What is the required frequency for LVN Supervision in Home Health?

[Nurse Beth, MSN]

State guidelines are more specific than CMS Home Health guidelines  (Code of Federal Regulations ) regarding the frequency of LVN supervision by an RN in home health, so I'll point you to a couple of state guidelines. CMS states "regularly" for frequency, leaving it up to the states to decide.

State guidelines can vary depending on the acuity of the patient. 

Note: CMS does outline specific requirements regarding supervisory visits for home health aides. "A registered nurse or other appropriate skilled professional who is familiar with the patient, the patient's plan of care, and the written patient care instructions described in paragraph (g) of this section, must complete a supervisory assessment of the aide services being provided no less frequently than every 14 days."

California

California Code of Regulations talks about RNs supervising LVNs who supervise Home Health Aides: "When a licensed vocational nurse is delegated supervision of home health aide services that are provided in conjunction with skilled nursing services, a registered nurse shall make the on-site supervisory visit to the patient's home at least every three months, to observe the patient and patient care environment" and

"When a licensed vocational nurse is delegated supervision of home health aide/personal care services (when the patient is only receiving these services), the registered nurse shall at least alternate on-site supervisory visits to the patient's home with the licensed vocational nurse, to observe the patient and the patient care environment."

Only RNs can conduct the initial assessment and coordinate services, which relates to scope of practice limitations; however, these scope of practice factors also influence RN visit frequency.

Texas

Texas Administrative Code states, "When skilled nursing care, PT, or OT are also being furnished to a recipient, an RN must make a supervisory visit to the recipient's residence at least every two weeks."

Always refer to your state nursing boards and your specific home health agency's policies for up-to-date regulations.

I hope this helps,

Nurse Beth

 

[NRSKarenRN, BSN, RN]

Based on my 30+yrs in homecare responsible for survey preparation., CMS Home Health Medicare regulations 42CFR Part 484  does not list specifically a time interval for LPN supervision. Some state guidelines do have regulations when an home health aide is providing care under an LPN as Beth stated.

Look at:

§ 484.115 Condition of participation: Personnel qualifications.

484.75 Condition of participation: Skilled professional services.

Quote

Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under § 484.115 and who practice according to the HHA's policies and procedures.

"a licensed practical nurse who is under the supervision of a registered nurse." is part of the regulations.   In audits, surveyor's have looked at what your agency policy states regarding supervision + if staff evaluations meet your policy.

CMS Interpretive statements   used by surveor to confirm compliance and issue any non-compliance code
 

Quote

G702
(Rev. 219; Issued: 04-12-24; Effective: 04-12-24; Implementation: 04-12-24)
§484.75(a) Standard: Provision of services by skilled professionals.
Skilled professional services are authorized, delivered, and supervised only by health care professionals who meet the appropriate qualifications specified under §484.115 and who practice according to the HHA's policies and procedures

PA's RULES AND REGULATIONS FOR HOME HEALTH CARE AGENCIES

Ch. 601 HOME HEALTH CARE AGENCIES 28 § 601.21   

GOVERNANCE AND MANAGEMENT
§601.21. Organization, service and administration.
(f) Personnel policies

Quote

Personnel practices shall be supported by appropriate, written personnel policies. Personnel records shall include job descriptions, qualifications, licensure, performance evaluations, health examinations and documentation of orientation provided. Records shall be kept current.

Home Health industry standard is a YEARLY employee supervisory evaluation.  For  direct care staff/personal care aides in a home care agency, I provide a yearly competency evaluation along with an employee eval while staff providing care at a  clients home..