Current through Reg. 49, No. 38; September 20, 2024
(a) When
a nursing facility (NF) contracts for hospice services for residents, the
nursing facility must:
(1) have a written
contract for the provision of arranged services, which must be signed by
authorized representatives of the NF and hospice and must include the
following:
(A) the services to be
provided;
(B) a stipulation that
hospice-related services performed by NF staff may be provided only with the
express authorization of the hospice;
(C) how the contracted services are to be
coordinated, supervised, and evaluated by the hospice and the NF;
(D) delineation of the roles of the hospice
and the NF in the admission process, recipient and family assessment, and the
interdisciplinary team case conferences;
(E) a requirement for documentation of
services furnished; and
(F) the
qualifications of the personnel providing the services;
(2) provide room and board services, which
include the performance of personal care services, including assistance in the
activities of daily living, administration of medication, socializing
activities, maintaining the cleanliness of a resident's room, and supervision
and assisting in the use of durable medical equipment and prescribed
therapies;
(3) immediately notify
the hospice of any significant changes in the hospice recipient's
condition;
(4) have joint
procedures with the hospice provider for ordering medications that ensure the
proper payor is billed and for reconciling billing between NF and hospice,
including:
(A) contacting the hospice prior
to filling a new prescription; and
(B) ensuring that drugs unrelated to the
terminal illness are ordered through the Vendor Drug program; and
(5) ensure that hospice
documentation is a part of the current clinical record, which, at a minimum,
must include the current and past:
(A) Texas
Medicaid Hospice Recipient Election/Cancellation form;
(B) MDS assessment;
(C) Physician Certification of Terminal
Illness form;
(D) Medicare Election
Statement, if dually eligible;
(E)
verification that the recipient does not have Medicare Part A;
(F) hospice interdisciplinary
assessments;
(G) hospice plan of
care; and
(H) current
interdisciplinary notes, which include the following:
(i) nurses notes and summaries;
(ii) physician orders and progress notes;
and
(iii) medication and treatment
sheets during the hospice certification period.
(b) The NF and hospice must ensure
that the coordinated plan of care reflects the participation of the hospice,
the NF, the recipient, and the recipient's legal representative to the extent
possible. The plan of care must include directives for managing pain and other
uncomfortable symptoms, and must be revised and updated as necessary to reflect
the recipient's current status.
(c)
The recipient has the right to refuse any services from the nursing facility
and the hospice provider.
(d) The
hospice retains overall professional management responsibility for directing
the implementation of the plan of care related to the terminal illness and
related conditions, which includes:
(1)
designation of a hospice registered nurse to coordinate the implementation of
the plan of care;
(2) provision of
substantially all core services (physician, nursing, medical social work, and
counseling services) that must be routinely provided directly by the hospice
employees, and cannot be delegated to the NF, as outlined under 42 Code of
Federal Regulations §418.80;
(3) provision of drugs and medical supplies
as needed for palliation and management of the terminal illness and related
conditions; and
(4) involvement of
NF personnel in assisting with the administration of prescribed therapies in
the plan of care only to the extent that the hospice would routinely use the
services of a hospice patient's family or caregiver in the home
setting.
(e) The hospice
may arrange to have non-core hospice services provided by the NF if the hospice
assumes professional management responsibility for the services and assures
these services are performed in accordance with the policies of the hospice and
the recipient's plan of care.
