(1) The nursing home must ensure that the resident is seen by the physician whenever necessary.
(2) Except as specified in RCW
74.42.200, a physician must personally approve in writing a recommendation that an individual be admitted to a nursing home.
(3) The nursing home must ensure that:
(a) Except as specified in RCW
74.42.200, the medical care of each resident is supervised by a physician;
(b) Another physician supervises the medical care of residents when their attending physician is unavailable; and
(c) Physician services are provided twenty-four hours per day, in case of emergency.
(4) The physician must:
(a) Write, sign and date progress notes at each visit;
(b) Sign and date all orders; and
(c) In medicare and medicare/medicaid certified facilities, review the resident's total program of care, including medications and treatments, at each federally required visit.
(5) Except as specified in subsections (6), (7), and (9) of this section, a physician may delegate tasks to a physician's assistant or advanced registered nurse practitioner who is:
(a) Licensed by the state;
(b) Acting within the scope of practice as defined by state law; and
(c) Under the supervision of the physician.
(6) The physician may not delegate a task when the delegation is prohibited under state law or by the facility's own policies.
(7) If the resident's primary payor source is medicare, the physician may:
(a) Alternate federally required physician visits between personal visits by:
(i) The physician; and
(ii) An advanced registered nurse practitioner or physician's assistant; and
(b) Not delegate responsibility for the initial required physician visit. This initial visit must occur within the first thirty days of admission to the facility.
(8) If the resident's payor source is medicaid, the physician may delegate any federally required physician task, including tasks which the regulations specify must be performed personally by the physician, to a physician's assistant or advanced registered nurse practitioner who is not an employee of the facility but who is working in collaboration with a physician.
(9) If the resident's payor source is not medicare or medicaid:
(a) In the medicare only certified facility or in the medicare certified area of a medicare/medicaid facility, the physician may alternate federally required physician visits between personal visits by the physician and an advanced registered nurse practitioner or physician's assistant. The physician may not delegate responsibility for the initial required physician visit.
(b) In the medicaid only certified facility or in the medicaid certified area of a medicare/medicaid facility, the physician may delegate any federally required physician task, including tasks which the regulations specify must be performed personally by the physician, to a physician's assistant or advanced registered nurse practitioner who is not an employee of the facility but who is working in collaboration with a physician.
(10) The following table describes the physician visit requirements related to medicare or medicaid certified area and payor type.
| Beds in medicare only certified area | Beds in medicare/medicaid certified area | Beds in medicaid only certified area |
Payor source: | Initial by physician | Initial by physician | N/A |
medicare | Physician may delegate alternate visits | Physician may delegate alternate visits | |
Payor source: | N/A | Delegate all tasks | Delegate all tasks |
medicaid | | Nonemployee | Nonemployee |
Payor source: | Initial by physician | Initial by physician | Delegate all tasks |
Others: such as insurance, private pay, Veteran Affairs | Physician may delegate alternate visits | Physician may delegate alternate visits | Nonemployee |
(11) The attending physician, or the physician-designated advanced registered nurse practitioner or physician's assistant must:
(a) Participate in the interdisciplinary plan of care process as described in WAC
388-97-1020;
(b) Provide to the resident, or where applicable the resident's surrogate decision maker, information so that the resident can make an informed consent to care or refusal of care (see WAC
388-97-0260); and
(c) Order resident self-medication when appropriate.
(12) The nursing home must obtain from the physician the following medical information before or at the time of the resident's admission:
(a) A summary or summaries of the resident's current health status, including history and physical findings reflecting a review of systems;
(b) Orders, as necessary for medications, treatments, diagnostic studies, specialized rehabilitative services, diet, and any restrictions related to physical mobility; and
(c) Plans for continuing care and discharge.