in-20260527-IR-410260149FNA: RESIDENTIAL CARE FACILITIES

TITLE 410 INDIANA DEPARTMENT OF HEALTH Notice of First Public Comment Period LSA Document #26-149 RESIDENTIAL CARE FACILITIES PURPOSE OF NOTICE The Indiana Department of Health (IDOH) is soliciting public comment on amending rules at 410 IAC 16.2-5 concerning residents' rights and care in residential care facilities. ADDITIONAL DOCUMENTS Regulatory Analysis: 20260527-IR-410260149RAA Notice of Public Hearing: 20260527-IR-410260149PHA CITATIONS AFFECTED: 410 IAC 16.2-5 AUTHORITY: IC 16-28-1-7 OVERVIEW Basic Purpose and Background IDOH licenses two types of long term care facilities, residential care facilities and comprehensive care facilities. Residential care facilities provide residential nursing care or administer medications prescribed by a physician. Comprehensive care facilities are licensed to provide more complicated nursing and medical services than residential care facilities, but may have separate parts of the facility that operate as residential care facilities. Comprehensive care facilities are not required to be licensed as a residential care facility, but Indiana does do separate surveys for any residential sections. These rule updates pertain to residential care facilities or residential care portions of comprehensive care facilities. On March 17, 2014, the Centers for Medicare and Medicaid Services (CMS) issued regulations, known as the HCBS Settings Final Rule (Final Rule), that define the settings in which it is permissible for states to pay for Medicaid Home and Community-Based Services (HCBS). The purpose of these regulations is to ensure that individuals receive Medicaid HCBS in settings that are integrated and support full access to the greater community. Community integration includes opportunities for residents who receive HCBS waiver funds to seek employment and work in competitive and integrated settings, engage in community life, control personal resources, and receive services in the community to the same degree as individuals who do not receive HCBS. These changes will maximize the opportunities for participants in HCBS programs to have access to the benefits of community living and receive services in the most integrated setting. Indiana offers eight Medicaid HCBS programs that target specific groups. To be eligible for any HCBS program, an individual must meet Medicaid guidelines and HCBS program-specific eligibility guidelines. HCBS programs allow members to live in a community setting and avoid institutional placement. Indiana's HCBS programs are administered through the Family and Social Services Administration (FSSA). IC 16-28-2-11 provides: “The state department shall amend rules concerning the licensure of a residential care facility to comply with federal law and regulation concerning the provision of home and community-based services in the Medicaid program in order for a residential care facility to qualify as a home and community-based services provider.”. States must ensure all HCBS settings comply with the new requirements by completing an assessment of existing state standards, including rules, regulations, standards, policies, licensing requirements, and other provider requirements to ensure settings comply with the HCBS settings requirements. States must submit a transition plan to CMS that includes timelines and deliverables for compliance with 42 CFR 441.301(c)(4)(5), and Section 441.710(a)(1)(2). States must be in full compliance with the federal requirements by the time frame approved in the transition plan, but not later than March 17, 2023. FSSA created a statewide transition plan (plan) to assess compliance with the Final Rule and identify strategies and timelines for complying with the plan as it relates to all FSSA HCBS programs. The implementation costs of the proposed rule are not expected to exceed the threshold set in IC 4-22-2-22.7(c)(6). For purposes of IC 4-22-2-28.1, small businesses affected by this rulemaking may contact the Small Business Regulatory Coordinator: For purposes of IC 4-22-2-28.1, the Small Business Ombudsman designated by IC 5-28-17-6 is: Resources available to regulated entities through the small business ombudsman include the ombudsman's duties stated in IC 5-28-17-6, specifically IC 5-28-17-6(9), investigating and attempting to resolve any matter regarding compliance by a small business with a law, rule, or policy administered by a state agency, either as a party to a proceeding or as a mediator. REQUEST FOR PUBLIC COMMENT IDOH is soliciting public comment on the proposed rule. Comments may be submitted in one of the following ways: COMMENT PERIOD DEADLINE All comments must be postmarked or time-stamped not later than June 26, 2026. The rule, Regulatory Analysis, appendices referenced in the Regulatory Analysis, and materials incorporated by reference (if applicable) are on file at the Indiana Department of Health, Office of Legal Affairs, 2 North Meridian Street, Indianapolis, Indiana and are available for public inspection. Copies of the rule, Regulatory Analysis, and appendices referenced in the Regulatory Analysis are available at the Indiana Department of Health office. If IDOH does not receive substantive comments during the public comment period or public hearing, the rule may be adopted with text that is the same as or does not substantially differ from the text of the proposed rule published in this notice. PROPOSED RULE 410 IAC 16.2-5-0.5 Scope of residential care facilities Sec. 0.5. (a) A health facility that provides residential nursing care or administers medications prescribed by a physician must be licensed as a residential care facility. A health facility licensed as a comprehensive care facility is not required to also be licensed as a residential care facility in order to provide residential nursing care. (b) A residential care facility may not provide comprehensive nursing care except to the extent allowed under this rule. (c) A residential care facility that provides services, such as room, meals, laundry, activities, housekeeping, and limited assistance in activities of daily living, without providing administration of medication or residential nursing care, is not required to be licensed. The provision by a licensed home health agency of medication administration or residential nursing care in a facility which provides providing room, meals, a laundry, activities, housekeeping, and limited assistance in activities of daily living does not require the facility to be licensed, regardless of whether the facility and the home health agency have common ownership, provided however, that the licensed facility ensures facilitation of individual choice regarding services and support that the resident is given, and the opportunity to contract with other home health agencies at any time during the resident's stay at the facility. (d) Notwithstanding subsection (f), (g), a resident is not required to be discharged if receiving hospice services through an appropriately licensed provider of the resident's choice. (e) Notwithstanding subsection (f)(2), (f)(3), (f)(4), (g)(2), (g)(3), (g)(4), and (f)(5), (g)(5), a residential care facility that retains appropriate professional staff may provide comprehensive nursing care to residents needing care for a self-limiting condition. (f) A residential care facility shall carry out a rental or resident agreement with the resident, which must provide that the resident has all rights enumerated in section 1.2 of this rule and as set forth in IC 32-31-5-6 and IC 32-31-8-5. (f) the (g) Except as provided in subsection (f), a residential care facility may take action to evict a resident must be discharged if the or terminate a rental or resident agreement if any of the following apply: (g) (h) After receiving an eviction notice, a resident may file a request for hearing with the department. The hearing must be conducted by the department or its designee to determine whether eviction is authorized by these regulations. (i) For purposes of IC 16-28-5-1, a breach of: Sec. 1.2. (a) Residents have the right to have their rights recognized by the licensee. The licensee shall establish written policies regarding residents' rights and responsibilities in accordance with this article, and shall be responsible, through the administrator, for their implementation. These policies, and any adopted additions or changes thereto shall be made available to the resident, staff, legal representative, and general public. Each resident shall be advised of residents' rights prior to before admission and shall signify, in writing, upon on admission and thereafter, if the residents' rights are updated or changed. There shall must be documentation that each resident is in receipt of has received the described residents' rights and responsibilities. A copy of the residents' rights must be available in a publicly accessible area. The copy must be in at least 12-point type and a language the resident understands. (b) Residents have the right to a dignified existence, self-determination, and communication with and access to persons people and services inside and outside the facility. Residents shall have full access to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community. Residents shall have the ability to control their own schedules. Residents have the right to exercise their rights as a resident of the facility and as a citizen or resident of the United States. (c) Residents have the right to exercise any or all of the enumerated rights without: by the facility. These rights shall not be abrogated or changed in any instance, except that, but when the resident has been adjudicated incompetent, the rights devolve to the resident's legal representative. When a resident is found by his or her their physician to be medically incapable of understanding or exercising his or her their rights, the rights may be exercised by the resident's legal representative. (d) Residents have the right to be treated with consideration, respect, and recognition of their dignity and individuality. (e) Residents have the right to be provided, at the time of admission to the facility, the following: (f) Residents have the right to be informed of any facility policy regarding overnight guests. This policy shall be clearly stated in the admission agreement. (g) (f) Residents have the right to be informed by the facility, in writing at least thirty (30) days in advance of the effective date, of any changes in the rates or services that these rates cover. (h) (g) The facility must shall furnish on admission the following: (i) (h) The facility will distribute to each resident upon on admission the state developed written description of law concerning advance directives. (j) (i) Residents have the right to the following: (k) (j) The facility must shall immediately consult the resident's physician and the resident's legal representative when the facility has noticed: (l) (k) If the facility participates in the Medicaid waiver or residential care assistance programs, or both, the facility must provide to residents written information about how to apply for Medicaid benefits and room and board assistance. (m) (l) The facility must promptly notify shall ensure that the resident and, if known, the resident's legal representative when there is a change in is able to meet a prospective roommate assignment. and make an informed choice pertaining to the choice of a roommate, including the right to refuse a specific roommate. (m) Resident units must have entrance doors lockable by the individual, with only appropriate staff having keys to resident unit doors. (n) Residents may, throughout the period of their stay, voice grievances to the facility staff or to an outside representative of their choice, recommend changes in policy and procedure, and receive reasonable responses to their requests without fear of reprisal or interference. (o) Residents have the right to form and participate in a resident council, and families of residents have the right to form a family council, to discuss alleged grievances, facility operation, residents' rights, or other problems, and to participate in the resolution of these matters as follows: (p) Residents have the right to the examination of the results of the most recent annual survey of the facility conducted by the state surveyors, any plan of correction in effect with respect to the facility, and any subsequent surveys. (q) Residents have the right to appropriate housing assignments as follows: (r) The transfer and discharge rights of Residents of a facility are as follows: undergoing an eviction proceeding have the following rights: (s) Residents have the right to have reasonable access to the use of the telephone for local or toll free calls for emergency and personal use where calls can be made without being overheard. (t) Residents have the right to manage their personal affairs and funds. When the facility manages these services, a resident may, by written request, allow the facility to execute all or part of their financial affairs. Management does not include the safekeeping of personal items. If the facility agrees to manage the resident's funds, the facility must: (u) Residents have the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident's medical symptoms. (v) Residents have the right to be free from: (w) Residents have the right to be free from verbal abuse. (x) Residents have the right to confidentiality of all personal and clinical records. Information from these sources shall not be released without the resident's consent, except when the resident is transferred to another health facility, when required by law, or under a third party payment contract. The resident's records shall must be made immediately available to the resident for inspection, and the resident may receive a copy within five (5) working days, at the resident's expense. (y) Residents have the right to be treated as individuals, with consideration and respect for their privacy within their living unit. Privacy shall must be afforded for at least the following: (z) Residents have the right to: (aa) Residents have the right to privacy in written communications, including the right to: (bb) Residents have the right to, and the facility must shall provide, immediate access to any resident by: (cc) Residents have the right to choose with whom they associate. The facility shall provide reasonable visiting hours, which should include at least twelve (12) hours a day, and the hours shall be made available to each resident. Policies shall also provide for emergency visitation at other hours. The facility shall not restrict visits, from the resident's legal representative or spiritual advisor, except at the request of the resident. Residents have the right to form collective house rules that include visitor guidelines. House rules may not conflict with the resident's rental or resident agreement, so long as the rental agreement complies with this rule and 42 CFR Parts 430 through 456. (dd) The facility shall provide reasonable access to any resident, consistent with facility policy, by any an entity or individual that provides health, social, legal, and other services to any a resident, subject to the resident's right to deny or withdraw consent at any time. (ee) The facility shall allow representatives of the state ombudsman to examine a resident's clinical records with the permission of the resident or the resident's legal representative and consistent with state law. (ff) Residents have the right to participate in social, religious, community services, and other activities of their choice that do not interfere with the rights of other residents at the facility. (gg) Residents have the right to individual expression through retention of personal clothing and belongings, including the right to furnish and decorate their own living units, as space permits, unless to do so would infringe upon the rights of others or would create a health or safety hazard. (hh) The facility shall exercise reasonable care for the protection of residents' property from loss and theft. The administrator or his or her their designee is responsible for investigating reports of lost or stolen resident property and that the results of the investigation are reported to the resident. (ii) If the resident's personal laundry is laundered by the facility, the facility shall must identify these items in a suitable manner at the resident's request. (jj) Residents may use facility equipment, such as washing machines, if permitted by the facility. (kk) For purposes of IC 16-28-5-1, a breach of: Sec. 1.4. (a) Each facility shall have specific procedures written and implemented for the screening of prospective employees. Appropriate inquiries shall must be made for prospective employees. The facility shall have a personnel policy that considers references and any convictions in accordance with IC 16-28-13-3. (b) Staff shall be sufficient in number, qualifications, and training in accordance with applicable state laws and rules to meet the twenty-four (24) hour scheduled and unscheduled needs of the residents and services provided. The number, qualifications, and training of staff shall depend on skills required to provide for the specific needs of the residents. A minimum of one (1) awake nursing staff person, who may be a nurse aide as defined in 42 CFR 483.5, with current CPR and first aid certificates, shall must be on site at all times. If fifty (50) or more residents of the facility regularly receive residential nursing services or administration of medication, or both, at least one (1) nursing staff person shall must be on site at all times. Residential facilities with over one hundred (100) residents regularly receiving residential nursing services or administration of medication, or both, shall have at least one (1) additional nursing staff person awake and on duty at all times for every additional fifty (50) residents. Personnel shall be assigned only those duties for which that they are trained to perform. Employee duties shall must conform with written job descriptions. (c) Any An unlicensed employee providing more than limited assistance with the activities of daily living must be either a certified nurse aide or a home health aide. Existing facilities that are not licensed on the date of adoption of this rule and that seek licensure within one (1) year of adoption of this rule have two (2) months in which to ensure that all employees in this category are either a certified nurse aide or a home health aide. (d) Prior to working independently, each employee shall be given an orientation to the facility by the supervisor, or his or her the supervisor's designee, of the department in which the employee will work. Orientation of all employees shall include includes the following: (e) There shall must be an organized inservice in-service education and training program planned in advance for all personnel in all departments at least annually. Training shall must include, but is not limited to, residents' rights, prevention and control of infection, fire prevention, safety, accident prevention, the needs of specialized populations served, medication administration, and nursing care, when appropriate, as follows: (f) A health screen shall be is required for each employee of a facility prior to resident contact. upon hire. The health screen shall include a tuberculin skin test, using the Mantoux method (5 TU, PPD), unless a previously positive reaction can be documented. The result shall be recorded in millimeters of induration with the date given, date read, and by whom administered. The facility must assure the following: must be consistent with current accepted standards of practice, to include, but not limited to, tuberculosis (TB) screening that includes a baseline individual TB risk assessment, a TB symptom evaluation, TB testing via either a two-step skin test (TST) or a single blood test (IGRA), and additional evaluation as indicated. Annual TB testing of employees is not recommended unless there is a known exposure or ongoing transmission at a health care facility. All employees should receive TB education annually. TB education should include, but is not limited to, information on TB risk factors, the signs and symptoms of TB disease, and TB infection control policies and procedures. Employees with untreated latent TB infection should receive an annual TB symptom screen. Symptoms for TB disease include any of the following: Facilities should follow current accepted standards of practice for screening and testing of employees. (g) The facility must shall prohibit employees with evidence of an active communicable disease or infected skin lesions from direct contact with residents or their food, if direct contact will transmit the disease. An employee with signs and symptoms of communicable disease, including, but not limited to, an infected or draining skin lesion, a cough, a fever, and unexplained weight loss, shall be handled addressed according to current accepted standards of practice and a facility's policy regarding direct contact with residents, their food, or resident care items until the condition is resolved. Persons with a suspected or proven active tuberculosis communicable disease will not be permitted to work until determined to be noninfectious by a licensed medical provider and documentation is provided for the employee record. (h) The facility shall maintain current and accurate personnel records for all employees. The personnel records for all employees shall must include the following: (i) The employee personnel record shall be retained for at least three (3) years following termination or separation of the employee from employment. (j) For purposes of IC 16-28-5-1, a breach of: Sec. 2. (a) An evaluation of the individual needs of each resident shall must be initiated prior to before admission and shall be updated at least semiannually and upon a known substantial change in the resident's condition, or more often at the resident's or facility's request. A licensed nurse shall evaluate the nursing needs of the resident. (b) The preadmission evaluation (interview) shall provide the baseline information for the initial evaluation. Subsequent evaluations shall compare the resident's current status to his or her their status on admission, and shall be are used to assure that the care the resident requires is within the range of personal care and supervision provided by a residential care facility. (c) The scope and content of the evaluation shall must be delineated in the facility policy manual, but at a minimum, the needs assessment shall must include an evaluation of the following: (d) The evaluation shall must be documented in writing and kept in the facility. (e) Following After completion of an evaluation, the facility, using appropriately trained staff members, shall meet with the resident, the resident's representative, and requested persons of the resident's choice to identify and document the services to be provided by the facility, as follows: (f) For purposes of IC 16-28-5-1, a breach of: (g) Nothing in this section shall be deemed a waiver of any requirements set forth in 42 CFR 441.725 for residents receiving services through a home and community-based services waiver program. Sec. 4. (a) Each resident shall have a primary care physician selected by the resident. (b) Each resident may have a dentist selected by the resident. (c) Each facility shall choose whether or not it administers medication or provides residential nursing care, or both. These policies shall must be delineated in the facility policy manual and clearly stated in the admission agreement. (d) Personal care and assistance with activities of daily living shall must be provided based upon on individual needs and preferences. (e) The administration of medications and the provision of residential nursing care shall must be as ordered by the resident's physician and shall be supervised by a licensed nurse on the premises or on call as follows: (f) The facility shall have available on the premises or on call the services of a licensed nurse at all times. (g) For purposes of IC 16-28-5-1, a breach of: Sec. 5.1. (a) The facility shall provide, arrange, or make available three (3) well-planned substantial meals a day, seven (7) days a week, that which include at least three (3) menu items at one (1) time, one (1) of which includes a high-quality protein and represents not less than twenty percent (20%) of the day's total nutritional requirement, provide a balanced distribution of the daily nutritional requirements, and ensure that residents have access to food at any time. At least two (2) meals per day must include hot food options. (b) The menu or substitutions, or both, for all meals shall must be approved by a registered dietician. dietitian. (c) The facility must shall meet: (d) All modified diets shall must be prescribed by the attending physician. (e) All food shall must be served at a safe and appropriate temperature. (f) All food preparation and serving areas, excluding areas in residents' units, are maintained in accordance with state and local sanitation and safe food handling standards, including 410 IAC 7-24. 410 IAC 7-26. (g) There shall must be an organized food service department directed by a supervisor competent in food service management and knowledgeable in sanitation standards, food handling, food preparation, and meal service. (h) Diet orders shall must be reviewed and revised by the physician as the resident's condition requires. (i) For purposes of IC 16-28-5-1, a breach of: Sec. 6. (a) Residents who self-medicate may keep and use prescription and nonprescription medications in their unit, as long as they keep them secured from other residents, and may not be subject to any administrative fee by the facility. (b) The facility shall maintain clear written policies and procedures on medication assistance. The facility shall provide for ongoing training to ensure competence of medication staff. (c) If the facility controls, handles, and administers medications for a resident, the facility shall must do the following for that resident: (d) If a facility operates its own duly licensed pharmacy, it shall must comply with IC 25-26-13. (e) Medicine or treatment cabinets or rooms shall must be appropriately locked at all times except when authorized personnel are present. All Schedule II drugs administered by the facility shall must be kept in individual containers under double lock and stored in a substantially constructed box, cabinet, or mobile drug storage unit. (f) Residents may use the pharmacy of their choice for medications administered by the facility, as long as the pharmacy: (g) Unused portions of medications not released with the resident or returned for credit shall must be rendered nonretrievable within three (3) days by the consultant pharmacist or licensed nurse, and a witness. (h) To be rendered nonretrievable, a medication must be rendered chemically unusable, to such an extent that the medication cannot be recovered or used in the chemically transformed form, and disposed of pursuant to under federal, state, or local law, or it must be stored in a locked, authorized storage container within the facility. (i) An authorized storage container must contain a locked, hard outer layer securely attached to a permanent structure of the building and a removable inner liner, and shall must include the following requirements: (j) Disposition of any released, returned, or destroyed medication shall must be written in the resident's clinical record and shall must include the following information: (k) For purposes of IC 16-28-5-1, a breach of: Sec. 7.1. (a) The facility shall provide activities programs appropriate to the abilities and interests of the residents being served and ensure an integrated setting that provides full access to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community. (b) The facility shall provide and/or coordinate or assist in coordinating scheduled transportation to community-based activities, employment, and services, ensuring that options available to the surrounding community are communicated to residents. (c) An activities director shall be designated and must be one (1) of the following: (d) After July 1, 1984, any person who has not completed an activities director course approved by the division shall receive consultation until the person has completed such a that course. Consultation shall must be provided by: (e) For purposes of IC 16-28-5-1, a breach of: Sec. 8.1. (a) The facility must shall maintain clinical records on each resident. These records must be maintained under the supervision of an employee of the facility designated with that responsibility. The records must be as follows: (b) Clinical records must be retained after discharge: (c) The facility must shall safeguard clinical record information against loss, destruction, or unauthorized use. (d) The facility must shall keep confidential all information contained in the a resident's records, regardless of the form or storage method of the records, and release such those records only as permitted by law. (e) The clinical record must contain the following: (f) The facility shall have a policy that ensures the staff has sufficient information to meet the residents' needs. (g) A transfer form shall must include the following: (h) Current clinical records shall must be completed promptly, and those of discharged residents shall must be completed within seventy (70) days of after the discharge date. (i) A current emergency information file shall must be immediately accessible for each resident, in case of emergency, that which contains the following: (j) If a death occurs, information concerning the resident's death shall must include the following: (k) The facility shall store inactive clinical records in accordance with applicable state and federal laws in a safe and accessible manner. The storage facilities shall must provide protection from vermin and unauthorized use. (l) For purposes of IC 16-28-5-1, a breach of: Sec. 12. (a) The facility must shall establish and maintain an infection control practice designed to provide a safe, sanitary, and comfortable environment, and to help prevent the development and transmission of diseases and infection. (b) The facility must shall establish an infection control program that includes the following: (c) Each resident shall have a diagnostic chest x-ray completed no more than six (6) months prior to admission. (d) (c) Prior to admission, each resident shall be is required to have a health assessment, including history of significant past or present infectious diseases and a statement that the resident shows no evidence screening for current signs and symptoms of tuberculosis in an infectious stage as verified upon admission and yearly thereafter. (TB). A TB test must be completed within three (3) months before or on admission unless there is documentation of a previous positive TB test. TB testing must be completed within three (3) months before admission, using current accepted standards of practice, for either a two-step skin test (TST) or single blood test (IGRA). Routine or baseline chest x-rays are not required or recommended before or at the time of admission. (e) In addition, a tuberculin skin test shall be completed within three (3) months prior to admission or upon admission and read at forty-eight (48) to seventy-two (72) hours. The result shall be recorded in millimeters of induration with the date given, date read, and by whom administered and read. (f) For residents who have not had a documented negative tuberculin skin test result during the preceding twelve (12) months, the baseline tuberculin skin testing should employ the two-step method. If the first step is negative, a second test should be performed within one (1) to three (3) weeks after the first test. The frequency of repeat testing will depend on the risk of infection with tuberculosis. (g) (d) All residents who have a positive reaction to the tuberculin skin test shall be are required to have a chest x-ray and other physical and laboratory examinations in order to complete a diagnosis. An asymptomatic resident with a new positive TST or IGRA must have a medical evaluation and chest x-ray within one (1) week. Once TB disease is ruled out, the resident should be considered and evaluated for treatment. Residents with latent TB infection (LTBI) should be screened for HIV infection. The facility shall confirm that LTBI has been reported to the state agency by the diagnosing physician or hospital, or both. Residents with symptoms of pulmonary TB and an abnormal chest x-ray consistent with TB disease should have an evaluation done as soon as possible and be placed in airborne transmission-based precautions. Periodic chest x-rays of residents with a history of positive TST or IGRA are not advised and are not necessary unless the individual develops signs and symptoms of TB disease. (h) (e) All skin testing for tuberculosis shall must be done using the Mantoux method (5TU, PPD), administered by persons having documentation of training from a department-approved course of instruction in intradermal tuberculin skin testing, reading, and recording. (i) (f) Persons with a documented history of a positive tuberculin skin test, adequate treatment for disease, or preventive therapy for infection shall be are exempt from further skin testing. In lieu The prior positive test should have been followed by a clinical evaluation for TB that included a chest x-ray. Results of that evaluation should be acquired by the facility and be in the patient's record. There is no time limit on this evaluation. If documentation of this evaluation cannot be obtained, a clinical evaluation with a chest x-ray should be performed. In the absence of symptoms, this can be delayed up to one (1) week after admission. Instead of a tuberculin skin test, these persons should have an annual risk assessment for the development of symptoms suggestive of tuberculosis, including, but not limited to, cough, fever, night sweats, and weight loss. If symptoms are present, the individual shall must be evaluated immediately with a chest x-ray. (j) (g) When the infection control program determines that a resident needs isolation to prevent the spread of infection, the facility must isolate the resident only to the degree needed to isolate the infecting organism. (k) (h) The facility must shall require staff to wash their hands after each direct resident contact for which hand washing is indicated by accepted professional practice. (l) (i) For purposes of IC 16-28-5-1, a breach of: Sec. 13. (a) Each dining assistant shall successfully complete a sixteen (16) hour training program for dining assistants that has been approved by the department. (b) A dining assistant training program must obtain approval from the department prior to before providing instruction to individuals. (c) The facility shall do the following: (d) The scope of practice for dining assistants is as follows: (e) The dining assistant training program shall must consist of, but is not limited to, the following: (f) The dining assistant training program and training facility, if applicable, must ensure that clinical instruction provides for the direct supervision of the dining assistant by a licensed nurse. (g) Each training program shall must have a qualified instructor responsible for program oversight who, at a minimum: (h) An approved program director of a department nurse aide training program constitutes a qualified instructor under subsection (g) and may conduct dining assistant training without additional training. (i) Dining assistant training may only be provided by: Certified nurse aide and qualified medication aide personnel shall not participate in or provide any dining assistant training. (j) In order To issue a certificate or letter of completion to the dining assistant, the dining assistant training program shall must ensure that the dining assistant demonstrates competency in all areas of instruction, using a checklist approved by the department. (k) Each approved program shall must maintain a student file that: (l) The department may revoke an approved dining assistant training program if evidence exists that the program has not been administered in accordance with this section. (m) For purposes of IC 16-28-5-1, a breach of: LSA Document #26-149 Documents Incorporated by Reference: None Received by Publisher Small Business Regulatory Coordinator: Z. Claire Dyer, Advisory Chief, Indiana Department of Health, 2 North Meridian Street, Indianapolis, IN 46204, (317) 454-0040, ZDyer@health.in.gov