Part 400. Rules for Nursing Homes

20 CAR § 400-1101. Purpose of assignment and reporting of licensed beds by class. (a) This subpart establishes a classification system and process for a Medicaid-certified skilled nursing facility to differentiate, document, and report to the Department of Human Services: (1) The…

20 CAR § 400-1102. Classes of resident rooms. (a) Class A. (1) A Class A room is a private single occupancy resident bedroom in a Medicaid-certified skilled nursing facility that: (A) Has an adjoining private bathroom or an en suite bathroom shared with one (1) other adjoining Cl…

20 CAR § 400-1103. Private and en suite bathroom facilities for Class A and Class B rooms. (a) For designation as Class A or Class B, a Medicaid-certified skilled nursing facility resident room must have either: (1) An adjoining private bathroom to only serve one (1) Class A or C…

20 CAR § 400-1104. Registered architect required. (a) Each Medicaid-certified skilled nursing facility shall contract with a registered architect to: (1) Physically inspect the facility’s resident rooms and bathroom facilities; (2) Prepare the simplified annotated floor plan desc…

20 CAR § 400-1105. Simplified annotated floor plans. (a) A simplified annotated floor plan shall be submitted with each report on resident room classifications and assignment of total bed licenses described in 20 CAR § 400-1106. (b) Each simplified annotated floor plan shall: (1)…

20 CAR § 400-1106. Reports on resident room classifications and assignment of bed licenses. (a) Purpose. This section specifies the required and optional reports by a Medicaid-certified skilled nursing facility to document the classification of each resident room and the assignme…

20 CAR § 400-1107. Department review of reports and annotated floor plans. (a) To verify the accuracy and completeness of a report submitted under 20 CAR § 400-1106 or an annotated floor plan submitted under 20 CAR § 400-1105, the Department of Human Services may, through departm…

20 CAR § 400-1201. Admission only on recommendation of a physician. (a) Patients shall be admitted to the facility only on recommendation of a physician. (b) At the time of admission the physician must document level of care needed by the patient. (c) A certification statement by…

20 CAR § 400-1202. Continued supervision of care. (a) The health care of every patient shall be under the continuing supervision of a physician, who, based on a medical evaluation of the patient's immediate and long-term needs, prescribes a planned regimen of total patient care. …

20 CAR § 400-1203. Physical examination of patients. (a) The medical evaluation of the patient shall be based on a history and physical examination done within seventy-two (72) hours of admission unless such examination was performed within fifteen (15) days prior to admission. (…

20 CAR § 400-1204. Planned regimen of care. The planned regimen of total care for each patient shall be based on the attending physician's order and shall cover: (1) Medication; (2) Treatment; (3) Rehabilitative services (where appropriate); (4) Diets; (5) Precautions related to …

20 CAR § 400-1205. Establishment restoration potential. (a) The attending physician shall establish at the time of admission a restoration potential for the patient. (b) This should be updated as needed but not less than on an annual basis.

20 CAR § 400-1206. Emergency physician. (a) The facility should make arrangements for emergency coverage by a physician if the attending physician or his or her attendant cannot be located. (b) This should be done by a written agreement signed by the physician and the facility ad…

20 CAR § 400-1301. Professional nurse supervision. (a)(1) A licensed registered nurse shall be employed full time as the director of nursing services and normally work on the day shift. (2) In skilled nursing facilities registered nurse relief shall be provided for the off days o…

20 CAR § 400-1302. Charge nurse. (a)(1) In skilled nursing facilities, the director of nursing services shall designate as charge nurse for each shift a: (A) Registered nurse; (B) Licensed practical nurse; or (C) Licensed psychiatric technician nurse. (2) Responsibilities of the …

20 CAR § 400-1303. Nursing staff. (a) All registered nurses, licensed practical nurses, and licensed psychiatric technicians employed in the nursing home shall be currently licensed in the State of Arkansas. (b) The licensed nursing staff required shall be computed in accordance …

20 CAR § 400-1304. Personal assignments. (a) The nursing staff shall be engaged in the direct care and treatment of the patients. (b) No aide shall be permitted to combine the duties of housekeeping, laundry, or kitchen duties with nursing because of the danger of cross infection…

20 CAR § 400-1305. Restrictions in employment and/or assignment. No person who has been a patient in a mental hospital and who has not been completely discharged by that institution shall be employed in a nursing home in a supervisory capacity.

20 CAR § 400-1306. Nursing care requirements. (a) Charting. (1) Summary charting should address: (A) The resident's problems/needs; (B) Interventions to resolve those needs; and (C) The progress made toward achieving the resident goals as listed on the care plan. (2) All discipli…

20 CAR § 400-1307. Treatment and medications. (a)(1) No medication or treatment shall be given without the written order of the physician or dentist. (2) Drugs shall be administered in accordance with orders. (3) Venapuncture by licensed practical nurses to obtain blood samples f…

20 CAR § 400-1308. Rehabilitative nursing. (a)(1) Nursing personnel shall be trained in rehabilitative nursing measures. (2) This shall be documented in the orientation program, and in-service on this subject shall be conducted at least annually. (b) The facility shall have an ac…

20 CAR § 400-1309. Supervision of patient nutrition. Nursing personnel shall: (1) Be aware of the nutritional needs, food, and fluid in-take of patients; and (2) Assist promptly where necessary in the feeding of patients.

20 CAR § 400-1401. Definitions. For purposes of this subpart, the following definitions apply: (1) "Average direct care hours per resident day" means the total number of hours of direct care services provided by direct care staff in a month, divided by the number of calendar days…

20 CAR § 400-1402. Condition of licensure. (a) As a condition of licensure by the Department of Human Services, a nursing facility, except a private pay-only nursing facility, shall be certified to participate in: (1) The federal Medicare program as a skilled nursing facility; (2…

20 CAR § 400-1403. Consistency with federal requirements. (a) Under 42 U.S.C. § 1395i-3 and 42 U.S.C. § 1396r, a certified nursing facility: (1) Is subject to federal requirements of participation; and (2) Must demonstrate substantial compliance with applicable federal requiremen…

20 CAR § 400-1404. Average direct care hours per resident — Certified nursing facilities. (a) Each certified nursing facility shall: (1) Provide each month direct care services by direct care staff equivalent to at least three and thirty-six hundredths (3.36) average direct care …

20 CAR § 400-1405. Average direct care hours per resident — Private pay-only nursing facilities. (a) Each private pay-only nursing facility shall: (1) Provide each month direct care services by direct care staff equivalent to at least three and thirty-six hundredths (3.36) averag…

20 CAR § 400-1406. Certified medication assistants. (a) Any licensed nursing facility may elect to use certified medication assistants (medication assistants-certified) to perform the delegated nursing function of medication administration and related tasks: (1) Under the supervi…

20 CAR § 400-1407. Modern staffing practices supported. (a) A licensed nursing facility may: (1) Engage the services of direct care staff and other personnel on a full-time or part-time basis and through employment, contracting, and staffing agencies, or any combination thereof; …

20 CAR § 400-1408. Posting of staffing information. Each licensed nursing facility shall comply with the information posting requirements of 42 C.F.R. § 483.35.

20 CAR § 400-1409. Waivers and variances. (a) In the event of a public health emergency, natural disaster, other major emergency, or severe labor shortage, the Department of Human Services may temporarily waive the average direct care hours per resident day standard in 20 CAR §§ …

20 CAR § 400-1501. Services based on resident needs. In addition to rehabilitative nursing, the facility shall, as ordered by a physician, provide, according to the needs of each patient, specialized and supportive services, i.e., physical therapy, speech pathology, audiology, an…

20 CAR § 400-1502. Written plan of care. If provided, specialized rehabilitative services shall be provided under a written plan of care, initiated by the attending physician, and developed in consultation with appropriate therapist or therapists and nursing services.

20 CAR § 400-1503. Review of resident progress. A report of the patient's progress shall be communicated to the attending physician within two (2) weeks of the initiation of the specialized rehabilitative services and regularly thereafter.

20 CAR § 400-1504. Re-evaluation of plan. The plan of specialized rehabilitative care shall be re-evaluated as necessary, but at least every thirty (30) days by the physician and/or the therapist.

20 CAR § 400-1505. Documentation of services. The physician's orders, the plan of specialized rehabilitative care, services rendered, evaluation of progress, and other pertinent information shall be recorded in the patient's medical record and dated and signed by the physician or…

20 CAR § 400-1601. Responsibility for pharmacy compliance. (a) The administrator shall be responsible for full compliance with federal and state laws governing procurement, control, and administration of all drugs. (b) Full compliance is expected with the Comprehensive Drug Abuse…

20 CAR § 400-1602. Pharmacy consultants permit. (a) Each nursing home shall have a formal arrangement with a licensed pharmacist to provide supervision and consultation on methods and procedures for ordering, storing, administering, disposition, and record keeping of drugs and bi…

20 CAR § 400-1603. Prescriptions on individual basis. (a) All drugs prescribed for each patient shall be on an individual prescription basis. (b) Medications prescribed for a specific patient shall not be administered to another patient.

20 CAR § 400-1604. Administration of medication. (a) No medication shall be given without a written order by a physician or dentist. (b)(1) All medications shall be given by authorized nursing personnel. (2) The administrator or his or her appointed assistant shall be responsible…

20 CAR § 400-1605. Equipment for administering medications. (a) There shall be calibrated medicine containers to correctly measure liquid medications. (b) Calibrated medicine containers include calibrated syringes when used to measure odd liquid dosages, such as 4cc, 8cc, etc. (c…

20 CAR § 400-1606. Medicine cards. (a) In administering medications, medication cards current with the physician’s orders must be used. (b) Medicine cards shall be provided to include: (1) Name of patient; (2) Rooms or bed number; (3) Medication and dosage; and (4) Hours to be gi…

20 CAR § 400-1607. Stop order policy. (a) Medications not specifically limited as to time or number of doses when ordered by the physician shall be controlled by the facility’s policy regarding automatic stop orders. (b) The facility’s automatic stop order policy, at a minimum, s…

20 CAR § 400-1608. Storage of drugs. (a) All drugs on the premises of a nursing home, except for the emergency tray, as defined by the State Board of Health and the Arkansas State Board of Pharmacy, shall be properly labeled containers dispensed upon prescription by the pharmacy.…

20 CAR § 400-1609. Emergency drug box. (a)(1) A container that contains emergency stimulants and drugs for life saving measures must be maintained. (2) This box should: (A) Be located where it can be readily available to nursing personnel but kept in a secure place; and (B) Have …

20 CAR § 400-1610. Record of controlled drugs. (a)(1) A record shall be kept in a bound ledger book with consecutively numbered pages of all controlled drugs procured and administered. (2) This record shall contain on each separate page the: (A) Name, strength, and quantity of dr…

20 CAR § 400-1611. Controlled drug accountability. (a)(1) There shall be a count of all C-II controlled medications at each change of shift. (2) All C-III, C-IV, and C-V controlled medications should be counted at least once daily unless a true unit dose system is used. (3)(A) Th…