Georgia Administrative Code

The HMO shall have written policies and procedures governing the provision of services which are based on the stated objectives of the HMO. Policies and procedures shall be approved by the governing body and reviewed and updated at least annually. All policies/procedures shall be…

(1) The HMO shall develop, compile, evaluate, and report statistics to the Department as requested relating to the cost of its operations, the pattern of utilization of its services, and the availability and accessibility of its services. The HMO shall provide the Department with…

(1) The HMO shall be available at all reasonable and/or scheduled operating hours for observation and examination by properly identified representatives of the Department. These examinations shall pertain to all matters relating to the quality of healthcare services of the HMO an…

Upon certification to the Insurance Commissioner's Office that the HMO does not meet the requirements of Section 56-3603(1) (b) of the HMO Act of Georgia; or the HMO is unable to fulfill its obligations to furnish health care services as required under its health benefits plan(s)…

(1) Informal Procedure. If the Commissioner shall for any reason have cause to believe that any violation of these rules and regulations or of the Georgia Laws governing HMO's has occurred or is threatened, the Commissioner may give notice to the HMO and to its representatives, o…

These regulations are applicable only to HMO's and the services provided therein, and do not modify or revoke any of the provisions of other published rules of DCH.

In the event that any rule, sentence, clause or phrase of any of these rules and regulations may be construed by any court of competent jurisdiction to be invalid, illegal, unconstitutional, or otherwise unenforceable, such determination or adjudication shall in no manner affect …

Under the authority of O.C.G.A. § 31-7-150, the Department of Community Health is authorized and required to establish the licensing procedures and standards of operation for home health agencies operating in this State. These rules and regulations are provided for this purpose.

Each person, private or public organization, political subdivision, or other governmental agency desiring to operate a home health agency, as defined herein, must first apply for and obtain a license using the forms furnished by the Department of Community Health. A license is no…

Home health agencies which are required by state laws to obtain a certificate of need shall submit evidence that such requirements have been met when applying for a license.

These rules and regulations shall not apply to services which are provided under the following conditions: (a) Persons who provide personal or paraprofessional health services, either with or without compensation when there is no claim that the service is provided as a part of a …

For the purpose of insuring compliance with these rules and regulations, each home health agency shall be subjected to periodic inspections by an authorized representative of the Department. Such inspections shall take place during reasonable hours and, if possible, during schedu…

Unless a different meaning is required or given in the context, the following terms as used in these rules and regulations shall have the meaning respectively ascribed to them: (a) "Administrator" means the full-time person by whatever title used, to whom the governing body has d…

(1) Organizations, Services, Administration. Organizations, services provided, administrative control, and lines of authority for the delegation of responsibility down to the patient care level shall be clearly set forth in written policies and procedures. Administrative and supe…

A home health agency shall provide part-time or intermittent skilled nursing services and at least one other therapeutic service, e.g., physical, speech, or occupational therapy; medical social services; or home health aide services. Services shall be made available on a visiting…

Patients shall be accepted for treatment on the basis of a reasonable expectation that the patient's medical, nursing, and social needs can be met adequately by the agency in the patient's place of residence. Patients shall not be denied services because of their age, sex, race, …

Any person who operates a home health agency without first obtaining a license pursuant to the provisions of the Georgia Home Health Agency Act shall be deemed guilty of a misdemeanor, and upon conviction shall be fined not to exceed $500.00 or imprisoned for a period not to exce…

Each application for initial and annual renewal licenses shall be accompanied by a fee as prescribed by the Department.

The administration and enforcement of these rules and regulations shall be as prescribed in the "Georgia Administrative Procedure Act," O.C.G.A. § 50-13-1et seq.

These regulations are applicable only to home health agencies as defined herein and the services they provide, and do not modify or revoke any of the provisions of other published rules of the Department.

In the event that any rule, sentence, clause or phrase of any of these rules and regulations may be construed by any court of competent jurisdiction to be invalid, illegal, unconstitutional, or otherwise unenforceable, such determination or adjudication shall in no manner affect …

These rules shall be known as the Rules and Regulations for Hospices. The purpose of these rules is to provide for the inspection and issuance of licenses for hospices and to establish minimum requirements for facilities operating under hospice licenses.

The legal authority for this Chapter is O.C.G.A § 31-7-170et seq., the "Georgia Hospice Law" and O.C.G.A. § 31-2-4et seq.

(1) Unless the context otherwise requires, these identified terms mean the following when used in these rules: (a) "Administrator" means the person, by whatever title used, to whom the governing body has delegated the responsibility for the day-to-day administration of the hospic…

(1) Operating, establishing or maintaining a hospice in the State of Georgia without first obtaining a valid license from the Department is prohibited. (2) Use of the term "hospice" to imply or indicate that a person or entity is providing hospice services to patients and their f…

(1) The hospice staff, any facilities where hospice care is being delivered, and the hospice patients must be accessible during all hours of operation to properly identified representatives of the Department for inspections and investigations relating to the hospice's license. (2…

(1) Patient Incidents Requiring Report. The hospice must report to the Department, on forms made available by the Department, within 24 hours or the next business day, whenever any of the following incidents involving patients occurs or the hospice has reasonable cause to believe…

(1) The hospice must have an established and functioning governing body that is responsible for the conduct of the hospice and that provides for effective hospice governance, management, and budget planning. (2) The governing body must appoint an administrator and delegate to the…

(1) Each hospice must have a qualified administrator, designated by the governing body, who must be responsible for the ongoing and day-to-day operation of the hospice. (2) The hospice administrator must be either a Georgia-licensed health care professional, who has at least one …

(1) The hospice must appoint an interdisciplinary quality management committee that reflects the hospice's scope of services. The committee must develop and implement a comprehensive, effective and ongoing quality management, utilization, and peer review program that evaluates, m…

(1) The hospice must ensure that patients and their families receive hospice care and palliative care for persons with advanced and progressive diseases, when offered, in a manner that respects and protects their dignity and ensures all patients' rights to: (a) Participate in the…

(1) Every hospice must have a current disaster preparedness plan that addresses potential situations where services to patients may be disrupted and outlines appropriate courses of action in the event a local or widespread disaster occurs including communications with patients an…

The hospice must have an effective infection control program designed to reduce the transmission of infections in patients, health care workers, caregivers, families, visitors and volunteers. (a) The hospice must develop an infection control surveillance plan that is tailored to …

(1) All persons providing services for a hospice must be qualified by education, training, and experience to carry out all duties and responsibilities assigned to them. (2) All persons providing services for a hospice must receive an orientation to the hospice to include, but not…

(1) Admissions. The hospice must not admit any patients unless the hospice believes that it is capable of meeting the care needs of the patients. The hospice must have written criteria that address the eligibility for admission into home hospice care, residential, or inpatient ho…

(1) The hospice must designate a hospice care team for each patient admitted by the hospice. The hospice care team must be composed of individuals who provide or supervise the care and services offered by the hospice. (2) The hospice care team must include at least the following …

(1) The hospice must provide home care services to patients primarily in the patients' home. At least 51 percent of the total of all hospice care days, delivered by the hospice in the fiscal year to terminally ill patients must be delivered in the homes of the terminally ill pati…

(1) Medical services must be under the direction of the medical director. In addition to palliation and management of the terminal illness and related conditions, physicians of the hospice, including the physician members of the hospice care team, must also address the basic medi…

(1) The hospice shall have a system to make available nursing services 24-hours a day, seven days a week to meet the needs of the patients. (a) A registered nurse must be available at all times to provide or supervise the provision of nursing care. (b) On-site nursing services mu…

Hospices must make supportive services available to both the patient and the patient's family unit, including, but not limited to, bereavement services provided both prior to and after the patient's death, as well as spiritual counseling and any other counseling services identifi…

(1) The hospice must establish a program that utilizes volunteers to provide services to terminally ill patients and family units in accordance with patients' plans of care and/or to provide administrative support services for the hospice. (2) The hospice must designate a coordin…

(1) The hospice must provide for the procurement, storage, administration, and destruction of drugs and biologicals utilized for hospice care in accordance with accepted professional principles and in compliance with all applicable state and federal laws. (2) The hospice must: (a…

The hospice must make available sufficient medical supplies and equipment for the palliative care and management of the illness or conditions directly attributable to the terminal diagnosis of terminally ill patients. (a) If the hospice directly provides medical supplies and equi…

(1) In accordance with accepted standards of practice, the hospice must establish and maintain a medical record for every patient admitted for care and services. The medical record must be complete, promptly and accurately documented, readily accessible, and systematically organi…

(1) Hospices providing home care services may establish, as optional services, small home-like residential facilities or units, in order to provide 24-hour non-acute palliative hospice care, and/or inpatient units, in order to provide short-term, 24-hour acute hospice care to ter…

(1) A hospice may request a waiver or variance of a specific rule by application on forms provided by the Department. (2) The Department may grant or deny the request for waiver or variance at its discretion. If the waiver or variance is granted, the Department may establish cond…

A hospice that fails to comply with licensing requirements as contained in the Rules and Regulations for Hospices, Chapter 111-8-37 and the Rules and Regulations for General Licensing and Enforcement Requirements, Chapter 111-8-25, is subject to civil and administrative actions b…