Hospice Regulatory Update

Transcription

1 Hospice Regulatory Update Richard J. Brockman Monica Nelson Fischer Johnston Barton Proctor & Rose LLP Topics of Discussion 1. Two Important Rule Changes regarding nursing home hospice care: 1. A) Final rule from CMS for hospice services provided in nursing homes. 2. B) Amendment to the ADPH respite hospice rules regarding RN staffing in a nursing home. 2. Opportunities for hospice services in nursing homes. CMS Nursing Home Rules Revised to Include Hospice On June 25, CMS published a final rule governing the provision of hospice services in a nursing home. This rule is effective August 26, It is amends 42 CRF Requirements for Long Term Care Facilities This elements of the new rule are consistent with the Hospice Conditions of Participation published by CMS in

2 New Hospice Rules Hospice care is covered under the umbrella of a number of F-Tags (e.g., F- 279 care plans; F-309 quality of care) CMS may add new F-Tags dealing specifically with hospice to coincide with these new rules. Focus Primary focus of the CMS revised Rule is the information that must be contained in an agreement for hospice services between a hospice and a nursing home. Rationale The Rule s rationale is to promote better cooperation and collaboration between the nursing home and hospice provider. Formerly a nursing home was guided by its conditions of participation and its hospice contract. Under the Rule, a nursing home will have specific guidance requiring its conduct with hospice. 2

3 What s New? Form over substance Not much is new in the nursing home s actual responsibility, but The Nursing Home/Hospice Agreement must contain reference to certain nursing home responsibilities that are not delineated under the hospice conditions of participation. The Hospice Agreement must set out the following provisions: 1. A description of the services the hospice will provide. 2. The hospice s responsibilities for determining the appropriate hospice plan of care. 3. The services the nursing home will continue to provide based on a resident s plan of care. 4. A communication process, including how the communication will be documented between the nursing home and the hospice provider. 5. A provision that the nursing home must notify the hospice about a significant change in condition, a need to alter the plan of care, a need to transfer the resident or a resident s death. 3

4 6. A provision stating that the hospice assumes responsibility for determining the appropriate course of hospice care. 7. An agreement that it is the nursing home s responsibility to furnish 24-hour room and board care, meet the resident s personal care and nursing needs in coordination with the hospice, and ensure that the level of care is appropriate. 8. A delineation of the hospice s responsibilities to the patient. 9. A provision that when the nursing home is responsible for the provision of prescribed therapies, the nursing home may administer the therapies where permitted by State law and as specified by the nursing home. 10. A provision that the nursing home must report all alleged violations involving mistreatment, neglect, abuse to the hospice administrator immediately. 11. A delineation of the responsibilities of the hospice and nursing home to provide bereavement services to nursing home staff. 4

5 Additionally, each nursing home must designate a member of the interdisciplinary team who is responsible for working with hospice representatives to coordinate care to the residents. This person is responsible for many things including: obtaining required information from the hospice, collaborating with hospice representatives in care planning, communicating with hospice representations, and ensuring that nursing home staff provides proper orientation to hospice staff. The New Agreement Elements Of the above elements, these are new: A description of the services the nursing home will provide. An agreement that it is the nursing home s responsibility to furnish 24-hour room and board care, meet the resident s personal care and nursing needs in coordination with the hospice, and ensure that the level of care is appropriate. The New Agreement Elements A provision that when the nursing home is responsible for the provision of prescribed therapies, the nursing home may administer the therapies where permitted by State law and as specified by the nursing home. A provision that the nursing home must report all alleged violations involving mistreatment, neglect, abuse to the hospice administrator immediately. 5

6 ADPH Respite Hospice Rule Amendment to Ala. Admin. Code r (Nursing Services). This rule is being amended to modify the respite hospice rules to conform with changes to the federal regulations. ADPH Hospice Rule This change eliminates the requirement that RN be continuously on site during every shift during a respite hospice admission of a home care hospice patient. It still requires that the respite admission of a hospice patient to nursing homes be supervised by the Registered Nurse employed by the nursing home. ADPH Hospice Rule The amendment also requires the hospice agency to maintain ultimate responsibility for the quality of care for such patients. 6

7 There are four levels of hospice (1) Routine Home Care (2) () Respite Care (3) Continuous Care (4) General Inpatient Care At least three levels can be provided in a nursing home: Routine home care- Nursing home provides room and board with some nursing and is paid at least 95% of the Medicaid rate. Respite care- Same as routine care but limited to 5 days. -General Inpatient- For patients needing intensive care and treatment. Requires 24 hour RN involvement and is short term (less than 14 days). Reimbursement is at a much higher rate. Most nursing homes contract with local hospices for routine home care and respite care. General Inpatient Care ( GIP ) GIP) is seldom used. Hospice residents are typically located throughout the nursing home in a scattered bed approach. 7

8 Nursing home can dedicate an area of its facility for hospice. All hospice (routine home, respite and GIP) would be rendered d in this area. Physical plant could be modified for this approach (private rooms, separate dining, family room, outside area with garden and walking, soothing décor), and separate activities plan. This unit would be managed by a hospice person to coordinate among community providers. Separate care plan meetings with more frequency to ensure hospice patients are properly assessed, services are rendered and coordinated, and GIP needs identified. Staff on this unit would be specially trained to focus on hospice population The Approach: Lease or Manage Lease Approach Unit is leased to a hospice provider and licensed by it as free standing hospice. Nursing home is paid a rent plus service fees for housekeeping, dietary, laundry, maintenance and other overhead. 8

9 Hospice is financially responsible for the unit. Hospice is responsible for staffing. A CON is required. This unit would be separately licensed as an inpatient hospice and the unit would have to be separated by fire walls and doors, with a separate entrance, lobby, public restrooms and offices. Risk that nursing home beds could be lost and require CON to reinstate them if the lease is terminated. Leasing to a single hospice operator may deter other community hospices for admitting. Management Approach Nursing home keeps unit license as nursing home beds and is fiscally responsible for management. Nursing home responsible for staffing unit. Nursing home hires a manager that gets a management fee or salary. 9

10 Manager should be neutral so that community hospice providers would not feel threatened. No CON or licensure implications. Conclusion 10