hospice contracting checklist for inpatient services...

HOSPICE CONTRACTING CHECKLIST FOR INPATIENT SERVICES, RESPITE CARE AND VENDOR AGREEMENTS

The following checklist can be used to verify that the regulatory requirements are addressed in hospice contracts for inpatient services, respite care, and vendorservices. This checklist is separated into three categories: (1) General hospice obligations for all types of hospice contracts; (2) Specific obligations for inpatientservices and respite care agreements; and (3) Specific hospice regulatory obligations related to a variety of vendor contracts. In each part of the checklist, theobligations with asterisks are required by regulation to be included in the applicable agreement.

OBLIGATION & CITATION BRIEF DESCRIPTION

GENERAL HOSPICE OBLIGATIONS

*Authorization by Hospice

42 C.F.R. § 418.100(e)

Services must be authorized by the hospice.

*Safe and Effective Services

42 C.F.R. § 418.100(e)

Services must be furnished in a safe and effective manner by qualified personnel.

*Plan of Care

42 C.F.R. § 418.100(e)

Services must be delivered in accordance with the patient's plan of care.

*Criminal Background Checks

42 C.F.R. § 418.114(d)

Hospice contracts must require that all contracted entities obtain criminal background checks on contracted employees whohave direct patient contact or access to patient records.

*Inspection of Records by

Government

42 C.F.R. § 420.300

The provider shall make available until the expiration of five years from the termination of the agreement, upon written request,to the Secretary of Health and Human Services, and upon request, to the Comptroller General of the United States, or any oftheir duly authorized representatives, the agreement and any of the provider's books, documents, and records that arenecessary to certify the nature and costs of Medicare reimbursable services provided under the agreement.

If and to the extent the provider carries out any of its duties under this agreement through a subcontract with a relatedorganization having a value or cost of $10,000 or more over a 12-month period, the provider shall ensure the subcontractcontains a clause comparable to the clause above.

Professional Management

Responsibility

42 C.F.R. § 418.100(e)

The hospice must retain administrative and financial management and oversight of staff and services for all arranged services,to ensure the provision of quality care.

QAPI

42 C.F.R. § 418.58

The hospice's quality assessment and performance improvement program (QAPI) must involve all hospice services, includingthose services furnished under contract.

* Obligations with asterisks are specifically required by regulation to be included in the written agreement.Prepared by Reinhart Hospice and Palliative Care Practice Group, Meg Pekarske, chair

© 2014 All Rights Reserved Reinhart Boerner Van Deuren s.c.

OBLIGATION & CITATION

Coordinating Care

42 C.F.R. § 418.56(e)

BRIEF DESCRIPTION

The hospice must develop and maintain a system of communication and integration to either:• ensure that the IDG maintains responsibility for directing, coordinating, and supervising the care and services provided;

• ensure that the care and services are provided in accordance with the plan of care;

• ensure that the care and services provided are based on all assessments of the patient and family needs; and

• provide for and ensure the ongoing sharing of information between all disciplines providing care and services in all settings, whether the care and services are provided directly or under arrangement.

Availability of Services

42 C.F.R. § 418.100(c)(2)

Nursing services, physician services, and drugs and biologicals must be made routinely available on a 24-hour basis, 7 days perweek. Other covered services must be available on a 24-hour basis when reasonable and necessary to meet the needs of thepatient and family.




Training

42 C.F.R. §§ 418.100(g); 418.60(c)

• The hospice must provide orientation about the hospice philosophy to all contracted staff who have patient and family contact.

• The hospice must assess the skills and competence of all individuals furnishing care and, as necessary, provide in-service training and education programs where required. The hospice must have written policies and procedures describing methods of assessment of competency.

• The hospice must provide infection control education to contracted providers.

Licensed Professional Services

42 C.F.R. § 418.62

• Licensed professionals must actively participate in the coordination of all aspects of the patient's hospice care, in accordance with current professional standards and practice, including participating in ongoing interdisciplinary comprehensive assessments, developing and evaluating the plan of care, and contributing to patient and family counseling and education.

• Licensed professionals must participate in the hospice's quality assessment and performance improvement program and hospice sponsored in-service training.

• Specific training requirements, duties, and supervision requirements for individuals providing these services are also addressed in 42 C.F.R. § 418.76.

Method for Criminal

Background Checks

42 C.F.R. § 418.114(d)

Criminal background checks must be obtained in accordance with state requirements. If there are no state requirements,criminal background checks must be obtained within three months of the date of employment for all states in which theindividual has lived or worked in the past three years.


Compliance with Laws

42 C.F.R. § 418.116

BRIEF DESCRIPTION

Staff must operate and furnish services in compliance with all applicable federal, state, and local laws and regulations related to the health and safety of patients.

Patient Grievances

42 C.F.R. § 418.52(b)(1)(iii)

The hospice must be notified of patient grievances regarding treatment or care that is (or fails to be) furnished and the lack ofrespect for property by anyone who is furnishing services on behalf of the hospice.

Caregiver Misconduct

42 C.F.R. § 418.52(b)(4)

The hospice must be notified of all alleged violations involving mistreatment, neglect or verbal, mental, sexual, and physicalabuse, including injuries of unknown source, and misappropriation of patient property by anyone furnishing services on behalf of the hospice.




Standards of Practice

42 C.F.R. § 418.70

Services must be provided in a manner consistent with current standards of practice.

General Personnel Qualifications

42 C.F.R. §§ 418.114(a);

418.114(c)

• All professionals who furnish services directly, under an individual contract, or under arrangements with a hospice, must be legally authorized (licensed, certified, or registered) in accordance with applicable federal, state, and local laws, and must act only within the scope of his or her state license, or state certification, or registration.

• All personnel qualifications must be kept current at all times.


*Specify Inpatient Services

42 C.F.R. § 418.108(c)(1)

BRIEF DESCRIPTION

• The inpatient services to be furnished;

* Policies and Procedures

42 C.F.R. § 418.108(c)(2)

• That the inpatient provider has established patient care policies consistent with those of the hospice;

*Palliative Care Protocol and

Plan of Care

42 C.F.R. § 418.108(c)(2)

• That the inpatient provider agrees to abide by the palliative care protocols and plan of care established by the hospice for its patients;

*Inpatient Clinical Record

42 C.F.R. § 418.108(c)(3)

• That the hospice patient's inpatient clinical record includes a record of all inpatient services furnished and events regarding care that occurred at the facility;

*Discharge Summary

42 C.F.R. § 418.108(c)(3)

• That a copy of the discharge summary be provided to the hospice at the time of discharge;

INPATIENT SERVICES CONTRACTS

*Copy of Plan of Care

42 C.F.R. § 418.108(c)(1)

• That the hospice supplies the inpatient provider a copy of the patient's plan of care;



Inpatient Care for Symptom

Management and Pain Control

42 C.F.R. § 418. 108(a)

Inpatient care for pain control and symptom management must be provided in (1) a Medicare-certified hospice that meets theconditions of participation for providing inpatient care directly as specified in 418.110; or (2) a Medicare-certified hospital or askilled nursing facility that also meets the standards specified in § 418.220(b) and (e) regarding 24-hour nursing services andpatient areas. [Note: Does not apply to respite services agreements.]

Inpatient Care for Respite

Purposes

42 C.F.R. § 418. 108(b)

(1) Inpatient care for respite purposes must be provided by one of the following:

• a provider [qualified to provide inpatient care for symptom management and pain control] specified in paragraph (a) of this section; or

• a Medicare or Medicaid-certified nursing facility that also meets the standards specified in 418.110.

(2) The facility providing respite care must provide 24-hour nursing services that meet the nursing needs of all patients and are furnished in accordance with each patient's plan of care. Each patient must receive all nursing services as prescribed and must be kept comfortable, clean, well-groomed, and protected from accident, injury, and infection.

*Inpatient Care Under

Arrangement – Written

Agreement

42 C.F.R. § 418.108(c)

If a hospice has an arrangement with a facility to provide for short-term inpatient care, the arrangement is described in a writtenagreement, coordinated by the hospice, and at a minimum specifies:


24-hour Nursing

42 C.F.R. § 418.110(b)

BRIEF DESCRIPTION

• The facility must provide 24-hour nursing services that meet the nursing needs of all patients and are furnished in accordance with each patient's plan of care.

• Each patient must receive all nursing services as prescribed.

• Each patient must be kept comfortable, clean, well-groomed, and protected from accident, injury and infection.

Direct RN Care

42 C.F.R. § 418.110(b)

If at least one patient in the hospice facility is receiving general inpatient care, then each shift must include a registered nursewho provides direct patient care. [Note: Does not apply to respite services.]

Home Like Environment

42 C.F.R. § 418.110(e)

The facility must provide a home-like atmosphere and ensure that patient areas are designed to preserve the dignity, comfort,and privacy of patients.

Private Visitation

42 C.F.R. § 418.110(e)

The facility must provide physical space for private patient and family visiting.

Overnight Accommodations

42 C.F.R. § 418.110(e)

The facility must provide accommodations for family members to remain with the patient throughout the night.

INPATIENT SERVICES CONTRACTS

Privacy After Death

42 C.F.R. § 418.110(e)

The facility must provide physical space for family privacy after a patient's death.

*Training of Personnel

42 C.F.R. § 418.108(c)(5)

• That the hospice retains responsibility for ensuring that the training of personnel who will be providing the patient's care in the inpatient facility has been provided;

*Documentation of Training

42 C.F.R. § 418.108(c)(5)

• That a description of the training and the names of those giving the training is documented; and

*Verification of Regulatory

Requirements

42 C.F.R. § 418.108(c)(6)

• A method for verifying that the requirements in paragraphs (c)(5) of this section are met.

*Responsible Facility

Representative

42 C.F.R. § 418.108(c)(4)

• That the inpatient facility has identified an individual within the facility who is responsible for the implementation of the provisions of the agreement;



*Copy of Inpatient Record

42 C.F.R. § 418.108(c)(3)

• That a copy of the inpatient clinical record is available to the hospice at the time of discharge;


Medical Equipment and

Supplies

42 C.F.R. § 418.106(f)

BRIEF DESCRIPTION

• Hospices may only contract for DME services with a DME supplier that meets the Medicare DMEPOS Supplier Quality and Accreditation Standards at 42 C.F.R. § 424.57.

• The hospice must ensure that manufacturer recommendations for performing routine and preventive maintenance on DME are followed. The equipment must be safe and work as intended for use in the patient's environment.

• The hospice must ensure that the patient, where appropriate, as well as the family and/or other caregiver(s), receive instruction in the safe use of DME and supplies. The patient, family, and/or caregiver must be able to demonstrate the appropriate use of DME to the satisfaction of hospice staff.

Physical Therapy,

Occupational Therapy and

Speech-Language Pathology

42 C.F.R. § 418.72

• 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.

• Also refer to the qualification requirements for physical therapists, physical therapy assistants, occupational therapists, occupational therapy assistants, and speech language pathologists listed in 42 C.F.R. § 418.114(b).

Laboratory Services

42 C.F.R. § 418.116(b)

If the hospice refers specimens for laboratory testing to a reference laboratory, the reference laboratory must be certified in theappropriate specialties and subspecialties of services in accordance with the applicable requirements of 42 C.F.R. part 493.

HOSPICE VENDOR CONTRACTING REQUIREMENTS

Hospice Aide and Homemaker

Services

42 C.F.R. § 418.76

Hospice aides, individuals providing homemaker services, and individuals providing personal care services must meet theapplicable qualifications listed in 42 C.F.R. § 418.76.

Pharmacy (Drugs and

Biologicals)

42 C.F.R. § 418.106(b)-(e)

• The hospice must obtain drugs and biologicals from community or institutional pharmacists or stock drugs and biologicals itself.

• Drugs and biologicals must be labeled in accordance with currently accepted professional practice and must include appropriate usage and cautionary instructions, as well as an expiration date (if applicable).

Pharmacy Consulting

42 C.F.R. § 418.106(a)

The hospice must ensure that the IDG confers with an individual with education and training in drug management as defined inhospice policies and procedures and state law, who is an employee of or under contract with the hospice to ensure that drugsand biologicals meet each patient's needs.

Dietary Counseling

42 C.F.R. § 418.64(d)(2)

• Dietary counseling may only be provided by a contracted provider if the hospice has obtained a waiver from CMS pursuant to 42 C.F.R. § 418.74.

• Dietary counseling must be provided by qualified individuals, which may include a registered nurse, dietitian, or nutritionist.



Visitation Hours

42 C.F.R. § 418.110(e)

The facility must provide the opportunity for patients to receive visitors at any hour, including infants and small children.

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