NAC449.74515. Physicians.

     1. A patient may be admitted to a facility for skilled nursing only upon the written approval of a physician. Upon a patient’s admission to the facility, the facility shall ensure that orders for the immediate care of the patient have been received from the patient’s attending physician.

     2. Each patient admitted to a facility for skilled nursing must remain under the care of a physician.

     3. A facility for skilled nursing shall ensure that:

     (a) The medical care of each patient in the facility is supervised by a physician; and

     (b) A physician other than the attending physician of a patient supervises the care of that patient when the attending physician is not available.

     4. A patient in a facility for skilled nursing must be visited by a physician at least once every 30 days for the first 90 days after his or her admission to the facility, and at least once every 60 days thereafter. For the purposes of this subsection, a visit from a physician shall be deemed to be timely if it occurs not later than 10 days after the date on which the visit is required. Except as otherwise provided in this section, each visit required by this subsection must be made by the physician.

     5. At each visit to a patient required by subsection 4:

     (a) The patient’s plan of care must be reviewed, including, without limitation, the medications and treatments prescribed for the patient;

     (b) Progress notes of the visit must be prepared, signed and dated; and

     (c) Any orders for the treatment of the patient must be signed and dated.

     6. After the initial visit to a patient is made by a physician, every other visit to the patient may be made by a physician assistant, nurse practitioner or clinical nurse specialist on behalf of the physician if the physician assistant, nurse practitioner or clinical nurse specialist is acting:

     (a) Within the authorized scope of his or her practice and under the supervision of the physician; and

     (b) In accordance with state law and the policies of the facility for skilled nursing.

     7. A facility for skilled nursing shall provide or arrange for the provision of physicians’ services 24 hours a day in the case of an emergency.

     (Added to NAC by Bd. of Health by R051-99, eff. 9-27-99)