Section 4.06 - Proper Foot Care in a Skilled Nursing Home Facility(1)Independent Practice in Nursing Home. A podiatrist attending patients in a skilled nursing home facility acts independently and is not under the supervision or control of any person employed by or practicing nursing or medicine at the nursing home facility. A licensed podiatrist is not required to obtain the approval or authorization of another physician or any other person before providing podiatry services in a skilled nursing home except from the patient or the patient's guardian who may request or refuse a podiatrist's services at any time. The direction and performance of a patient's podiatric care shall not fall within the purview of the nursing or medical staff at any level of the nursing home facility.(2)Patient Evaluation. A patient evaluation and management service, with treatment plan, detailing the type of care as well as its frequency, should be prescribed exclusively by the attending podiatrist. This is particularly appropriate for patients who will be receiving palliative foot care on a regular basis. [Board Form PD 1102 is approved and recommended for this service.] A reevaluation should be performed and treatment plan prescribed by the attending podiatrist approximately every 12 months or however often it is deemed necessary by the attending podiatrist for patients who receive palliative care.(3) Documentation of palliation (trimming of nail and calvi) as well as treatment for onychomycosis, onychogryphosis and onychauxia should be minimized so as to allow the podiatrist the maximum opportunity to provide direct patient care. [Board Form PD1101 is approved and recommended for these services.](4) A patient who demonstrates any level of vascular insufficiency diagnosed by the attending podiatrist shall receive palliative foot care approximately every 60 days or however frequently the attending podiatrist deems that this service may be medically necessary. The podiatrist is the arbiter of podiatric medical necessity.(5) A patient evaluation should be performed and treatment plan prescribed by the attending podiatrist at least every 12 months or more often if necessary. [Board Form PD1102 is approved and recommended for this evaluation and management service.]Amended by Mass Register Issue 1269, eff. 9/12/2014.Amended by Mass Register Issue 1330, eff. 1/13/2017.Amended by Mass Register Issue 1480, eff. 10/14/2022.