b) The program director shall be a qualified
					 professional in the field of nursing, social work, psychology or recreational,
					 occupational or physical therapy with demonstrated or potential competence in
					 working with the impaired, elderly living at home. The director shall be
					 knowledgeable of physical, social and mental health programs operating within a
					 licensed health facility or clinic. The director shall have no other duties
					 than those related to adult day health care and during those hours shall not be
					 included in the staff ratios of any other licensed facility.
(c) The duties of the program director shall
					 include:
(1) Developing the program in
					 accordance with the needs of the participants served.
(2) Implementing and coordinating the
					 program.
(3) Evaluating the
					 participant's changing needs and making necessary program
					 adjustments.
(4) Supervising
					 employees and volunteers.