Current through Register Vol. 18, September 20, 2024
(1) The following definitions apply in this
rule and ARM
37.106.2305 and
37.106.2311:
(a) "Bereavement" means that period of time
during which survivors mourn a death and experience grief.
(b) "Bereavement services" means support
services to be offered during the bereavement period.
(c) "Contract services" means persons or
organizations who, under written agreement, provide goods and services to the
hospice and its patients and their families.
(d) "Core services" means physician services,
nursing services, pastoral counseling, services provided by trained volunteers,
and counseling services routinely provided by hospice staff.
(e) "Family" means individuals who are
closely linked with the hospice patient, including the immediate family, the
primary care giver, and individuals with significant personal ties.
(f) "Hospice" or "hospice program" means a
public agency or private organization (or a subdivision thereof) as defined in
50-5-101(22),
MCA, which is primarily engaged in providing hospice care.
(g) "Hospice care" means palliative and
supportive care to meet the needs of a terminally ill patient and the patient's
family arising out of physical, psychological, spiritual, social, and economic
stresses experienced during the final stages of illness and dying, and that
includes a formal bereavement component.
(h) "Hospice staff" means paid or unpaid
persons, including volunteers, who are directly supervised by the hospice
program.
(i) "Interdisciplinary
team" means the number of appropriately qualified interdisciplinary health care
professionals and volunteers that are needed to meet the hospice's patients'
care needs.
(j) "Managed directly
by" means that core services are provided by a hospice program.
(k) "Palliation" means controlling pain and
other symptoms which are manifested during the dying process and are consistent
with professional practice and regulations of the Montana Board of
Pharmacy.
(l) "Respite care" means
short-term in-patient care provided to the individual only when necessary to
relieve the family members or other persons caring for the
individual.
(2) A
hospice program may be licensed to operate either:
(a) as a part of a licensed hospital without
its own license when the department finds that the hospital's hospice program
meets the requirements set forth in this rule; or
(b) with its own hospice license when the
department finds that it meets the requirements set forth in this
rule.
(3) A hospice
program must have the following organizational components:
(a) a formally established governing body,
individual, group, or corporation with authority to make decisions affecting
the operation of the hospice;
(b)
an organization chart defining reporting relationships among hospice
workers;
(c) a statement of patient
rights and the rights of a patient's family;
(d) established policies for the
administration and operation of the program, including but not limited to:
(i) written criteria for program admission
and discharge;
(ii) procedures for
bereavement referrals and assistance;
(iii) development of a plan of
care;
(iv) agreements with other
licensed health care facilities for proper transfer of patients and follow up
of plans of care;
(v) system(s) for
recordkeeping;
(vi) patient care
procedures; and
(vii) in-service
education.
(e)
development of annual budgets; and
(f) annual evaluation of each aspect of the
hospice program, including the program's quality assessment and improvement
measures and a system to implement recommendations for future program
planning.
(4) A hospice
program must have an interdisciplinary team responsible for the provision of
hospice care. The interdisciplinary team must:
(a) confer or meet regularly;
(b) have responsibility for implementation of
each individual plan of care as directed by an identified coordinator;
and
(c) encourage the
patient/family to participate in developing the interdisciplinary team plan of
care and in the provision of hospice services.
(5) A hospice program must assure that each
patient has a physician who is the patient's primary physician and assists in
the development of the patient's care plan.
(6) A hospice program must maintain a medical
record for every individual accepted as a hospice patient. The medical record
must include:
(a) patient identification,
diagnosis, and prognosis;
(b)
patient's medical history:
(c)
patient's plan of care;
(d) a
record of doctor's hospice orders;
(e) progress notes, dated and signed;
and
(f) evidence of timely action
by the patient care team.
(7) A hospice program which utilizes
volunteers must provide volunteer training which includes:
(a) information concerning hospice
philosophy;
(b) instruction on the
volunteer's role, responsibilities, restrictions, and expectations;
and
(c) information concerning the
physical, emotional, and spiritual issues encountered by hospice patients and
families.
(8) A hospice
program must allow the patient and the patient's family to make the decision to
participate in a hospice program and shall encourage the patient and the
patient's family to assume as much responsibility for care as they
choose.
(9) A hospice program must
assure that all services identified in the hospice plan of care for a patient,
including skilled nursing services, are offered to the patient.
(10) A hospice program must:
(a) have a plan for providing bereavement
follow up for families desiring it;
(b) monitor and assess the quality of
contract services through annual review;
(c) ensure that hospice nursing emergency
care is available on a 24-hour basis;
(d) hire, train, and supervise hospice staff
and ensure that hospice staff adhere to hospice policies; and
(e) establish, update, and implement
infection control policies and procedures that are sufficient to prevent
transmission of disease.
(11) The hospice program must comply with ARM
37.106.2901,
37.106.2902,
37.106.2904,
37.106.2905, and
37.106.2908, pertaining to
restraints, safety devices, assistive devices, and postural supports.
50-5-103,
50-5-210,
MCA; IMP,
50-5-103,
50-5-204,
50-5-210,
MCA;
