CHAPTER 449 - MEDICAL AND OTHER RELATED FACILITIES

GENERAL PROVISIONS

449.002 Definitions. 449.0022 “Administrator” defined. 449.0024 “Affiliated facility” defined. 449.0026 “Agent” defined. 449.0028 “Bureau” defined. 449.0029 “Centers for Medicare and Medicaid Services” defined. 449.003 “Deficiency” defined. 449.0032 “Emergency” defined. 449.0034 “Facility” defined. 449.0038 “Health Division” defined. 449.0042 “Holiday” defined. 449.0043 “Home for individual residential care” defined. 449.0044 “Immediate and serious threat” and “immediate jeopardy” defined. 449.0046 “Incident” defined. 449.0048 “License” defined. 449.005 “Licensee” defined. 449.0052 “Medicaid” defined. 449.0054 “Medicare” defined. 449.0056 “Party” defined. 449.0058 “Person” defined. 449.006 “Recipient” defined. 449.0061 “Referral agency” defined. 449.0062 “Resident” defined. 449.0064 “Residential facility” defined. 449.0066 “Sanction” defined. 449.0068 “Services” defined. 449.007 “Survey” defined. 449.0072 “Treatment” defined. 449.0074 “Welfare Division” defined. 449.008 Computation of time. 449.010 Severability.

GENERAL REQUIREMENTS FOR LICENSURE

449.011 Application for license. 449.0112 Investigation; prelicensure survey; inspection for fire safety. 449.0114 Display of license; compliance with law; notice of transfer of real property or change in

administrator, ownership, location or services. 449.0115 Review of building plans for new construction or remodeling by certain applicants:

Required documents; payment of fees and costs. 449.0116 Renewal of license: Application; validity of existing license pending decision on

application; inspection of facility; untimely filing or failure to file application. 449.0118 Denial, suspension or revocation of license: Grounds. 449.0119 Denial, suspension or revocation of license: Appeals.

FEES

449.012 Definitions. 449.0121 “Ambulatory surgical center” defined. 449.01215 “Branch office” defined.

449.01225 “Facility for hospice care” defined. 449.01227 “Facility for refractive laser surgery” defined. 449.01229 “Facility for treatment with narcotics” defined. 449.0123 “Home health agency” defined. 449.01235 “Home office” defined. 449.0124 “Hospice care” defined. 449.01245 “Intermediate care facility for the mentally retarded or persons with developmental

disabilities” defined. 449.0125 “Medication unit” defined. 449.01252 “Mobile unit” defined. 449.01255 “Nursing pool” defined. 449.0126 “Rural clinic” defined. 449.01265 “Rural hospital” defined. 449.0127 “Subunit agency” defined. 449.013 License and renewal fees to operate ambulatory surgical center, facility for treatment of

irreversible renal disease, home office, subunit agency or branch office of home health agency, rural clinic, obstetric center, program of hospice care, independent center for emergency medical care, nursing pool, facility for treatment with narcotics, medication unit, referral agency, halfway house for recovering alcohol and drug abusers, facility for refractive laser surgery and mobile unit; expiration of application for license.

449.016 License and renewal fees to operate skilled nursing facility, hospital, rural hospital, intermediate care facilities, residential facility for groups, facility for treatment of abuse of alcohol or drugs, facility for hospice care, home for individual residential care and facility for modified medical detoxification; expiration of application for license.

449.0168 Fees for modification of certain licenses.

PROVISION OF HOSPICE CARE

General Provisions

449.017 Definitions. 449.0171 “Bereavement services” defined. 449.0172 “Facility for hospice care” defined. 449.0173 “Governing body” defined. 449.0175 “Hospice care” defined. 449.0176 “Medical director” defined. 449.0177 “Patient” defined. 449.0178 “Terminally ill” defined.

Licensing

449.0181 Compliance with regulations required for license to operate facility for hospice care. 449.0183 Report of change in ownership, address or staff of program of hospice care.

Administration

449.0184 Governing body required; duties of governing body and administrator.

Medical Services

449.0185 Requirements for program of hospice care. 449.0186 Requirements for plan of care. 449.0187 Requirements for operation of facility for hospice care. 449.0188 Continuity of service to patients required.

FACILITIES FOR TREATMENT OF ABUSE OF ALCOHOL OR DRUGS

General Provisions

449.019 Definitions. 449.022 “Administrator” defined. 449.025 “Alcohol and drug abuse treatment” defined. 449.030 “Case management services” defined. 449.031 “Client” defined. 449.034 “Detoxification” defined. 449.043 “Facility” defined. 449.044 “Facility for modified medical detoxification” defined. 449.046 “Governing body” defined. 449.060 “Medically managed intensive detoxification program” defined. 449.064 “Overall program” defined. 449.068 “Qualified social worker” defined. 449.069 “Residential program” defined. 449.072 “Social model detoxification program” defined.

Licensing

449.079 Denial, revocation or suspension of license if facility not certified by Health Division; appeal.

449.081 New construction or remodeling: Submission and approval of building plans; prerequisites to approval of licensing.

Administration and Personnel

449.085 Governing body; bylaws. 449.088 Policies and procedures. 449.091 Transfer of client to another facility. 449.094 Money of clients. 449.098 Preparations for disasters; reporting of fire or disaster. 449.102 Inventory and return of client’s belongings. 449.105 Insurance. 449.108 General requirements for programs. 449.111 Administrator: Duties. 449.114 Employees: General provisions. 449.117 Employees: Proof of compliance with provisions concerning tuberculosis.

Social Model Detoxification Programs

449.121 Certain facilities authorized to offer program. 449.1214 General requirements. 449.1218 Program of ongoing quality improvement.

Operation of Facility

449.123 General sanitary requirements. 449.126 Laundry requirements. 449.129 Design, construction, equipment and maintenance. 449.132 Accommodations for clients. 449.135 Safety from fire. 449.141 Health services. 449.144 Medication. 449.147 Dietary services. 449.150 Records of clients. 449.153 Discrimination prohibited.

FACILITIES FOR MODIFIED MEDICAL DETOXIFICATION

449.15311 Definitions.

449.15313 “Administrator” defined. 449.15315 “Client” defined. 449.15317 “Facility” defined. 449.15319 “Overall program” defined. 449.15321 “Program” defined. 449.15323 Proof of certification required; revocation of license. 449.15325 Governing body; bylaws and policies. 449.15327 Policies and procedures for services and operation of facility. 449.15329 Transfer of client. 449.15331 Handling of money of client. 449.15333 Inventory of belongings of client. 449.15335 Liability insurance. 449.15337 Program: Requirements; review. 449.15339 Responsibilities and duties of administrator. 449.15341 Policies and procedures concerning employees. 449.15343 Nursing services. 449.15345 Health services. 449.15347 Pharmaceutical services. 449.15349 Medication and biologicals. 449.15351 Dietary services. 449.15353 Records of clients. 449.15355 Safety and sanitation; temperature. 449.15357 Laundry requirements. 449.15359 New construction or remodeling: Submission and approval of building plans;

prerequisites to approval of facility for licensure. 449.15361 Design, construction, equipment and maintenance. 449.15363 Accommodations for clients. 449.15365 Safety from fire. 449.15367 Preparations for disasters; reporting of fire or disaster. 449.15369 Discrimination prohibited.

FACILITIES FOR TREATMENT WITH NARCOTICS; MEDICATION UNITS

General Provisions

449.154 Definitions. 449.15415 “DEA” defined. 449.1542 “Facility for treatment with narcotics” defined. 449.1543 “Medical director” defined. 449.15435 “Medication unit” defined. 449.15438 “SAMHSA” defined. 449.1544 Health Division is state authority for certain federal regulations.

Licensing

449.15445 License and federal certification required to operate facility or unit. 449.1545 Filing requirements; recommendation for certification. 449.15455 Investigation and prelicensure survey. 449.1547 Suspension, revocation or cancellation of license; provisional license; denial of

application.

Operation of Facility or Unit

449.1548 Operational requirements. 449.15485 Continuing review of operations; investigation of complaints.

HALFWAY HOUSES FOR RECOVERING ALCOHOL AND DRUG ABUSERS

449.1549 Definitions. 449.154901 “Administrator” defined. 449.154903 “Client” defined. 449.154905 “Facility” defined.

449.15491 Administrator: Qualifications. 449.154911 Administrator: General duties. 449.154913 General operational guidelines. 449.154915 Policies and procedures: Establishment; maintenance of manual. 449.154917 Limitation on admissions. 449.154919 Health and sanitation. 449.154921 Laundry facilities. 449.154923 Kitchens; storage of food. 449.154925 Bedrooms; bedding. 449.154927 Use of certain areas as bedroom prohibited. 449.154929 Bathrooms and toilet facilities; toilet articles. 449.154931 Accommodations for residents with restricted mobility. 449.154933 First aid. 449.154935 Medication. 449.154937 Telephones; telephone number. 449.154939 Notification to Bureau under certain circumstances. 449.154941 Rights of clients. 449.154943 Client files: Maintenance; contents; confidentiality. 449.154945 Safety from fire.

HOMES FOR INDIVIDUAL RESIDENTIAL CARE

449.15511 Definitions. 449.15513 “Caregiver” defined. 449.15515 “Director” defined. 449.15517 “Home” defined. 449.15519 “Protective supervision” defined. 449.15521 Director: Qualifications. 449.15523 Director: Duties. 449.15525 Requirements for safety and sanitation of facility. 449.15527 Agreement between operator of home and resident concerning rates; maintenance of

records of residents. 449.15529 On-site survey of home by Bureau.

RESIDENTIAL FACILITIES FOR GROUPS

General Provisions

449.156 Definitions. 449.1565 “Administer” defined. 449.157 “Administrator” defined. 449.1575 “Board” defined. 449.1585 “Caregiver” defined. 449.1591 “Category 1 resident” defined. 449.1595 “Category 2 resident” defined. 449.1597 “Dietary supplement” defined. 449.160 “Division” defined. 449.164 “Hospice care” defined. 449.169 “Medical professional” defined. 449.172 “Residential facility” defined. 449.173 “Residential facility which provides care to persons with Alzheimer’s disease” defined. 449.176 “Staff of a facility” defined.

Licensing

449.179 Submission and approval of plan for new construction or remodeling; inspection; evidence of compliance.

449.180 Requirements for purchasing licensed facility. 449.190 License: Contents; validity; transferability; issuance of more than one type.

449.193 Renewal of license: Form; fee; required information.

Administration and Personnel

449.194 Responsibilities of administrator. 449.196 Qualifications and training of caregivers. 449.197 Medical services may be provided only by medical professional. 449.199 Staffing requirements; limitation on number of residents; written schedule for each

shift; direct supervision of certain employees. 449.200 Personnel files. 449.202 Rights of staff members during investigation of facility; duties of investigator.

General Operational Requirements

449.204 System of financial accounting; insurance. 449.205 Advertising and promotional materials. 449.208 Restrictions on conducting other businesses or providing other services on premises. 449.209 Health and sanitation. 449.211 Automatic sprinkler systems. 449.213 Laundry and linen services. 449.216 Common areas; dining rooms. 449.217 Kitchens; storage of food; adequate supplies of food; permits; inspections. 449.2175 Service of food; seating; menus; special diets; nutritional requirements; dietary

consultants. 449.218 Bedrooms: Floor space; windows and doors; privacy; storage space; bedding; personal

furnishings; lighting. 449.220 Bedroom doors. 449.221 Use of certain areas in facility as bedroom prohibited. 449.222 Bathrooms and toilet facilities; toilet articles. 449.224 Housing for staff members. 449.226 Safety requirements for residents with restricted mobility or poor eyesight; water

hazards; auditory systems for bathrooms and bedrooms; access by vehicles. 449.227 Accommodations for residents with restricted mobility. 449.229 Requirements and precautions regarding safety from fire. 449.231 First aid and cardiopulmonary resuscitation. 449.232 Telephone; list of telephone numbers. 449.241 Limitations on use of volunteers; requirements concerning residents who volunteer to

assist staff or perform other duties. 449.258 Written policies for facility; policy on visiting hours; residents’ mail; compliance with

policies. 449.259 Supervision and treatment of residents generally. 449.260 Activities for residents. 449.262 Provision of dental, optical and hearing care and social services; report of suspected

abuse, neglect, isolation or exploitation; restrictions on use of restraints, confinement or sedatives.

449.267 Money and property of residents. 449.268 Rights of residents; procedure for filing grievance, complaint or report of incident;

investigation and response. 449.269 Discrimination prohibited.

Admitting, Transferring and Discharging Residents

449.2702 Written policy on admissions; eligibility for admission. 449.2704 Disclosure of information concerning rates and payment for services. 449.2706 Transfer of resident whose condition deteriorates. 449.2708 Discharge of resident; notice of discharge; issuance of notice to quit to resident for

improper or harmful behavior.

Restrictions on Admitting or Retaining Residents With Certain Medical Needs or Conditions

449.271 Residents requiring gastrostomy care or suffering from staphylococcus infection or other serious infection or medical condition.

449.2712 Residents requiring use of oxygen. 449.2714 Residents requiring use of intermittent positive pressure breathing equipment. 449.2716 Residents having colostomy or ileostomy. 449.2718 Residents requiring manual removal of fecal impactions or use of enemas or

suppositories. 449.272 Residents requiring use of indwelling catheter. 449.2722 Residents having unmanageable condition of bowel or bladder incontinence; residents

having manageable condition of bowel or bladder incontinence. 449.2724 Residents having contractures. 449.2726 Residents having diabetes. 449.2728 Residents requiring regular intramuscular, subcutaneous or intradermal injections. 449.2732 Residents requiring protective supervision. 449.2734 Residents having tracheostomy or open wound requiring treatment by medical

professional; residents having pressure or stasis ulcers. 449.2736 Procedure to exempt certain residents from restrictions. 449.2738 Review of medical condition of resident; relocation or transfer of resident having certain

medical needs or conditions.

Medical Services, Medical Records and Other Records Concerning Residents

449.274 Medical care of resident after illness, injury or accident; periodic physical examination of resident; rejection of medical care by resident; written records.

449.2742 Administration of medication: Responsibilities of administrator, caregiver and employee of facility.

449.2744 Administration of medication: Maintenance and contents of logs and records. 449.2746 Administration of medication: Restrictions concerning medication taken as needed by

resident; written records. 449.2748 Medication: Storage; duties upon discharge, transfer and return of resident. 449.2749 Maintenance and contents of separate file for each resident; confidentiality of

information. 449.275 Residents receiving hospice care: Responsibilities of staff; retention of resident with

special medical needs.

Special Types of Facilities

449.2754 Residential facility which provides care to persons with Alzheimer’s disease: General requirements.

449.2756 Residential facility which provides care to persons with Alzheimer’s disease: Standards for safety; personnel required; training for employees.

449.2758 Residential facility for elderly or disabled persons: Training for caregivers. 449.2762 Residential facility for mentally retarded adults: Training for caregivers; program to

modify behavior of resident. 449.2764 Residential facility for persons with mental illnesses: Training for employees. 449.2766 Residential facility for persons with chronic illnesses: Training for employees.

BUSINESSES THAT PROVIDE REFERRALS TO RESIDENTIAL FACILITIES FOR GROUPS

449.27811 Definitions. 449.27813 “Client” defined. 449.27817 “Financial assessment” defined. 449.27819 “Needs assessment” defined. 449.27821 “Residential facility for groups” defined. 449.27823 License not required by certain persons to make referrals; application for licensure. 449.27827 Requirements for employees. 449.27829 Responsibilities of referral agency. 449.27831 Contract for services; fees; maintenance of client records.

HOSPITALS

General Provisions

449.279 Definitions. 449.285 “General hospital” defined. 449.286 “Governing body” defined. 449.287 “Hospital” defined. 449.289 “Inpatient” defined. 449.297 “Outpatient” defined. 449.298 “Outpatient department” defined. 449.299 “Patient” defined. 449.300 “Restraint” defined.

Licensing and Administration

449.307 Applicability of license; liability coverage. 449.310 Limitation on number of patients; annual on-site inspection not required under certain

circumstances. 449.312 Change in ownership, use or construction; correction of deficiencies. 449.313 Responsibilities and duties of governing body; bylaws; appointment and duties of chief

executive officer; protocol for organ donations; annual operating budget. 449.314 Quality of care; scope of services. 449.3152 Quality improvement program. 449.3154 Construction, remodeling, maintenance and change of use: General requirements;

prerequisites to approval of licensure. 449.3156 Compliance with certain guidelines for design and construction; correction of

deficiencies.

Policies and Procedures for Operation of Hospital

449.316 Physical environment: Safety and well-being of patients; plan for emergency preparedness; safety management.

449.317 Risk management. 449.319 Requirements for personal needs of patients. 449.322 Housekeeping and laundry services. 449.325 Prevention, control and investigation of infections and communicable diseases. 449.327 Preparation, sterilization, storage and distribution of sterile supplies and medical and

surgical equipment. 449.329 Admission of patients. 449.331 Emergency services and medical care; transfer agreements. 449.332 Discharge planning. 449.337 Dietary services: General requirements. 449.338 Dietary services: Provision for needs of patients; facilities; standards; permits; records. 449.3385 Dietary services: Personnel. 449.339 Dietary services: Nutritional status of patients. 449.3395 Dietary services: Sanitary conditions; supplies. 449.340 Pharmaceutical services. 449.343 Orders for medication and biologicals. 449.344 Administration of medication; security. 449.346 Rehabilitative services. 449.349 Emergency services. 449.352 Social services. 449.355 Discrimination prohibited. 449.358 Medical staff. 449.361 Nursing services. 449.3622 Appropriate care of patients. 449.3624 Assessment of patients. 449.3626 Rights of patients. 449.3628 Protection of patients; use of physical restraints. 449.363 Personnel policies concerning employment, licensing and certification. 449.364 Obstetrical services: Administration; staffing and equipment.

449.3645 Obstetrical services: Labor rooms; delivery rooms; utility rooms; area for cleaning instruments.

449.365 Obstetrical services: Required services. 449.3655 Obstetrical services: Transfer or discharge of patient. 449.367 Obstetrical services: Nurseries. 449.370 Outpatient services. 449.371 Intensive care services. 449.373 Laboratory services; pathology services; blood and blood products. 449.3735 Transfusions of blood. 449.374 Nuclear medicine services. 449.375 Records for nuclear medicine services; authorization. 449.376 Radiological services. 449.377 Radiological therapeutic services. 449.379 Medical records. 449.382 Medical library. 449.385 Surgical services. 449.388 Anesthesia services. 449.389 Respiratory care services. 449.391 Dental services. 449.394 Psychiatric services.

FACILITIES FOR CARE OF ADULTS DURING THE DAY

General Provisions

449.4061 Definitions.

Licensing

449.4063 Design, construction, equipment and maintenance of facility: General requirements; prerequisites to approval for licensure.

449.4065 Consultation with representative of Division; notice of nonconformity. 449.4067 Operation in combination with other medical facility or facility for the dependent. 449.4069 Insurance.

Operation of Facility

449.407 Advertising and promotional materials. 449.4071 Policies and procedures; accounting. 449.4072 Director and employees: Qualifications and duties; physical and mental health. 449.40723 Supervision of clients; volunteers. 449.40725 Orientation and training of employees and volunteers. 449.4073 Files concerning employees. 449.4074 Requirements of facility; health and sanitation; medications; exits. 449.4075 Preparations for fires and other emergencies; reporting of fire or disaster. 449.4076 First aid. 449.4077 Policy for admissions; retention of signed copy. 449.4078 Requirements for admission; designation of physician. 449.4079 Required services. 449.408 Housekeeping and maintenance. 449.4081 Administration of medication; accidents or illnesses. 449.4082 Service of food; dietary consultants. 449.4083 Discrimination prohibited. 449.40833 Summary of client’s care; referrals. 449.40835 Records.

Medical and Ancillary Services

449.4084 Contract for provision by another person. 449.4085 Provision by facility authorized. 449.4086 Evaluation of programs and policies. 449.4087 Written assessments of clients.

449.4088 Plan of care; periodic assessment. 449.4089 Menus.

FACILITIES FOR REFRACTIVE LASER SURGERY

449.450 “Facility” defined. 449.4502 Applicability of provisions. 449.4504 Administrator of facility: Appointment; duties; qualifications. 449.4506 Staffing requirements; personnel files. 449.4508 Maintenance of patient records. 449.451 Written policies and procedures. 449.4512 Program of quality improvement. 449.4514 Rights of patients; informed consent. 449.4516 Equipment and supplies. 449.4518 Liability for use of leased equipment. 449.4522 Sanitation and hygiene; space and storage. 449.4524 Medical care of patients. 449.4526 Application for indemnification for certain damages; claims against surety bond or

substitute thereof.

FACILITIES FOR TREATMENT OF IRREVERSIBLE RENAL DISEASE

General Provisions

449.501 Definitions. 449.502 “Advanced practitioner of nursing” defined. 449.504 “Charge nurse” defined. 449.5045 “Competency” defined. 449.505 “Dialysis” defined. 449.5053 “Dialysis technician” defined. 449.5055 “Direct supervision” defined. 449.5065 “End-stage renal disease” defined. 449.507 “Facility” defined. 449.508 “Hemodialysis” defined. 449.510 “Immediate supervision” defined. 449.511 “Intermediate level disinfection” defined. 449.513 “Licensed practical nurse” defined. 449.516 “Product water” defined. 449.517 “Supervision” defined. 449.519 “Training” defined.

Construction; Health and Safety

449.520 New construction or remodeling: Notification; increase in number of stations for which facility is licensed.

449.5205 New construction or remodeling: Submission of plans and specifications; minor changes; inspection.

449.522 Construction, space and design; physical environment; restrictions for treatment of patients with hepatitis B.

449.5225 Safety and comfort of patients during construction; imposition of more stringent design and space requirements.

449.523 Safety requirements. 449.5235 Maintenance and repair of equipment. 449.525 Water treatment system: General requirements. 449.5255 Water treatment system: Chemical testing of product water; records. 449.526 Water treatment system: Microbiological testing of product water. 449.5265 Reuse of hemodialyzer; transport of used dialyzer. 449.528 Adoption of more stringent requirements for treatment of water and reuse of

hemodialyzers. 449.5285 Sanitation: Precautions regarding blood and bodily fluids. 449.529 Sanitation: Control of infections; nonsmoking policy.

449.5295 Sanitation: Provision of sanitary environment; walls, floors and ceilings; blood spills. 449.531 Sanitation: Disinfection of dialysis machines; culturing dialysate; cleaning of machines

and equipment; handling of waste. 449.5315 Hepatitis B: Vaccinations for certain staff members; postvaccination screening; adoption

of related provisions. 449.532 Hepatitis B: Vaccinations for certain patients. 449.5325 Hepatitis B surface antigen: Screening of patients; additional serologic screening. 449.534 Hepatitis B surface antigen: Treatment of patients who test positive. 449.5345 Tuberculosis: Screening of staff and patients.

Provision of Services

449.540 Program of quality assurance; recordation of accidents and incidents; reporting of certain events.

449.5405 Rights of patients. 449.541 Interdisciplinary teams; plans for care of patients. 449.5415 Preparations for emergencies and disasters. 449.543 Pharmaceutical services. 449.5435 Nursing services; physicians and other staff. 449.544 Nutrition services. 449.5445 Social services. 449.546 Patient care: Advanced practitioners of nursing and physician assistants; medical

emergencies. 449.5465 Patient care: Licensed practical nurses and dialysis technicians. 449.547 Self-dialysis: Provision of training and certain services. 449.5475 Continuous ambulatory peritoneal dialysis. 449.549 Continuous cycling peritoneal dialysis. 449.5495 Patient services by contract; laboratory.

Administration and Personnel

449.550 Governing body. 449.5505 Medical director. 449.552 Physicians. 449.5525 Orientation program for new employees; continuing education. 449.553 Medical staff: Generally. 449.5535 Nurses. 449.555 Dietitians. 449.5555 Social workers. 449.556 Staff responsible for operating water treatment system. 449.5565 Staff that repairs or maintains equipment used to provide care to patients.

Clinical Records

449.558 Preparation and maintenance. 449.5585 Additional requirements. 449.559 Medical history and physical examination. 449.5595 Transient patients. 449.561 Discharge or transfer of patients; removal of records. 449.5615 Cessation of operation of facility.

Dialysis Technicians

449.570 General qualifications; identification to be worn during training; provision of care; requirements to act as preceptor.

449.5705 Qualification of technician determined to be qualified before July 1, 2001. 449.571 Program of training: Curriculum; duties of instructor; written examinations. 449.5715 Program of training: Qualifications of instructors. 449.573 Program of training: Certain persons authorized to provide instruction and serve as

preceptor. 449.5735 Program of training: Required hours. 449.574 Committee to review program of training. 449.5745 Written list concerning knowledge and skills.

449.576 Peritoneal dialysis: Additional activities required. 449.5765 Cannulation or administration of normal saline or heparin: Additional activities

required. 449.577 Cannulation or administration of normal saline, heparin or lidocaine: Verification and

documentation of competency required. 449.5775 Documentation of successful completion of program of training; employment by another

facility. 449.579 Patient care: Technicians must demonstrate certain knowledge and competency. 449.5795 Prohibited acts.

PROVISION OF CERTAIN SPECIAL SERVICES

Obstetric Care

449.6113 Definitions. 449.61132 Authorized obstetric care. 449.61134 Eligible maternal patients. 449.61138 Denial of application for or renewal of license; revocation or suspension of license. 449.6114 Design, construction, equipment and maintenance of obstetric center: General

requirements; prerequisites to approval for licensure. 449.61142 Required facilities and services. 449.61144 Required emergency electrical power. 449.61146 Requirements for birth room, toilet and bathing facilities, hallways and doors, water

supply and office-based facilities. 449.61148 Governing body of obstetric center; duties. 449.6115 Physician operator or advanced practitioner of nursing operator as licensee. 449.61152 Designation and responsibilities of medical director; privileges of members of medical

staff; provision of consultation services with specialists. 449.61154 Medical records: Maintenance; access. 449.61156 Medical records: Contents. 449.61158 Program for review of quality of care. 449.6116 Miscellaneous requirements concerning staff, provision of service and equipment. 449.61162 Requirements for transfer or discharge of patient. 449.61164 Written protocol for discharge of patient. 449.61166 Policies and procedures for control of infectious agents and diseases; program to

monitor health of employees. 449.61168 Laboratory services; transfer of maternal patient who needs blood or blood products. 449.6117 Possession, distribution, administration and storage of drugs and controlled substances. 449.61172 Anesthesia. 449.61174 Transfer of patient to hospital or medical facility licensed to provide high-risk perinatal

care. 449.61176 Death of patient; notification of Health Division; provision of counseling. 449.61178 Required information to be provided or made available to patient; complaints.

Open-Heart Surgery

449.612 Definitions. 449.612011 “Approval” defined. 449.612012 “Approved hospital” defined. 449.612014 “Cardiac surgery” defined. 449.612017 “Open-heart surgery” defined. 449.61202 Prerequisites to initial provision of service. 449.61204 Form and contents of application for approval to provide service. 449.61206 Notification of applicant upon review of application; site inspection required. 449.61208 Composition and duties of site inspection team. 449.6121 Hospital to pay costs of inspection. 449.61212 Approval or denial of application; period of validity of approval; cessation of

performance of surgeries. 449.61214 Amount of surgery required following approval. 449.61216 Provision of patient with preoperative instruction. 449.61218 Surgical team: Composition; privileges and qualifications of members; participation of

qualified nurses.

449.6122 Qualifications of anesthesiologist. 449.61222 Qualifications of nurse in charge of service. 449.61224 Perfusion team: Use required; qualifications; approval of members by surgeon of

record. 449.61226 Operating rooms: General requirements. 449.61228 Operating rooms: Equipment and staff. 449.6123 Intensive care facility: General requirements. 449.61232 Intensive care facility: Staff. 449.61234 Intensive care facility: Equipment and supplies. 449.61236 Orientation and continuing education of personnel. 449.61238 Maintenance of blood bank. 449.6124 Maintenance of cardiac catheterization laboratory. 449.61242 Maintenance of medical laboratory. 449.61244 Maintenance of facilities to perform contrast studies and equipment to review films of

operations. 449.61246 Maintenance of registry to record results for each patient. 449.61248 Maintenance of program to follow recovery of patient. 449.6125 Annual review and inspection of hospital. 449.61252 Annual inspection of hospital: Assessment of rate of mortality. 449.61254 Further review or on-site inspection for failure to comply with provisions or for

excessive rate of mortality; notice; plan for compliance. 449.61256 Denial, suspension or revocation of approval: Grounds; hearing.

Transplantation of Organs

449.6126 Definitions. 449.61262 Application for approval to provide services. 449.61264 Evaluation of application for approval. 449.61266 Duties of hospital providing services. 449.61268 Revocation of approval. 449.6127 Notice of intent to deny application or revoke approval; hearing.

INDEPENDENT CENTERS FOR EMERGENCY MEDICAL CARE

Licensing

449.61302 Limitations on issuance of license. 449.61306 Denial of application for license or renewal of license. 449.61308 Compliance with regulations; ground for suspension or revocation of license.

Administration and Personnel

449.6132 Requirement of governing body; adoption of written rules. 449.61322 Exception to requirements of governing body. 449.61324 Standards of care; policy for authentication. 449.61326 Program to review quality of care; contents of program. 449.61328 Integration into local emergency medical system. 449.6133 Appointment and responsibilities of administrator. 449.61332 Employment and duties of medical director. 449.61334 Standards and procedures for selection, treatment and retention of medical staff and

members of allied health professions. 449.61336 Rules for organization of medical staff. 449.61338 Employment and duties of chief nurse; size of on-duty nursing staff; limitation on scope

of practice by person who is not registered nurse; oversight of nursing staff.

Facilities

449.6135 Design, construction, equipment and maintenance: General requirements; prerequisites to approval for licensure.

449.61352 Contents of center: Emergency entrance; reception and waiting areas; treatment and examination rooms; space for storage and maintenance of medical records and supplies.

449.61354 Contents of treatment rooms; accessibility to person in wheelchair.

Medical Services and Medical Records

449.6137 Requirement for minimum level of care in certain situations. 449.61372 Criteria for denial of care, transfer or discharge of patient; compliance with state and

federal laws. 449.61374 Laboratory services and reports; procedures for storage and administration of tissue

specimens, blood and blood products; agreements with outside blood banks; review of blood transfusions and reactions.

449.61376 Program for control of infection. 449.61378 Radiological services: Availability; interpretation and reporting of films; storage and

retention. 449.6138 Distribution and administration of drugs and controlled substances. 449.61382 Medical records: Maintenance; access; authorized release; completion after discharge. 449.61384 Contents of medical records.

INTERMEDIATE CARE FACILITIES

General Provisions

449.614 Definitions. 449.617 “Administrator” defined. 449.620 “Developmentally disabled person” defined. 449.623 “Facility” defined. 449.629 “Intermediate care facility as a distinct part of a health and care facility furnishing more

than one level of care” defined. 449.632 “Intermediate care facility for the mentally retarded or persons with developmental

disabilities” defined. 449.635 “Licensee” defined. 449.638 “Long-term care facility” defined. 449.641 “Mentally retarded person” defined. 449.644 “Mixed facility” defined. 449.647 “New facility” defined. 449.650 “Nursing home” defined. 449.653 “Patient in an intermediate care facility I” defined. 449.656 “Patient in an intermediate care facility II” defined. 449.659 “Resident” defined.

Licensing

449.668 Provisional licenses.

Administration and Personnel

449.671 Financing; liability insurance. 449.674 Administrator: Qualifications. 449.677 Employees: General requirements. 449.680 Employees: Health; physical examinations. 449.681 Employees of facility which provides care to persons with dementia: Continuing

education.

Construction and Operation: Generally

449.685 Design, construction, equipment and maintenance: General requirements; prerequisites to approval of facility for licensure.

449.692 Sanitary requirements. 449.695 Laundry requirements. 449.698 Fire inspections; hazardous conditions; operation of other business. 449.701 Preparations for emergencies; reporting of fire or disaster. 449.704 Written policies and procedures for facility; admission agreements; transfer agreements. 449.707 Money of residents. 449.710 Inventory of residents’ belongings.

449.713 Program requirements. 449.716 Dietary services. 449.719 Health services. 449.722 Pharmaceutical services. 449.725 Records. 449.728 Supervision by physician; volunteers; advertising. 449.731 Discrimination prohibited.

Construction and Operation: Facilities for Mentally Retarded or Persons With Developmental Disabilities

449.732 Definitions. 449.7322 “Facility” defined. 449.7324 “New facility” defined. 449.7326 Standards for construction, remodeling or change in use of facility; fire alarms;

emergency radio system; submission and approval of building plans. 449.7328 Elevators 449.733 Electrical systems. 449.7332 Mechanical systems. 449.7334 Doors, windows, ceilings, walls and floors. 449.7336 Entrances and lobbies; miscellaneous space. 449.7338 Dining and storage space. 449.7342 Facilities for employees and volunteers. 449.7344 Areas for engineering and maintenance. 449.7346 Janitors’ closets. 449.7348 Linen service. 449.735 Area for medical records. 449.7352 Nursing units. 449.7354 Service areas. 449.7356 Processing of waste. 449.736 Personnel. 449.737 Plan of care. 449.740 Corporal punishment; restraints. 449.743 Records.

FACILITIES FOR SKILLED NURSING

General Provisions

449.744 “Facility for skilled nursing” defined.

Licensing and Administration of Facility

449.74411 Applicability of license; limitation on number of patients; liability coverage. 449.74413 Change in ownership, use or construction of facility. 449.74415 Responsibilities of governing body. 449.74417 Administrator of facility. 449.74419 Committee for quality assurance. 449.74421 Procedures for emergency or disaster.

Admission, Transfer and Discharge of Patient

449.74423 Certain conditions for admission prohibited. 449.74425 Admission of patient with mental illness or mental retardation. 449.74427 Agreement with hospital for transfer of patients. 449.74429 Transfer or discharge of patient. 449.74431 Summary of discharge.

Assessment of Patients and Plan of Care

449.74433 Comprehensive assessment of needs of patient. 449.74435 Quarterly assessment of patient. 449.74437 Conduct of assessments. 449.74439 Comprehensive plan of care.

Medical Records

449.74441 Maintenance. 449.74443 Inspection.

Rights of Patients

449.74445 Generally. 449.74447 Communications with other persons; examination of records by advocate. 449.74449 Notice to patients of rights, services and charges. 449.74451 Charges to be consistent with notice of charges. 449.74453 Notice to patients of programs available for assistance in payment of services. 449.74455 Discrimination prohibited. 449.74457 Policies and procedures for advance directives by patient; information to be furnished

regarding physicians. 449.74459 Examination by patient of survey of facility and plan of correction. 449.74461 Finances of patient: System for maintenance and accounting. 449.74463 Finances of patient: Authorization to withhold money. 449.74465 Sending and receiving mail. 449.74467 Performance of services for facility by patient.

Quality of Care

449.74469 Standards of care. 449.74471 Administration of drugs. 449.74473 Program for control of infections. 449.74475 Vision and hearing. 449.74477 Pressure sores. 449.74479 Urinary problems. 449.74481 Range of motion. 449.74483 Mental or psychosocial behavior. 449.74485 Nasogastric tubes. 449.74487 Nutritional health; hydration. 449.74489 Physical or chemical restraint of patients. 449.74491 Prohibition of certain practices regarding patients; investigation of certain violations

and injuries to patients; unfit employees. 449.74493 Notification of changes or condition of patient. 449.74495 Development of program of activities. 449.74497 Daily activities of patient. 449.74499 Participation in activities.

Staff and Attending Physicians

449.74511 Personnel policies; personnel records. 449.74513 Medical director. 449.74515 Physicians. 449.74517 Nursing staff. 449.74519 Nursing assistants and nursing assistant trainees. 449.74521 Other health care professionals. 449.74522 Employees of facility which provides care to persons with dementia.

Provision of Services

449.74523 Social services. 449.74525 Dietary services. 449.74527 Specialized rehabilitative services. 449.74529 Dental services. 449.74531 Pharmaceutical services. 449.74533 Laboratory services. 449.74535 Radiological and other diagnostic services. 449.74537 Special services.

Physical Environment

449.74539 General requirements. 449.74543 Design, construction, equipment and maintenance: General requirements; prerequisites

to approval of facility for licensure. 449.74549 Patients’ rooms.

NURSING POOLS

General Provisions

449.747 Definitions.

Licensing

449.7471 License required. 449.7473 Location to which license applies; persons named in license; restrictions on use of license. 449.7474 Duties of licensee or applicant for license.

Administration and Personnel

449.7475 Administrator: Qualifications and duties. 449.7476 Director of professional services: Qualifications and duties. 449.7477 Personnel policies: Maintenance and availability. 449.7478 Requirements for contracts to provide nursing services. 449.7479 Referral of patients when services not available; provision of services; bonding of staff. 449.748 Duties of registered nurse; provision of nursing care by practical nurse or nursing

assistant. 449.7481 Annual evaluation of nursing pool by licensee.

HOME HEALTH AGENCIES

General Provisions

449.749 Definitions.

Licensing and Inspection

449.752 License required. 449.758 Location to which license applies; persons named in license; transferability; restrictions

on use of license; liability coverage. 449.761 Periodic inspections. 449.767 Action to enjoin operation without license. 449.768 Applicant or licensee to maintain home office in Nevada.

Administration and Personnel

449.770 Governing body; bylaws. 449.773 Administrator: Qualifications; duties. 449.776 Director of professional services. 449.779 Professional advisory group. 449.782 Personnel policies. 449.785 Contracts for home health services. 449.787 Duty to provide skilled nursing care and home health services; other services may be

included. 449.788 Services to patients. 449.791 Duties of personnel. 449.793 Evaluation by governing body; periodic review of contracts, operations, policies and

procedures.

Medical Services and Medical Records

449.794 Clinical records: General requirements.

449.797 Contents of clinical records. 449.800 Medical orders.

FINANCIAL REPORTING

449.951 Definitions. 449.953 Annual fee for insurers: Amount; notice; administrative fine for failure to pay. 449.957 Hospitals to file certain reports; certification; exception; extension. 449.960 Hospitals to submit quarterly financial and utilization report; certification; extension. 449.962 Facility for intermediate care or facility for skilled nursing to submit quarterly financial

and utilization report; certification; extension. 449.9625 Institution to submit quarterly financial and utilization report; certification; extension;

exception. 449.963 Information concerning discharged patients: Submission; limitation on disclosure. 449.966 Notice of insufficiency of submitted information. 449.969 Administrative fine for failing to meet deadlines.

MOBILE UNITS

449.970 Definitions. 449.9701 “Independent facility” defined. 449.97012 “Mobile unit” defined. 449.97014 “Parent facility” defined. 449.97016 “Service site” defined. 449.97018 “Staging area” defined. 449.9702 Applicability of provisions. 449.97022 Licensure. 449.97024 Application for licensure. 449.97026 Design, construction, equipment, maintenance and parking. 449.97028 Staging areas; disposal of biohazards and waste. 449.9703 Compliance with certain statutes and regulations. 449.97032 Compliance with regulations relating to evaluation of quality of services. 449.97034 Written policies for operation of unit; agreement with hospital or medical facility for

transfer of patients during emergencies. 449.97036 Rights of patients. 449.97038 Maintenance of schedule and records; supplies and equipment; diagnostic radiological

services; laboratory services. 449.9704 Occupancy; fire safety; exits; use and maintenance of equipment; telecommunications

device. 449.97042 Restrictions on operation; office of independent facility; operation pursuant to contract.

SURGICAL CENTERS FOR AMBULATORY PATIENTS

General Provisions

449.971 Definitions. 449.9715 “Allied health profession” defined. 449.972 “Ambulatory surgical center” defined. 449.9725 “Division” defined. 449.973 “Governing body” defined. 449.9735 “Licensee” defined. 449.974 “Patient” defined. 449.9741 “Physician” defined. 449.9742 “Registered nurse” defined. 449.9743 “Surgery” defined.

Licensing

449.9745 Compliance with requirements by accreditation. 449.9755 Investigation of applicant and inspection of center. 449.978 Effect of expiration of license.

449.9785 Conformance with regulations required.

Administration

449.979 Governing body required. 449.9795 Duties of governing body. 449.980 Responsibilities of governing body. 449.9801 Procedures for granting privileges to members of medical staff. 449.9805 Establishment of policy for authentication. 449.981 Appointment and responsibilities of administrator. 449.9812 Program for quality assurance. 449.9813 Committee for quality assurance. 449.9815 Maintenance. 449.982 Sanitation and housekeeping. 449.983 Protection from fire and other disasters. 449.9835 Exemption from requirements for governing body and administrator. 449.9837 Restrictions on operation of ambulatory surgical center; maintenance of records. 449.9843 Compliance with certain standards, laws, ordinances and codes; submission and

approval of building plans; prerequisites to approval of center for licensure.

Personnel

449.9855 Policies and requirements for personnel. 449.9865 Medical staff. 449.988 Nursing staff.

Medical Records, Services and Facilities

449.9885 Medical records: Maintenance. 449.989 Medical records: Contents. 449.9895 Sterilization. 449.990 Medication and treatment. 449.9902 Emergency equipment and supplies required. 449.9905 Pharmacist required; records, storage and administration of drugs. 449.991 Laboratory services. 449.992 Pathological services. 449.9925 Procurement, storage and transfusion of blood. 449.993 Diagnostic radiological services. 449.9935 Operating and recovery rooms; endoscopy suite. 449.9937 Extended recovery units. 449.994 Records required before surgery; report of surgery. 449.9945 Administration and record of anesthesia. 449.9955 Informing patient of rights, services and cost. 449.996 Transfer of patients. 449.9965 Prohibited locations for construction of center. 449.997 Conversion of hazardous building into center prohibited.

RECEIVERS

449.9981 List of interested and qualified persons. 449.99811 Experience. 449.99812 Authority. 449.99813 Compensation and payment of bond. 449.99814 Operation of facility.

ADMINISTRATIVE SANCTIONS

General Provisions

449.9982 Definitions. 449.99821 “Ban on admissions” defined. 449.99822 “Cluster” defined.

449.99823 “Compliance” and “substantially correct the deficiency” defined. 449.99824 “Costs” defined. 449.99825 “De minimis deficiency” defined. 449.998253 “Division of Health Care Financing and Policy” defined. 449.998255 “Facility” defined. 449.99826 “Immediate family” defined. 449.99827 “Initial deficiency” defined. 449.99828 “Major deficiency” defined. 449.99829 “Medicaid facility” defined. 449.9983 “Medicare facility” defined. 449.99832 “Monitor” defined. 449.99833 “New admission” defined. 449.99834 “Particular kinds of care, treatment or services” defined. 449.99835 “Plan of correction” defined. 449.99836 “Provider agreement” defined. 449.99837 “Repeated deficiency” defined. 449.99838 “Resurvey” defined. 449.99839 “Severity and scope score” defined. 449.9984 “Subsequent deficiency” defined. 449.99841 “Temporary management” defined. 449.99843 Purposes of administrative sanctions. 449.99844 Interpretation of provisions in accordance with federal standards.

Imposition: Generally

449.9985 Authority of Health Division and Bureau. 449.99851 Requirement for imposition; optional imposition. 449.99852 Requirement for imposition; multiple sanctions. 449.99853 Imposition of one or more sanctions; criteria for imposition of particular sanction. 449.99854 Imposition in lieu of or in addition to recommendation to terminate provider agreement;

duration of sanctions. 449.99855 Imposition in emergencies: Authority; notice. 449.99856 Deficiencies: Basis for imposition of sanctions; reporting; presumption of de minimis

deficiency. 449.99857 Classifications of severity and scope of deficiencies: Use. 449.99858 Scope of violations: Evaluation of representative sample of recipients; size of sample. 449.99859 Scope of deficiencies: Use of scope scale; basis for assessment. 449.9986 Scope of deficiencies: Criteria for evaluation. 449.99861 Severity of deficiencies: Use of severity scale; basis for assessment; criteria for

evaluation. 449.99862 Presumption when same deficiency found on resurvey; imposition of sanction for

subsequent deficiency. 449.99863 Available sanctions. 449.99864 Determination of appropriate sanction: Procedure. 449.99865 Determination of appropriate sanction: Initial assessment. 449.99866 Determination of appropriate sanction: Consideration of secondary factors. 449.99867 Determination of appropriate sanction: Basis for selection; presumption.

Plan of Correction

449.9987 Development and submission of plan; authority of Bureau when plan is not acceptable; effect of failure to submit plan.

Limitation on Occupancy of Residential Facility

449.99875 Purpose and scope of limitation; imposition in addition to partial ban on admissions. 449.99876 Criteria for imposition. 449.99877 Duration and termination of limitation. 449.99878 Notice of limitation: General requirements; effect of noncompliance.

Ban on Admissions

449.9988 Purpose and scope of ban.

449.99881 Criteria for imposition. 449.99882 Duration and termination of ban. 449.99883 Notice of ban: General requirements; effect of noncompliance.

Monitoring of Facility

449.99885 Authority of Bureau.

Monetary Penalties

449.99895 Imposition by Bureau; purpose; applicable criteria. 449.99896 Criteria for imposition; imposition of initial and daily penalties. 449.99897 Imposition of initial penalty pending hearing or appeal; stay of payment of penalties

pending appeal. 449.99898 Procedure for imposition; interest on total penalty assessed. 449.99899 Determination of amount of penalties. 449.999 Limitation on principal amount of total daily penalty. 449.99901 Daily penalty: Computation according to number of recipients. 449.99902 Increase in penalty for repeated deficiencies or false compliance. 449.99903 Presumption regarding deficiencies identified on resurvey. 449.99904 Reduction of penalty. 449.99905 Daily penalty: Effective beginning date. 449.99906 Daily penalty: Date and period of computation; notice to facility. 449.99907 Termination of daily penalties; failure of Medicaid facility to remove immediate and

serious threat after appointment of temporary management. 449.99908 Time for payment of penalties. 449.99909 Assessment of interest on unpaid balance of penalty. 449.9991 Recovery of costs for collection of penalty. 449.99911 Failure to pay penalty: Suspension of license of facility. 449.99912 Disposition of money collected.

Temporary Management

449.99915 Appointment of temporary manager when there is immediate and serious threat: Notice; effect of failure to accept manager and to remove threat.

449.99916 Appointment of temporary manager when there is no immediate and serious threat: Notice.

449.99917 Temporary manager: Qualifications. 449.99918 Temporary manager: Authority. 449.99919 Effect of failure to agree to appointment of or to relinquish authority to temporary

manager. 449.9992 Events requiring termination of management; initiation of judicial proceedings. 449.99921 Payment of costs and expenses.

Closure of Facility and Transfer of Residents

449.99925 Authority of Bureau. 449.99926 Requirements for notification. 449.99927 Appointment of temporary manager. 449.99928 Bureau to supervise or appoint temporary manager to supervise transfer; imposition of

other appropriate sanctions. 449.99929 Determination of appropriate placement of residents. 449.9993 Rights of appeal for transferred residents.

Facilities Participating in Medicaid

449.99935 Authorized recommendations in addition to available sanctions. 449.99936 Withholding of monetary penalties from payments owed to facility. 449.99937 Denial of payments for new admissions generally. 449.99938 Denial of payments for new admissions who have certain specified diagnoses or special

care needs. 449.99939 Suspension of payments for services furnished to Medicaid recipient on or after date of

deficiency.