42 C.F.R. Subpart A—General Provisions
Title 42 - Public Health
(a) Basis and scope. This part is based on the indicated provisions of the following sections of the Act: (1) Sections 1861(o) and 1891 establish the conditions that an HHA must meet in order to participate in Medicare. (2) Section 1861(z) specifies the Institutional planning standards that HHAs must meet. (3) Section 1895 provides for the establishment of a prospective payment system for home health services covered under Medicare. (b) This part also sets forth additional requirements that are considered necessary to ensure the health and safety of patients. [60 FR 50443, Sept. 29, 1995, as amended at 65 FR 41211, July 3, 2000] As used in this part, unless the context indicates otherwise—Bylaws or equivalent means a set of rules adopted by an HHA for governing the agency's operation. Branch office means a location or site from which a home health agency provides services within a portion of the total geographic area served by the parent agency. The branch office is part of the home health agency and is located sufficiently close to share administration, supervision, and services in a manner that renders it unnecessary for the branch independently to meet the conditions of participation as a home health agency. Clinical note means a notation of a contact with a patient that is written and dated by a member of the health team, and that describes signs and symptoms, treatment and drugs administered and the patient's reaction, and any changes in physical or emotional condition. HHA stands for home health agency. Nonprofit agency means an agency exempt from Federal income taxation under section 501 of the Internal Revenue Code of 1954. Parent home health agency means the agency that develops and maintains administrative controls of subunits and/or branch offices. Primary home health agency means the agency that is responsible for the services furnished to patients and for implementation of the plan of care. Progress note means a written notation, dated and signed by a member of the health team, that summarizes facts about care furnished and the patient's response during a given period of time. Proprietary agency means a private profit-making agency licensed by the State. Public agency means an agency operated by a State or local government. Subdivision means a component of a multi-function health agency, such as the home care department of a hospital or the nursing division of a health department, which independently meets the conditions of participation for HHAs. A subdivision that has subunits or branch offices is considered a parent agency. Subunit means a semi-autonomous organization that— (1) Serves patients in a geographic area different from that of the parent agency; and (2) Must independently meet the conditions of participation for HHAs because it is too far from the parent agency to share administration, supervision, and services on a daily basis. Summary report means the compilation of the pertinent factors of a patient's clinical notes and progress notes that is submitted to the patient's physician. Supervision means authoritative procedural guidance by a qualified person for the accomplishment of a function or activity. Unless otherwise specified in this part, the supervisor must be on the premises to supervise an individual who does not meet the qualifications specified in §484.4. Staff required to meet the conditions set forth in this part are staff who meet the qualifications specified in this section. Administrator, home health agency. A person who: (a) Is a licensed physician; or (b) Is a registered nurse; or (c) Has training and experience in health service administration and at least 1 year of supervisory or administrative experience in home health care or related health programs. Audiologist. A person who: (a) Meets the education and experience requirements for a Certificate of Clinical Competence in audiology granted by the American Speech-Language-Hearing Association; or (b) Meets the educational requirements for certification and is in the process of accumulating the supervised experience required for certification. Home health aide. Effective for services furnished after August 14, 1990, a person who has successfully completed a State-established or other training program that meets the requirements of §484.36(a) and a competency evaluation program or State licensure program that meets the requirements of §484.36 (b) or (e), or a competency evaluation program or State licensure program that meets the requirements of §484.36 (b) or (e). An individual is not considered to have completed a training and competency evaluation program, or a competency evaluation program if, since the individual's most recent completion of this program(s), there has been a continuous period of 24 consecutive months during none of which the individual furnished services described in §409.40 of this chapter for compensation. Occupational therapist. A person who: (a) Is a graduate of an occupational therapy curriculum accredited jointly by the Committee on Allied Health Education and Accreditation of the American Medical Association and the American Occupational Therapy Association; or (b) Is eligible for the National Registration Examination of the American Occupational Therapy Association; or (c) Has 2 years of appropriate experience as an occupational therapist, and has achieved a satisfactory grade on a proficiency examination conducted, approved, or sponsored by the U.S. Public Health Service, except that such determinations of proficiency do not apply with respect to persons initially licensed by a State or seeking initial qualification as an occupational therapist after December 31, 1977. Occupational therapy assistant. A person who: (a) Meets the requirements for certification as an occupational therapy assistant established by the American Occupational Therapy Association; or (b) Has 2 years of appropriate experience as an occupational therapy assistant, and has achieved a satisfactory grade on a proficiency examination conducted, approved, or sponsored by the U.S. Public Health Service, except that such determinations of proficiency do not apply with respect to persons initially licensed by a State or seeking initial qualification as an occupational therapy assistant after December 31, 1977. Physical therapist. A person who is licensed as a physical therapist by the State in which practicing, and (a) Has graduated from a physical therapy curriculum approved by: (1) The American Physical Therapy Association, or (2) The Committee on Allied Health Education and Accreditation of the American Medical Association, or (3) The Council on Medical Education of the American Medical Association and the American Physical Therapy Association; or (b) Prior to January 1, 1966, (1) Was admitted to membership by the American Physical Therapy Association, or (2) Was admitted to registration by the American Registry of Physical Therapist, or (3) Has graduated from a physical therapy curriculum in a 4-year college or university approved by a State department of education; or (c) Has 2 years of appropriate experience as a physical therapist, and has achieved a satifactory grade on a proficiency examination conducted, approved, or sponsored by the U.S. Public Health Service except that such determinations of proficiency do not apply with respect to persons initially licensed by a State or seeking qualification as a physical therapist after December 31, 1977; or (d) Was licensed or registered prior to January 1, 1966, and prior to January 1, 1970, had 15 years of full-time experience in the treatment of illness or injury through the practice of physical therapy in which services were rendered under the order and direction of attending and referring doctors of medicine or osteopathy; or (e) If trained outside the United States, (1) Was graduated since 1928 from a physical therapy curriculum approved in the country in which the curriculum was located and in which there is a member organization of the World Confederation for Physical Therapy. (2) Meets the requirements for membership in a member organization of the World Confederation for Physical Therapy, Physical therapist assistant. A person who is licensed as a physical therapist assistant, if applicable, by the State in which practicing, and (1) Has graduated from a 2-year college-level program approved by the American Physical Therapy Association; or (2) Has 2 years of appropriate experience as a physical therapist assistant, and has achieved a satisfactory grade on a proficiency examination conducted, approved, or sponsored by the U.S. Public Health Service, except that these determinations of proficiency do not apply with respect to persons initially licensed by a State or seeking initial qualification as a physical therapy assistant after December 31, 1977. Physician. A doctor of medicine, osteophathy or podiatry legally authorized to practice medicine and surgery by the State in which such function or action is performed. Practical (vocational) nurse. A person who is licensed as a practical (vocational) nurse by the State in which practicing. Public health nurse. A registered nurse who has completed a baccalaureate degree program approved by the National League for Nursing for public health nursing preparation or postregistered nurse study that includes content aproved by the National League for Nursing for public health nursing preparation. Registered nurse (RN). A graduate of an approved school of professional nursing, who is licensed as a registered nurse by the State in which practicing. Social work assistant. A person who: (1) Has a baccalaureate degree in social work, psychology, sociology, or other field related to social work, and has had at least 1 year of social work experience in a health care setting; or (2) Has 2 years of appropriate experience as a social work assistant, and has achieved a satisfactory grade on a proficiency examination conducted, approved, or sponsored by the U.S. Public Health Service, except that these determinations of proficiency do not apply with respect to persons initially licensed by a State or seeking initial qualification as a social work assistant after December 31, 1977. Social worker. A person who has a master's degree from a school of social work accredited by the Council on Social Work Education, and has 1 year of social work experience in a health care setting. Speech-language pathologist. A person who: (1) Meets the education and experience requirements for a Certificate of Clinical Competence in (speech pathology or audiology) granted by the American Speech-Language-Hearing Association; or (2) Meets the educational requirements for certification and is in the process of accumulating the supervised experience required for certification. [54 FR 33367, August 14, 1989, as amended at 56 FR 32973, July 18, 1991; 69 FR 66426, Nov. 15, 2004]
Title 42: Public Health
PART 484—HOME HEALTH SERVICES
Subpart A—General Provisions
§ 484.1 Basis and scope.
§ 484.2 Definitions.
§ 484.4 Personnel qualifications.
