§ 51.445 Physician services.

As a condition of enrollment in adult day health care program, a participant must have a written physician order for admission. Each participant's medical record must contain the name of the participant's primary care physician. If a participant's medical needs require that the participant be placed in an adult day health care program that offers medical supervision, the primary care physician must state so in the order for admission. Each participant must remain under the care of a physician. (a) Physician supervision. If the adult day health care program offers medical supervision, the program management must ensure that (1) The medical care of each participant is supervised by a primary care physician; and (2) Another physician is available to supervise the medical care of participants when their primary care physician is unavailable. (b) Frequency of physician reviews. If the adult day health care program offers medical supervision: (1) The participant must be seen by the primary care physician at least annually and as indicated by a change of condition. (2) The program management must have a policy to help ensure that adequate medical services are provided to the participant. (3) At the option of the primary care physician, required reviews in the program after the initial review may alternate between personal physician reviews and reviews by a physician assistant, nurse practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section. (c) Availability of acute care. If the adult day health care program offers medical supervision, the program management must provide or arrange for the provision of acute care when it is indicated. (d) Availability of physicians for emergency care. In case of an emergency, the program management must ensure that participants are able to obtain necessary emergency care. (e) Physician delegation of tasks. (1) A primary care physician may delegate tasks to (i) A certified physician assistant or a certified nurse practitioner, or (ii) A clinical nurse specialist who- (A) Is acting within the scope of practice as defined by State law; and (B) Is under the supervision of the physician. (2) The primary care physician may not delegate a task when the provisions of this part specify that the primary care physician must perform it personally, or when the delegation is prohibited under State law or by the State home's policies.