Medicare & Medicaid Program; Requirements for LTC Facilities; Hospice Services

The final rule regarding the requirement that long term care facilities have a written agreement with hospice providers was published in the June 27, 2013 Federal Register. This rule provides revisions to the requirements that skilled nursing facilities have to meet in order to participate in Medicare or nursing facilities need to participate in Medicaid. The intent of the rule is to improve the quality and consistency of care provided by long term care facilities and hospice providers by ensuring each party clearly knows its responsibilities for care.

Both long term care facilities and hospice providers offer many of the same services to residents who have elected to receive the hospice benefit, so in order to prevent duplicate services from being provided, each party should take ownership of certain responsibilities. Some of the areas listed where there is potential to be conflicting services provided include nursing services, dietary services, and physician services.

Some things to note in this new rule:

  • A written agreement that includes the following information (at a minimum) must be signed by both a representative of the hospice provider and the facility before services can begin:
    • Services that will be provided by hospice
    • The hospice’s responsibilities to determine the appropriate plan of care (Care plans must be updated every 15 calendar days, as set out by existing hospice regulations)
    • Services that will be provided by the long term care facility, based on the resident’s comprehensive care plan
    • The communication process that has been developed and documented between the two parties to ensure information is being shared and the resident’s needs are being met 24 hours per day
    • A provision that the LTC facility will notify the hospice provider about a significant change in the resident’s physical / mental / social or emotional status, any clinical complications that would require a change to the care plan, orthe death of the resident
    • A provision that the hospice provider is responsible for the hospice plan of care
    • An agreement that the facility will provide 24 hour room/board and will meet the resident’s personal care and nursing needs while coordinating with the hospice coordinator to ensure a sufficient level of care is being provided
    • A list of hospice’s responsibilities including, minimally, the following areas: medication direction, management of the resident, nursing, counseling, social work, provision of medical supplies, durable medical equipment and medication for symptoms related to the terminal illness
    • A provision that the facility’s staff is responsible for prescribed therapies, including those that are outlined in the hospice plan of care where the staff can administer those therapies
    • A provision that the facility will report all allegations of abuse to the hospice personnel as soon as the facility becomes aware of such actions
    • A list of responsibilities of each the hospice provider and the facility regarding providing bereavement services to the facility’s staff
    • A member of the long term care facility’s interdisciplinary team must be designated to be responsible for working with the designated hospice representative to coordinate care – this person must have clinical background and have the ability to assess or have access to someone who can assess the resident
    • The long term care facility must maintain a copy of both the facility’s most recent plan of care for the resident as well as the hospice’s plan of care, with the burden being placed on the facility to ensure the most up-to-date plans are available
  • If hospice care will be provided by an outside hospice provider, it is the LTC facility’s responsibility to ensure that the services being provided meet the standards of the facility to provide the highest quality of care, including the timeliness of services rendered. Several recommendations for training and orientation of both staffs are provided in the Register
  • This rule’s intent is to bring long term care facilities regulations closer to the regulations that have already been passed for hospice providers, which can be viewed at §418.112(c)(1)-(9)

The effective date for these regulations is August 26, 2013.

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