Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 437.000 - Hospice Services
Section 437.425 - Provider Responsibilities

Universal Citation: 130 MA Code of Regs 130.437

Current through Register 1531, September 27, 2024

In addition to meeting all of the qualifications set forth in 130 CMR 437.000 and 130 CMR 450.000: Administrative and Billing Regulations, hospice providers must meet all of the following requirements.

(A) Recordkeeping Requirements

(1) Administrative Records. Hospice providers must maintain administrative records in compliance with the record retention requirements set forth in 130 CMR 450.205: Recordkeeping and Disclosure. All records including, but not limited to, the following, must be accessible and made available on-site for inspection by the MassHealth agency:
(a) payroll and staff records, including evidence of completed staff orientation and training;

(b) financial records;

(c) staffing levels, including volunteers;

(d) complaints and grievances;

(e) contracts for subcontracted services, including a description of how the hospice provider will supervise the subcontracted services;

(f) contracts for independent contractor services, including a description of how the hospice provider will supervise the independent contractors and their services; and

(g) job descriptions that include titles, reporting authority, qualifications, and responsibilities.

(2) Clinical Records. All hospice providers must maintain a clinical record that meets the criteria in 42 CFR 418.104 for each member receiving care and services and includes the following information:
(a) initial plan of care, updated plans of care, initial assessment, comprehensive assessment, and any updated comprehensive assessments;

(b) the member's name, MassHealth member identification number, address, gender, age, and next of kin;

(c) completed hospice election statements signed and dated by the member or member's representative

(d) completed and submitted notices of hospice election as required in 130 CMR 437.412(C);

(e) pertinent medical history;

(f) complete documentation of all services and events, including
1. nursing and hospice aide/homemaker visit notes;

2. visit documentation for any other services furnished by the hospice provider, either directly or under contract;

3. documentation from bereavement counseling provided to the member and/or family;

4. documentation from any other counseling service provided to the member and/or family; and

5. documentation on any hospitalization or in-patient stay;

(g) the certification of terminal illness for each certification period the member elects with the hospice provider, as described in 130 CMR 437.411; and

(h) Signed copies of the notice of member rights in accordance with 130 CMR 437.425(B).

(3) Incident and Accident Records. Hospice providers must maintain an easily accessible record of member and staff incidents and accidents. The record may be kept within the individual member medical record or employee record or within a separate, accessible file.
(a) The hospice provider must submit to the MassHealth agency an incident or accident report within five days of having knowledge of the incident and under the following circumstances:
1. An incident or accident that occurred during a hospice service visit that results in serious injury to the member;

2. An incident or accident unrelated to the member's life prognosis due to their terminal illness and resulting in the member's unexpected death even if the hospice provider was not involved in the incident or accident;

3. An incident of abuse or neglect involving a staff member of the hospice provider, including a volunteer, and the member; and

4. An incident of abuse or neglect committed by another provider supporting the member (if known).

(b) The incident or accident report must include at least the following information.
1. general information including but not limited to member name and member identification;

2. general nature of incident or accident; and

3. any action that was taken as a result of the incident or accident including all outcomes.

(B) Member Rights. Members have the right to be informed of their rights, and the hospice provider must protect and promote the exercise of these rights in accordance with 42 CFR 418.52 and 130 CMR 437.000.

(1) The hospice provider must ensure the member has a right to the following:
(a) Receive effective pain management and symptom control from the hospice for conditions related to the terminal illness;

(b) Be involved in developing his or her hospice plan of care;

(c) Refuse care or treatment;

(d) Choose his or her attending physician;

(e) Have a confidential clinical record. Access to or release of member information and clinical records is permitted in accordance with 45 CFR parts 160 and 164.

(f) Be free from mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of member property;

(g) Receive information about the services covered under the hospice benefit;

(h) Receive information about the scope of services that the hospice will provide and specific limitations on those services;

(i) to voice grievances regarding treatment or care that is (or fails to be) furnished and the lack of respect for property by anyone who is furnishing services on behalf of the hospice;

(j) to not be subjected to discrimination or reprisal for exercising his or her rights.

(k) Receive information verbal or written concerning the hospice provider's policies on advance directives, including a verbal or written description of applicable state law, that complies with the requirements of 42 CFR Part 489 subpart I.

(2) Member Notice of Rights and Responsibilities. During the initial assessment visit in advance of furnishing care, the hospice provider must provide the member or representative with a written notice of the member's rights and responsibilities that complies with 130 CMR 437.424(B)(1) in a language and manner that the member understands. The hospice must obtain the member's or representative's signature confirming that he or she has received a copy of the notice of rights and responsibilities. The member notice must include the process for which a member may file a grievance regarding treatment or care that is furnished, and a clearly identifiable statement indicating that a member will not be subjected to discrimination or reprisal for exercising his or her rights.

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