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<regulation prefix="Regulation" num=".22" citation="COMAR 10.07.02.22" title_num="10" subtitle_num="07" chapter_num="02" heading="Specialized Rehabilitative Services — Occupational Therapy Services, Physical Therapy Services, Speech Pathology and Audiology Services.">
  <paragraph num="A.">
    <text>Rehabilitative Services — Admission Policies. In a nursing home which does not accept residents in need of specialized rehabilitative services, the minimal acceptable restorative service shall be the restorative nursing care plan designed to maintain function or improve the resident’s ability to carry out activities of daily living as set forth in Regulation .18G, of this chapter.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Arrangements for Services.</text>
    <paragraph num="(1)">
      <text>If a nursing home’s admission policies include the admission of residents requiring rehabilitative services, the nursing home shall provide, or arrange for under written agreement, specialized rehabilitative services by qualified personnel, such as a physical therapist, speech-language pathologist and audiologist, and occupational therapist.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Initiation of services to meet the rehabilitative needs of the resident shall occur within 48 hours, excluding Saturday, Sunday, and State and federal holidays, of the physician’s order for the specialized service.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The resident may not be accepted for admission if at least one service to meet the rehabilitative needs of the resident cannot be initiated within the 48-hour period, excluding Saturday, Sunday, and State and federal holidays.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Policies and Procedures.</text>
    <paragraph num="(1)">
      <text>Written administrative and resident care policies and procedures shall be developed for rehabilitative services by appropriate rehabilitation team members and representatives of the medical, administrative, and nursing staff.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Policies shall provide for the coordination of rehabilitative services and the rehabilitative aspects of nursing.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The nursing home shall make its administrative and resident care policies available for review by residents and the resident’s representative.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Written Plan of Care. Rehabilitative services shall be provided under a written plan of care, initiated by the attending physician, and developed in consultation with appropriate rehabilitation team members and the nursing service.</text>
  </paragraph>
  <paragraph num="E.">
    <text>Physician’s Orders.</text>
    <paragraph num="(1)">
      <text>Specialized rehabilitative services shall be provided only on written orders of the attending physician.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Orders shall include modalities to be used, frequency, and anticipated goals and shall be made a part of the resident care plan.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The physician shall review with the resident or the family or resident’s representative the goals and the treatment program. The frequency of communications between the physician and the rehabilitation team members shall depend on changes in the resident and the resident’s medical status.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Progress Notes.</text>
    <paragraph num="(1)">
      <text>Within 2 weeks of referral to specialized rehabilitative services, the rehabilitation team members shall provide the attending physician with a written report of the evaluation, including goals and progress of the resident.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Progress notes related to rehabilitative services shall be written at least every 2 weeks.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Reevaluation of Resident’s Progress.</text>
    <paragraph num="(1)">
      <text>The physician and the rehabilitation team members shall reevaluate the resident’s progress as necessary, but at least every 30 days.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The physician may document on the record that the reevaluation may be less frequent but in no case may the reevaluation exceed 60 days.</text>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>Resident’s Record.</text>
    <paragraph num="(1)">
      <text>The physician’s orders, the initial evaluations, the plan of rehabilitative care, goals, services rendered, evaluations of progress, and other pertinent information shall be:</text>
      <paragraph num="(a)">
        <text>Recorded in the resident’s medical record; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Dated and signed by the:</text>
        <paragraph num="(i)">
          <text>Physician ordering the service; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Those disciplines who provided the service.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The record and progress notes concerning the resident shall reflect at all times the most recent and current status of the resident, including current short-term and long-term goals.</text>
    </paragraph>
  </paragraph>
  <paragraph num="I.">
    <text>Proof of Licensure. The facility shall maintain a file which includes proof of current licensure of all the rehabilitative services' personnel.</text>
  </paragraph>
  <paragraph num="J.">
    <text>Job Descriptions. Current job descriptions for all rehabilitative services personnel shall be readily available in the facility.</text>
  </paragraph>
</regulation>