Question: What was August 26, 2013?
Answer: The deadline for compliance with new CMS regulations pertaining to the provision of hospice care in contracted Long Term Care (LTC) facilities.
Part 1: Options – A LTC facility may opt not to contract with a hospice provider. In this situation, the facility must either:
- Obtain a one-time contract with the desired Medicare-certified hospice to provide services to a particular resident; or
- Assist the resident who wants to receive hospice care with transferring to a facility where that care can be obtained.
Part 2: Agreements – Although any number of other issues may need to be addressed in the written agreement between a hospice and a LTC facility, the following items must be addressed:
- Identification of the services the hospice will provide.
- The hospice’s responsibilities for determining its POC.
- The services the LTC facility will continue to provide, based on each resident’s POC.
- A communication process that includes how communication between the LTC facility and hospice will be documented.
- A provision stating that the LTC facility must immediately notify the hospice: (a) About significant change in the resident’s physical, mental, social, or emotional status; (b) If clinical complications arise that could impact the POC; (c) If there is a need to transfer the resident from the facility (for any condition or reason); or, (d) Upon the resident’s death.
- The hospice assumes responsibility for determining the appropriate course of hospice care, including the patient’s level of hospice care.
- The LTC facility’s responsibility to providing 24-hour room and board care and its role in meeting the resident’s personal care and nursing needs, in coordination with the hospice.
- The hospice’s responsibilities for its services, including but not limited to: (a) Medical direction and management of the patient; (b) Nursing; (c) Counseling (including spiritual, dietary, and bereavement); (d) Social work; (e) Supplies, DME, and drugs; and, (f) All other hospice services that are necessary for the care of the patient’s terminal illness and related conditions.
- That LTC facility personnel may assist in the administration of prescribed therapies when permitted by State law and specified by the facility.
- That the LTC facility must immediately report all alleged violations involving mistreatment, neglect, abuse, misappropriation of patient property by hospice personnel to the hospice administrator.
- The responsibilities of the hospice and the LTC facility to provide bereavement support to LTC staff.
Part 3: Collaboration – The hospice must collaborate with the LTC facility to ensure that each party provides the appropriate care. A summary of these requirements are listed in the table below:
Part 4: Plan of Care (POC) – The hospice must collaborate with the LTC facility to ensure that the POC is appropriate, clear, and comprehensive. A summary of these requirements are listed in the table below:
Part 5: Training – The hospice and the LTC facility must provide orientation to one another to ensure that staff members understand their respective responsibilities. A summary of these requirements are listed in the table below:
Part 6: Weatherbee’s Recommendations – Commit to achieving full compliance no later than the August 26th deadline by:
- Obtaining and reading the new regulations.
- Providing copies of the new regulations to designated hospice staff members, physicians, nursing home partners, and other as appropriate.
- Reviewing all executed nursing home contracts to ensure that they contain all required elements.
- Developing and providing education for your hospice staff to ensure that they understand the regulations.
- Updating the education your hospice provides to its contracted LTC facilities to ensure that it meets the regulatory requirements.
- Providing, and documenting the provision of, the updated education to all contracted LTC facilities.
- Proactively partnering with your contracted LTC facilities to ensure that high quality end-of-life care is provided to all eligible residents who desire it and execute an election form. In particular: (a) Participating in all State, Medicare, complaint, accreditation, and other surveys; (b) Responding to complaints in a timely manner; (c) Identifying and resolving issues promptly; (d) Assuring the provision, supervision, and coordination of appropriate, value-added care; (e) Sharing patient/family satisfaction results and other Quality Assessment and Performance Improvement (QAPI) data and working collaboratively to improve performance, communication, and outcomes.
Part 7: Resources – Additional resources are available at:
- Federal Register with Final Rule
- Centers for Medicare and Medicaid
- Hospice Education Network
- National Hospice and Palliative Care Organization
Posted by Joy Barry, RN, M.Ed., LNC, President, Weatherbee Resources, Inc. & Hospice Education Network Inc.