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

3. www.cms.hhs.gov/center/hospice.asp

4. Secretary�s 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 (Con�t) 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

11. Initial Assessment Registered Nurse Completes within 48 hours of effective date of election Patient or Physician may request earlier assessment. Gathers key information to treat patient

12. Comprehensive Assessment

13. Comprehensive Assessment (Con�t)

14. Assessment Timeframes (example)

16. Plan of Care

17. Plan of Care (Con�t)

19. Performance Improvement Activities (Con�t)

20. Performance Improvement Projects

21. Performance Improvement Projects (Con�t)

23. Infection Control

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 hospice�s QAPI and in-service training programs

25. Hospice Core Services Physician Services (direct or under contract) Nursing Services Medical Social Services

26. Hospice Core Services (Con�t)

27. 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

30. Recruit, Train, & Supervise Hospice must: Document active volunteer recruitment Document retention plans Provide orientation & training for its volunteers�consistent with hospice industry standards Volunteer program must be supervised by a designated hospice employee