Hospice Conditions of Participation

1
Hospice Conditions of Participation

• Presented by
• Kim Roche, RN, BSN, RNC, CCS-P
• CMSO/SCG
• The Centers for Medicare Medicare Services
• January 22, 2009

2
Medicare Hospice Conditions of Participation

• Published May 27, 2008
• Effective December 2, 2008
• Performance Improvement Projects begin 02/02/09

3

• www.cms.hhs.gov/center/hospice.asp

4
Secretarys Advisory Committee on Regulatory
Reform

• Clarified relationship between NHs, ICF/MRs and
  hospices
• Changed respite care nursing requirements
• Allowed qualified nurses to provide dietary
  counseling

5
BBA 97 changes

• Medical director/physicians may be under contract
  (418.64 and 418.102)
• Waiver available to provide PT, OT, SLP, and
  dietary counseling on 24-hour basis (418.74 )

6
BBA 97 changes (Cont)

• Waiver available for providing dietary counseling
  directly (418.74)

7
MMA 2003

• Hospices may contract with another hospice to
  provide core hospice services
• Hospices may contract with RN for highly
  specialized services

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Hospices Responsibility
9
Patients Rights
Effective Pain Medication Respect for Property
Person Choose Attending
Confidential Clinical Records Symptom
Management Voice Grievances without reprisal
10
Patients Rights (Cont)
Exercise Rights Refuse Care or
Treatment Receive information about hospice
Freedom from Mistreatment, Neglect/
abuse Involvement with Care
11
Initial Assessment

• Completes within 48 hours of effective date of
  election
• Patient or Physician may request earlier
  assessment.
• Gathers key information to treat patient

• Registered
• Nurse

12
Comprehensive Assessment
13
Comprehensive Assessment (Cont)
14
Assessment Timeframes (example)
15
IDG
Meets Physical, Medical, Psychosocial, Emotional,
and Spiritual Needs of Pt/family
Includes MD or DO, SW, RN Counselor
Provides Education/ Training to Pt/Family
Consults with Attending Physician
16
Plan of Care
17
Plan of Care (Cont)
18
Performance improvement activities

• Focus on high risk, high volume, or
  problem-prone areas

• Track adverse patient events analyze causes

• Affect palliative outcomes, patient safety,
  and quality of care

19
Performance Improvement Activities (Cont)

• Consider incidence, prevalence, and severity
  of problems

• Take actions aimed at PI measure success

• Track PI actions to assure improvements are
  sustained

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Performance Improvement Projects

• Starts February 2, 2009

• Reflect scope, complexity past performance
  of hospices services operations.

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Performance Improvement Projects (Cont)

• Document the quality
• improvement projects conducted

• Document reasons for conducting the projects
  and measurable progress achieved

22
Infection Control

• Accepted standards of practice
• Prevents and Controls Infections Diseases

• Part of QAPI
• Educates/Protects, Patients, Staff and others

23
Infection Control

• Agency wide program for surveillance,
  identification, prevention, control and
  investigation

• Identifies Infectious and Communicable
  Diseases and Implements Appropriate Actions

24
Licensed Professional Services

• Services must be authorized, delivered, and
  supervised by qualified personnel
• Professionals participate in coordinating all
  patient care
• Professionals participate in the hospices QAPI
  and in-service training programs

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Hospice Core Services

• Physician Services (direct or under contract)
• Nursing Services
• Medical Social Services

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Hospice Core Services (Cont)

• Counseling Services
• Bereavement
• Dietary
• Spiritual

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Hospice Aide Qualifications

• Training competency evaluation OR
• Competency evaluation OR
• Nurse aide training and competency evaluation OR
  
• State licensure program

28
Hospice Aide Supervision

• RN supervises aide onsite once annually if no
  problems noted.
• RN visits patient q. 14 days to assess aide
  services (aide does not have to be present)
• If concerns, RN revisits to observe aide
• If concerns remain, aide completes competency
  evaluation

29
Volunteer Hours Level of ActivityExample
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Recruit, Train, Supervise

• Hospice must
• Document active volunteer recruitment
• Document retention plans
• Provide orientation training for its
  volunteersconsistent with hospice industry
  standards
• Volunteer program must be supervised by a
  designated hospice employee