What are the location requirements for CAH status? A person who. In such a case, the procedure in 42 CFR part 405, subpart R, will be followed to the extent that it is applicable. (iv) CEO or CEO-designated personnel contact information including name, title, telephone number, email address, and mailing address (the address must be a physical address, not a post office box). Hospices shall file the aggregate cap using data no earlier than 3 months after the end of the cap period. This web site is designed for the current versions of (ii) TIA 122 to NFPA 99, issued August 11, 2011. (c) Standard: Physical environment. (3) Fire detection, extinguishing, and alarm systems. (2) If State law permits registered nurses to see, treat, and write orders for patients, then registered nurses may provide services to beneficiaries receiving hospice care. All personnel qualifications must be kept current at all times. (A) Is licensed or otherwise regulated, if applicable, as an occupational therapist by the State in which practicing, unless licensure does not apply; (B) Graduated after successful completion of an occupational therapist education program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) of the American Occupational Therapy Association, Inc. (AOTA), or successor organizations of ACOTE; and. Physician means an individual who meets the qualifications and conditions as defined in section 1861(r) of the Act and implemented at 410.20 of this chapter. The CMS Chief Actuarys certification and determinations made by the Secretary designated the HHVBP Model as eligible for expansion nationwide through rulemaking. (a) The following services performed by hospice physicians and nurse practitioners are included in the rates described in 418.302: (1) General supervisory services of the medical director. (iv) If the services are initiated by the beneficiary, the hospice agency is required to maintain a record of the services and documentation that communication between the hospice medical director or physician and the beneficiary's physician occurs, with the beneficiary's permission, to the extent necessary to ensure continuity of care. The hospice must conduct exercises to test the emergency plan twice per year. (b) Standard: Initial certification of terminal illness. 418.70 Condition of participation: Furnishing of non-core services. (4) The effective date of the election, which may be the first day of hospice care or a later date, but may be no earlier than the date of the election statement. (B) Had achieved a satisfactory grade on an occupational therapist proficiency examination conducted, approved, or sponsored by the U.S. Public Health Service. (3) The individual hospice coinsurance period, (i) Begins on the first day an election filed in accordance with 418.24 is in effect for the beneficiary; and. The hospice must, (1) Have an adequate supply of hot water at all times; and. (5) If a hospice exceeds the number of inpatient care days described in paragraph (f)(4), the total payment for inpatient care is determined as follows: (i) Calculate the ratio of the maximum number of allowable inpatient days to the actual number of inpatient care days furnished by the hospice to Medicare patients. (d) When the hospice election is ended due to revocation, the hospice must file a notice of termination/revocation of election with its Medicare contractor within 5 calendar days after the effective date of the revocation, unless it has already filed a final claim for that beneficiary. The hospice must obtain written certification of terminal illness for each of the periods listed in 418.21, even if a single election continues in effect for an unlimited number of periods, as provided in 418.24(c). Except as provided in paragraph (a)(3) of this section, the hospice must obtain the written certification before it submits a claim for payment. (3) The hospice must coordinate its hospice aide and homemaker services with the Medicaid personal care benefit to ensure the patient receives the hospice aide and homemaker services he or she needs. Hospice staff must, (1) Make an appropriate entry in the patient's medical record as soon as they receive an oral certification; and. As a The hospice must have written policies and procedures for the management and disposal of controlled drugs in the patient's home. (1) The hospice must ensure that manufacturer recommendations for performing routine and preventive maintenance on durable medical equipment are followed. (3) Is not discharged from the hospice under the provisions of 418.26. Reporting and recordkeeping requirements. (3) The provisions of the adopted edition of the Life Safety Code do not apply in a State if CMS finds that a fire and safety code imposed by State law adequately protects patients in hospices. (b) The change of the designated hospice is not a revocation of the election for the period in which it is made. [55 FR 50834, Dec. 11, 1990, as amended at 70 FR 70547, Nov. 22, 2005; 79 FR 50509, Aug. 22, 2014; 84 FR 38544, Aug. 6, 2019; 86 FR 42605, Aug. 4, 2021]. (1) Ensure that the interdisciplinary group maintains responsibility for directing, coordinating, and supervising the care and services provided. (1) The patient moves out of the hospice's service area or transfers to another hospice; (2) The hospice determines that the patient is no longer terminally ill; or. (7) Had been found by CMS or the State under any Federal or State law to have: (i) Had its participation in the Medicare program terminated. A hospice aide competency evaluation program as specified in paragraph (c) of this section may be offered by any organization except by a home health agency that, within the previous 2 years: (1) Had been out of compliance with the requirements of 484.80 of this chapter. and. (3) May at any time elect to receive hospice care if he or she is again eligible to receive the benefit. (9) Name and signature of the individual (or representative) and date signed, along with a statement that signing this addendum (or its updates) is only acknowledgement of receipt of the addendum (or its updates) and not the individual's (or representative's) agreement with the hospice's determinations. (3) The physician must include a brief narrative explanation of the clinical findings that supports a life expectancy of 6 months or less as part of the certification and recertification forms, or as an addendum to the certification and recertification forms. The Home Health Quality Reporting Program (Home Health QRP) is a pay-for-reporting program for HHAs that report quality data to CMS. (ii) Maintain current and accurate records of the receipt and disposition of all controlled drugs. (d) Use of technology in furnishing services during a Public Health Emergency. (iv) Complying with infection control policies and procedures. Inpatient care may also be furnished as a means of providing respite for the individual's family or other persons caring for the individual at home. (2) If the hospice has more than one interdisciplinary group, it must identify a specifically designated interdisciplinary group to establish policies governing the day-to-day provision of hospice care and services. These services include nursing services, medical social services, and counseling. 418.113 Condition of participation: Emergency preparedness. The administrator must be a hospice employee and possess education and experience required by the hospice's governing body. In-service training may occur while an aide is furnishing care to a patient. Palliative care means patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. There are many types of disabilities, such as those that affect a persons: Although people with disabilities sometimes refers to a single population, this is actually a diverse group of people with a wide range of needs. (1) A hospice may request reconsideration of a decision by CMS that the hospice has not met the requirements of the Hospice Quality Reporting Program for a particular reporting period. A governing body (or designated persons so functioning) assumes full legal authority and responsibility for the management of the hospice, the provision of all hospice services, its fiscal operations, and continuous quality assessment and performance improvement. A graduate of a school of professional nursing. The individual only needs to demonstrate competency in the services the individual is required to furnish. The biweekly interim payment amount is based on the total estimated Medicare payments for the reporting period (as described in 418.302418.306). The hospice must maintain current and accurate records of the receipt and disposition of all controlled drugs. (C) An education program outside the United States determined to be substantially equivalent to physical therapist entry level education in the United States by a credentials evaluation organization approved by the American Physical Therapy Association or an organization identified in 8 CFR 212.15(e) as it relates to physical therapists. Condition of participation: Licensed professional services. The medical director or physician designee reviews the clinical information for each hospice patient and provides written certification that it is anticipated that the patient's life expectancy is 6 months or less if the illness runs its normal course. That plan of care must be established before hospice care is provided. (iii) Choosing the least restrictive intervention based on an individualized assessment of the patient's medical, or behavioral status or condition. Initial assessment means an evaluation of the patient's physical, psychosocial and emotional status related to the terminal illness and related conditions to determine the patient's immediate care and support needs. This may include a legal guardian. (3) Payment for nurse practitioner services are made at 85 percent of the physician fee schedule amount. (ii) Consider incidence, prevalence, and severity of problems in those areas. First, we are not finalizing our proposal for the Special Focus Program for poor-performing hospice programs that have repeated cycles of serious health and safety deficiencies. A qualified homemaker is, (1) An individual who meets the standards in 418.202(g) and has successfully completed hospice orientation addressing the needs and concerns of patients and families coping with a terminal illness; or. This part implements section 1861(dd) of the Social Security Act (the Act). At a minimum, physicians and attending physicians authorized to order restraint or seclusion by hospice policy in accordance with State law must have a working knowledge of hospice policy regarding the use of restraint or seclusion. (c) Standard: Rights of the patient. Additionally, the provisions require that state survey agencies establish a hospice program complaint hotline. We are finalizing the proposed surveyor prohibition of conflicts of interest and enforcement remedy provisions as proposed with two exceptions. 418.116 Condition of participation: Compliance with Federal, State, and local laws and regulations related to the health and safety of patients. (2) All physician employees and those under contract shall meet this requirement by either providing the services directly or through coordinating patient care with the attending physician. 1 . (6) The medical director or physician designee must be consulted as soon as possible if the attending physician did not order the restraint or seclusion. (1) The program must at least be capable of showing measurable improvement in indicators related to improved palliative outcomes and hospice services. (B) Registered nurse who has been trained in accordance with the requirements specified in paragraph (n) of this section. The individual is liable for the Medicare deductibles and coinsurance payments and for the difference between the reasonable and actual charge on unassigned claims on other covered services that are not considered hospice care. (ii) If an area of concern is noted by the supervising nurse, then the hospice must make an on-site visit to the location where the patient is receiving care in order to observe and assess the aide while he or she is performing care. Physical therapy services, occupational therapy services, and speech-language pathology services must be available, and when provided, offered in a manner consistent with accepted standards of practice. (a) Standard: Training. A hospice must ensure that the services described in 418.72 through 418.78 are provided directly by the hospice or under arrangements made by the hospice as specified in 418.100. The hospice must develop and maintain an emergency preparedness communication plan that complies with Federal, State, and local laws and must be reviewed and updated at least every 2 years. Also, you can decide how often you want to get updates. [48 FR 56026, Dec. 16, 1983, as amended at 76 FR 47332, Aug. 4, 2011; 80 FR 47207, Aug. 6, 2015; 83 FR 38655, Aug. 6, 2018; 86 FR 42606, Aug. 4, 2021]. (2) Instructions for homemaker duties must be prepared by a member of the interdisciplinary group. A routine home care day is a day on which an individual who has elected to receive hospice care is at home and is not receiving continuous care as defined in paragraph (b)(2) of this section. (4) Drugs and treatment necessary to meet the needs of the patient. (C) Is eligible to take, or has successfully completed the entry-level certification examination for occupational therapists developed and administered by the National Board for Certification in Occupational Therapy, Inc. (NBCOT). Access to or release of patient information and clinical records is permitted in accordance with 45 CFR parts 160 and 164. (5) The development of arrangements with other hospices and other providers to receive patients in the event of limitations or cessation of operations to maintain the continuity of services to hospice patients. (6) Drug profile. (5) Include integrated policies and procedures that meet the requirements set forth in paragraph (b) of this section, a coordinated communication plan and training and testing programs that meet the requirements of paragraphs (c) and (d) of this section, respectively. (1) The interdisciplinary group, as part of the review of the plan of care, must determine the ability of the patient and/or family to safely self-administer drugs and biologicals to the patient in his or her home. (i) A summary of the patient's stay including treatments, symptoms and pain management. (c) Standard: Education. The hospice must do the following: (i) Participate in an annual full-scale exercise that is community-based; or, (A) When a community-based exercise is not accessible, conduct an annual individual facility-based functional exercise; or. (2) Contact information for the following: (i) Federal, State, tribal, regional, and local emergency preparedness staff. Homemaker services must be provided by individuals who meet the personnel requirements specified in paragraph (j) of this section. Vendors may not use home-based or virtual interviewers to conduct the CAHPS Hospice Survey, nor may they conduct any survey administration processes (for example, mailings) from a residence. The individual or representative must acknowledge that the identified attending physician was his or her choice. (xi) TIA 124 to NFPA 101, issued October 22, 2013. Regulation Y (2) Clinical information and other documentation that support the medical prognosis must accompany the certification and must be filed in the medical record with the written certification as set forth in paragraph (d)(2) of this section. The hospice must provide a sanitary environment by following current standards of practice, including nationally recognized infection control precautions, and avoid sources and transmission of infections and communicable diseases. (2) For cap years ending October 31, 2012, and all subsequent cap years, a hospice's aggregate cap is calculated using the patient-by-patient proportional methodology described in paragraph (c) of this section, subject to the following: (i) A hospice that has had its cap calculated using the patient-by-patient proportional methodology for any cap year(s) prior to the 2012 cap year is not eligible to elect the streamlined methodology, and must continue to have the patient-by-patient proportional methodology used to determine the number of Medicare beneficiaries in a given cap year. (b) In reaching a decision to certify that the patient is terminally ill, the hospice medical director must consider at least the following information: (1) Diagnosis of the terminal condition of the patient. (d) Standard: Continuation of care. The hospice must do the following: (i) Participate in a full-scale exercise that is community-based every 2 years; or, (A) When a community-based exercise is not accessible, conduct an individual facility-based functional exercise every 2 years; or. Medical social services must be provided by a qualified social worker, under the direction of a physician. (b) General.
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