Current through Reg. 49, No. 38; September 20, 2024
(a)
Professional management. A hospice must assume responsibility for professional
management of the hospice services it provides to a resident of a skilled
nursing facility (SNF), nursing facility (NF), or an intermediate care facility
for individuals with an intellectual disability or related conditions
(ICF/IID), in accordance with the hospice plan of care. The hospice must make
arrangements, as necessary for hospice-related inpatient care in a
participating Medicare or Medicaid facility, in accordance with § 558.850
of this subchapter (relating to Organization and Administration of Hospice
Services) and § 558.863 of this subchapter (relating to Hospice Short-term
Inpatient Care).
(b) Written
contract. A hospice and SNF, NF, or ICF/IID must have a written contract that
allows the hospice to provide services in the facility. The contract must be
signed by an authorized representative of the hospice and the SNF, NF, or
ICF/IID before hospice services are provided. In addition to the requirements
in § 558.289 of this chapter (relating to Independent Contractors and
Arranged Services), the written contract must include:
(1) the way the SNF, NF, or ICF/IID and the
hospice are to communicate with each other and document such communications to
ensure that the needs of a client are addressed and met 24 hours a
day;
(2) a provision that the SNF,
NF, or ICF/IID immediately notifies the hospice of:
(A) a significant change in the client's
physical, mental, social, or emotional status;
(B) clinical complications that suggest a
need to alter the plan of care;
(C)
the need to transfer the client from the SNF, NF, or ICF/IID; or
(D) the death of a client;
(3) a provision stating that if
the SNF, NF, or ICF/IID transfers the client from the facility that the hospice
arranges for, and remains responsible for, any necessary continuous care or
inpatient care related to the terminal illness and related
conditions;
(4) a provision stating
that the hospice assumes responsibility for determining the appropriate course
of hospice care, including the determination to change the level of services
provided;
(5) an agreement that the
SNF, NF, or ICF/IID is responsible for furnishing 24-hour room and board care,
meeting the personal care and nursing needs that would have been provided by
the primary caregiver at home at the same level of care provided before the
client elected hospice care;
(6) an
agreement that the hospice is responsible for providing services at the same
level and to the same extent as those services would be provided if the SNF,
NF, or ICF/IID resident were in his or her own home;
(7) a delineation of the hospice's
responsibilities, which include providing medical direction and management of
the client; nursing; counseling, including spiritual, dietary and bereavement
counseling; social work; medical supplies, durable medical equipment, and drugs
necessary for the palliation of pain and symptoms associated with the terminal
illness and related conditions; and all other hospice services that are
necessary for the care of the resident's terminal illness and related
conditions;
(8) a provision that
the hospice may use the SNF, NF, or ICF/IID nursing personnel where permitted
by State law and as specified by the SNF, NF, or ICF/IID to assist in the
administration of prescribed therapies included in the plan of care, only to
the extent that the hospice would routinely use the services of a hospice
client's family in implementing the plan of care;
(9) a provision stating that the hospice must
report an alleged violation involving mistreatment, neglect, or verbal, mental,
sexual, and physical abuse, including injuries of unknown source, and
misappropriation of client property by non-hospice personnel to the SNF, NF, or
ICF/IID administrator within 24 hours after the hospice becomes aware of the
alleged violation;
(10) a
delineation of the responsibilities of the hospice and the SNF, NF, or ICF/IID
to provide bereavement services to SNF, NF, or ICF/IID staff; and
(11) a provision regarding management and
disposal, in compliance with applicable law, of drugs, including controlled
substance prescription drugs and biologicals.
(c) Hospice plan of care. In accordance with
§ 558.821 of this subchapter (relating to Hospice Plan of Care), a written
hospice plan of care must be established and maintained in consultation with
SNF, NF, or ICF/IID representatives. Hospice care must be provided in
accordance with the hospice plan of care.
(1)
A hospice plan of care must identify the care and services needed to care for
the client and specifically identify which provider is responsible for
performing the respective functions that have been agreed upon and included in
the hospice plan of care.
(2) A
hospice plan of care must reflect the participation of the hospice,
representatives of the SNF, NF, or ICF/IID, and the client and family to the
extent possible.
(3) Any changes in
the hospice plan of care must be discussed with the client or the client's LAR
, and SNF, NF, or ICF/IID representatives, and must be approved by the hospice
before implementation.
(d) Coordination of services. In addition to
the requirements in § 558.288 of this chapter (relating to Coordination of
Services) and § 558.823 of this subchapter (relating to Coordination of
Services by the Hospice), a hospice must:
(1)
designate a member of each interdisciplinary team (IDT) that is responsible for
a client who is a resident of a SNF, NF, or ICF/IID who is responsible for:
(A) providing overall coordination of the
hospice care of the SNF, NF, or ICF/IID resident with SNF, NF, or ICF/IID
representatives; and
(B)
communicating with SNF, NF, or ICF/IID representatives and other health care
providers participating in the provision of care for the terminal illness and
related conditions and other conditions to ensure quality of care for the
client and family; and
(2) ensure that the hospice IDT communicates
with the SNF, NF, or ICF/IID medical director, the client's attending
practitioner, and other physicians participating in the provision of care to
the client as needed to coordinate hospice care with medical care provided by
other physicians; and
(3) provide
the SNF, NF, or ICF/IID with:
(A) the most
recent hospice plan of care specific to the client;
(B) the hospice election form and any advance
directives specific to the client;
(C) physician certification and
recertification of the terminal illness specific to the client;
(D) names and contact information for hospice
personnel involved in hospice care of the client;
(E) instructions on how to access the
hospice's 24-hour on-call system;
(F) hospice medication information specific
to the client; and
(G) hospice
physician and, if any, attending practitioner orders specific to the
client.
(e)
Orientation and training of staff. Hospice personnel must ensure that SNF, NF
or ICF/IID staff who provide care to the hospice's clients have been oriented
and trained in the hospice philosophy, including the hospice's policies and
procedures regarding methods of comfort, pain control, and symptom management,
as well as principles about death and dying, how a person may respond to death,
the hospice's client rights, the hospice's forms, and the hospice's record
keeping requirements.
(f)
Management and disposal of drugs and biologicals. The policies and procedures
of the hospice may not impede the SNF, NF, or ICF/IID from adhering to state,
federal, and local law applicable to the disposal of drugs and biologicals in a
facility.
