(A)
Governing Body. The hospice provider must have a
governing body that assumes full legal responsibility for determining,
implementing, and monitoring policies governing the hospice's total operation.
The governing body must designate a person who is responsible for the
day-to-day management of the hospice program.
(B)
Medical
Director. The medical director must be a doctor of medicine or
osteopathy and assume overall responsibility for the medical component of the
hospice's patient-care program.
(C)
Hospice Interdisciplinary Team. The hospice provider
must designate a hospice interdisciplinary team composed of hospice personnel,
including a registered nurse, whose role is to provide coordination of care,
including in-home supports, continuous assessment of member and family needs,
and implementation of the interdisciplinary plan of care.
(1)
Composition of
Team. The hospice interdisciplinary team must include at least the
following individuals who are employees of the hospice, except in the case of
the physician described in
130
CMR 437.421(C)(1)(a), who
may be under contract with the hospice:
(a) a
doctor of medicine or osteopathy;
(b) a registered nurse;
(c) a social worker; and
(d) a pastoral or other counselor.
(2)
Role of
Team. The hospice interdisciplinary team must provide the care and
services offered by the hospice. The hospice must designate a registered nurse
that is a member of the interdisciplinary team to provide coordination of care
and to ensure continuous assessment of each patient's and family's needs and
implementation of the interdisciplinary plan of care. The team in its entirety
must also supervise care and services by
(a)
establishing a written, individualized plan of care for members and families
that includes all services necessary for the palliation and management of the
terminal illness and related conditions;
(b) providing for an ongoing sharing of
information with other non-hospice healthcare providers furnishing services
unrelated to the terminal illness and related conditions;
(c) ensuring that the plan of care is
coordinated with any services the member may be authorized to receive from the
MassHealth Personal Care Attendant Program or the MassHealth Adult Foster Care
Program and any in-home support services available to the member from a home-
and community-based service network;
(d) reviewing and revising the individualized
plan of care as frequently as the member's condition requires, but no less
frequently than every 15 calendar days; and
(e) establishing the policies governing the
day-to-day provision of hospice services to members, families, and
caregivers.
(D)
Contracted
Services. A hospice provider may arrange for the provision of
certain services on a contract basis, including highly specialized nursing
services that are provided so infrequently that the provision of such services
by direct hospice employees would be impractical and prohibitively expensive.
These services may not include routine nursing services, medical social
services, and counseling services specified in 130 CMR 437.000, except in
circumstances in 42 CFR
418.64. If the other covered services listed
in 130 CMR 437.423 (physician
services; physical, occupational, and speech/language therapy; homemaker/home
health aide services; drugs; durable medical equipment and supplies; and
short-term inpatient care) are provided by contract personnel, the hospice
provider must meet the following requirements.
(1)
Written
Agreement. The hospice provider must have a written agreement with
the contractor that
(a) identifies the
services to be provided on a contract basis;
(b) stipulates that services may be provided
only with the express authorization of the hospice provider;
(c) states how the contracted services will
be coordinated, supervised, and evaluated by the hospice provider;
(d) delineates the role of the hospice
provider and the contractor in the admission process, member/family assessment,
and the interdisciplinary team-care conferences;
(e) specifies requirements of documenting
that the contracted services are furnished in accordance with the agreement;
and
(f) details the required
qualifications for contract personnel.
(2)
Professional Management
Responsibility. The hospice provider must ensure that contracted
services are authorized by the hospice provider, furnished in a safe and
effective manner by qualified personnel, and delivered in accordance with each
member's plan of care.
(3)
Financial Responsibility. The hospice provider is
responsible for paying contract personnel who have provided hospice-approved
services according to the member's plan of care.
(4)
Inpatient Care.
The hospice provider must ensure that inpatient care is furnished in a
MassHealth-participating facility that meets the requirements specified in
42 CFR
418.108 or is a hospice inpatient facility as
defined in
130
CMR 437.402. The hospice provider must have a
written agreement with the facility that specifies
(a) that the hospice provider must furnish
the inpatient provider with a copy of the member's plan of care that specifies
the inpatient services to be provided;
(b) that the inpatient provider has
established policies consistent with those of the hospice provider and agrees
to abide by the patient-care protocols established by the hospice provider for
its patients;
(c) that the medical
record includes a record of all inpatient services and events and that a copy
of the discharge summary and, if requested, a copy of the medical record are
provided to the hospice provider;
(d) that the inpatient facility has
identified an individual within the facility who is responsible for the
implementation of the provision of; and
(e) that the hospice provider retains
responsibility for ensuring that the training of personnel who will be
providing the member's care in the inpatient facility has been
provided.
(5)
Room and Board in a Nursing Facility or ICF/IID. The
hospice provider and the nursing facility or ICF/IID must enter into a written
agreement under which the hospice provider takes full responsibility for the
professional management of the member's hospice services and the nursing
facility or ICF/IID agrees to provide room and board to the member. Room and
board includes performance of personal care services, including assistance in
activities of daily living, socializing activities, administration of
medication, maintaining the cleanliness of the member's room, and supervision
and assistance in the use of durable medical equipment and prescribed
therapies. In addition to all other applicable requirements established under
130
CMR 437.421(D), the written
agreement between the hospice provider and the nursing facility or IFC/nD must
also include:
(a) The manner in which the
nursing facility or ICF/IID and the hospice provider are to communicate with
each other and document such communications to ensure that the needs of members
are addressed and met 24 hours per day; and
(b) A provision that the nursing facility or
ICF/IID immediately notifies the hospice of any significant change in the
member's physical, mental, social, or emotional status, clinical needs or
health insurance coverage.
(E)
Volunteer
Services. The hospice provider must use volunteers in
administrative or direct patient-care roles. The hospice provider must
appropriately train volunteers and document its ongoing efforts to recruit and
retain volunteer staff. The hospice provider must complete the same personnel
screenings for volunteer staff that are required for paid employees of the
hospice provider.
(1)
Level of
Activity. A hospice provider must document that it maintains a
volunteer staff sufficient to provide administrative or direct patient care
that, at a minimum, equals 5% of the patient-care hours of all paid hospice
employees and contract staff. The hospice provider must document the continuing
level of volunteer activity and must record any expansion of care and services
achieved through the use of volunteers, including the type of services and the
time worked.
(2)
Proof
of Cost Savings. The hospice provider must document
(a) positions occupied by
volunteers;
(b) work time spent by
volunteers occupying those positions; and
(c) estimates of the dollar costs that the
hospice would have incurred if paid employees occupied the volunteer
positions.
