Kentucky Administrative Regulations
Title 902 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR PUBLIC HEALTH
Chapter 20 - Health Services and Facilities
Section 902 KAR 20:140 - Operation and services; hospice
Universal Citation: 902 KY Admin Regs Service 20:140
Current through Register Vol. 51, No. 3, September 1, 2024
RELATES TO: KRS 216B.010, 216B.015, 216B.042, 216B.105, 216B.155-216B.170, 216B.990
NECESSITY, FUNCTION, AND CONFORMITY: KRS 216B.042 requires the Cabinet for Health Services to regulate health facilities and health services. This administrative regulation establishes licensure requirements for hospice operation and services.
Section 1. Definitions.
(1) "Administrator" means a person who has:
(a) Served as a hospice administrator under a
state approved hospice program; or
(b) A bachelor of arts or bachelor of science
degree in a health care, human services, or administrative curriculum;
or
(c) Equivalent administrative
work experience in a health care facility.
(2) "Bereavement" means the period of time
during which a person experiences, responds emotionally, and adjusts to the
loss by death of another person.
(3) "Palliative care" means care directed at
reducing or abating pain and other troubling symptoms of the disease process in
order to achieve relief of distress.
(4) "Supplemental service" is a hospice
service provided under the health care facility's existing license.
(5) "Terminally ill" means a person who is
experiencing a fatal condition for which therapeutic strategies directed toward
care and control are no longer effective.
(6) "Volunteer" means a person who
contributes time and talent to the hospice program without economic
remuneration.
Section 2. Scope of Operation and Services. A hospice is a centrally administered program of palliative and supportive services, including skilled nursing services, intended to meet the physical, psychological, social, and spiritual needs of a terminally ill person and his family on a twenty-four (24) hour, seven (7) day- a-week, on-call basis. Services are provided in the home or in an inpatient health care facility as a supplemental service by a medically supervised, interdisciplinary team of professional and lay personnel during the final stages of illness, at death, and through bereavement.
Section 3. Administration and Organization.
(1) A hospice program shall seek licensure to
operate as:
(a) A freestanding hospice;
or
(b) A hospice operated by a
hospital, long term care facility, home health agency, or health maintenance
organization, or other licensed health care facility or service.
(2) The licensee shall be legally
responsible for the operation of the hospice and for compliance with federal,
state, and local law pertaining to the operation of the service.
(3) The licensee shall have permanent
facilities for the administration of the program and storage of the patient
records.
(4) The licensee shall
establish policies for the administration and operation of the service. The
policies shall include:
(a) Acceptance of
patients;
(b) Development of a plan
of care through the interdisciplinary team;
(c) Quality care audits for direct
service;
(d) Personnel policy and
procedure to include:
1. A description of each
personnel position;
2. Wage and
salary range for each position;
3.
A description of the lines of authority;
4. Personnel benefits;
5. Evaluation and grievance procedure;
and
6. Orientation and training
program information; and
(e) Use of volunteers, volunteer selection
criteria, training, and roles in the hospice program.
(5) Contracted services. If a hospice
contracts for services, the contract shall be in writing and shall:
(a) Designate clearly the services to be
provided;
(b) Describe how the
personnel under contract will provide the service and how they will be
supervised;
(c) Require hospice
staff to provide training, to participate in personnel, about hospice care;
and
(d) Describe the process of
coordination for medical recordkeeping, patient evaluation and care
planning.
(6) Contracted
services with health care facilities.
(a) A
contract between a hospice and an inpatient service provider or a health
facility, as defined at
KRS
216B.015(10), shall:
1. Comply with the requirements established
in subsection (5) of this section; and
2. Specify that the hospice maintain
professional, financial, and administrative responsibility for planning,
coordinating, and prescribing hospice services and care on behalf of the
hospice patient and his family.
(b) For a contract with an inpatient service
provider, the hospice shall:
1. Provide the
service provider a copy of the patient's plan of care;
2. Specify the inpatient services to be
furnished; and
3. Require that the
inpatient provider agree to the designation of services.
(c) A hospice shall not charge a fee for a
service provided directly by the hospice care team which is duplicative of a
contractual service provided by a health care facility to the individual or his
family.
(7) Medical
records.
(a) A medical record shall be
maintained for each individual who is accepted as a hospice patient. The
medical record shall include:
1. Written
referral from the attending physician of the patient to the hospice
program;
2. Medical
history;
3. Social and
psychological information on patient and family;
4. Doctors' orders;
5. The approved care plan; and
6. Documentation of medical services
provided.
(b) A medical
record shall be kept confidential and shall be retained for a minimum of five
(5) years, or in the case of a minor, three (3) years after the patient reaches
the age of majority under state law, whichever is the longer.
(8) Personnel. The hospice shall
have:
(a) A medical director who is a licensed
physician, available on at least a consultative basis, and who shall:
1. Direct medical aspects of the hospice care
program; and
2. Participate in the
development of medical policy and procedure.
(b) An administrator who shall:
1. Direct the daily operation of the hospice;
and
2. Implement policies and
procedures for activities and services, whether provided by hospice personnel
or by contract.
(c) A
patient-care coordinator who is a registered nurse who shall be:
1. Available on a full or part-time basis;
and
2. Knowledgeable of home-based
skilled nursing services for the terminally ill.
Section 4. Services.
(1) The hospice program shall provide
palliative and supportive services including skilled nursing services to meet
the physical, psychological, social, and spiritual needs of a terminally ill
person and his family. Hospice services shall:
(a) Be available on a twenty-four (24) hour,
seven (7) day a week, on-call basis;
(b) Be provided by an interdisciplinary team
which shall include:
1. The patient;
2. The patient's family, if willing to
participate;
3. The medical
director;
4. A nurse;
5. A social worker; and
6. The following team members, on an optional
basis:
a. The patient's attending
physician;
b. Other staff
physicians;
c. A representative of
the clergy if the patient so chooses; and
d. A volunteer.
(2) A patient may be admitted to a hospice
program only upon referral from a physician and upon the request of the patient
and family. The patient's attending physician shall be responsible for the
direct medical care of the patient's illness.
(3) The hospice shall provide the following
services directly:
(a) Coordination of the
medical aspects of the hospice program;
(b) Assessment of physical, psychological,
spiritual, social, and economic needs of the patient and his family;
(c) Development and coordination of a care
plan which includes the delineation of responsibilities of each team member and
provides for regularly scheduled team meetings for planning, evaluation, and
individual case management;
(d)
Patient counseling and bereavement counseling of the family; and
(e) Education and training services for
staff, volunteers, and family members.
(4) Skilled nursing services shall be
provided directly or through contract as indicated by the patient's
needs.
(5) The following services
shall be provided directly, through contract, or through referral, as indicated
by the patient and family needs:
(a)
Nutrition;
(b) Homemaker and home
health aide;
(c) Physical
therapy;
(d) Occupational therapy;
and
(e) Speech therapy.
(6) The hospice shall:
(a) Follow up on a patient referral to
determine if the service was provided; and
(b) Make an appropriate entry into the
patient's medical record for each service provided on a referral
basis.
(7) The patient's
plan of care shall be reviewed by the attending physician in consultation with
agency professional personnel at such intervals as the severity of the
patient's illness requires, but in all cases, at least once every two (2)
months. Verbal authorization to change the plan of care shall be reviewed and
signed by the attending physician within twenty-one (21) days after the order
is issued.
(8) An original order
for a drug and a change in an order for a drug shall be signed by the physician
and made a part of the patient's medical record. Verbal authorization by the
physician to change a drug order shall be reviewed and signed by the physician
within twenty-one (21) days after the order is issued.
STATUTORY AUTHORITY: KRS 216B.042(1)
Disclaimer: These regulations may not be the most recent version. Kentucky may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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