| (a) When a nursing facility (NF) contracts for hospice
services for residents, the nursing facility must:
(1) have a written contract for the provision of arranged
services, which must be signed by authorized representatives of the
NF and hospice and must include the following:
(A) the services to be provided;
(B) a stipulation that hospice-related services performed
by NF staff may be provided only with the express authorization of
the hospice;
(C) how the contracted services are to be coordinated,
supervised, and evaluated by the hospice and the NF;
(D) delineation of the roles of the hospice and the
NF in the admission process, recipient and family assessment, and
the interdisciplinary team case conferences;
(E) a requirement for documentation of services furnished;
and
(F) the qualifications of the personnel providing the
services;
(2) provide room and board services, which include
the performance of personal care services, including assistance in
the activities of daily living, administration of medication, socializing
activities, maintaining the cleanliness of a resident's room, and
supervision and assisting in the use of durable medical equipment
and prescribed therapies;
(3) immediately notify the hospice of any significant
changes in the hospice recipient's condition;
(4) have joint procedures with the hospice provider
for ordering medications that ensure the proper payor is billed and
for reconciling billing between NF and hospice, including:
(A) contacting the hospice prior to filling a new prescription;
and
(B) ensuring that drugs unrelated to the terminal illness
are ordered through the Vendor Drug program; and
(5) ensure that hospice documentation is a part of
the current clinical record, which, at a minimum, must include the
current and past:
(A) Texas Medicaid Hospice Recipient Election/Cancellation
form;
(B) MDS assessment;
(C) Physician Certification of Terminal Illness form;
(D) Medicare Election Statement, if dually eligible;
(E) verification that the recipient does not have Medicare
Part A;
(F) hospice interdisciplinary assessments;
(G) hospice plan of care; and
(H) current interdisciplinary notes, which include
the following:
(i) nurses notes and summaries;
(ii) physician orders and progress notes; and
(iii) medication and treatment sheets during the hospice
certification period.
(b) The NF and hospice must ensure that the coordinated
plan of care reflects the participation of the hospice, the NF, the
recipient, and the recipient's legal representative to the extent
possible. The plan of care must include directives for managing pain
and other uncomfortable symptoms, and must be revised and updated
as necessary to reflect the recipient's current status.
(c) The recipient has the right to refuse any services
from the nursing facility and the hospice provider.
(d) The hospice retains overall professional management
responsibility for directing the implementation of the plan of care
related to the terminal illness and related conditions, which includes:
(1) designation of a hospice registered nurse to coordinate
the implementation of the plan of care;
(2) provision of substantially all core services (physician,
nursing, medical social work, and counseling services) that must
be routinely provided directly by the hospice employees, and cannot
be delegated to the NF, as outlined under 42 Code of Federal Regulations
§418.80;
(3) provision of drugs and medical supplies as needed
for palliation and management of the terminal illness and related
conditions; and
(4) involvement of NF personnel in assisting with the
administration of prescribed therapies in the plan of care only to
the extent that the hospice would routinely use the services of a
hospice patient's family or caregiver in the home setting.
(e) The hospice may arrange to have non-core hospice
services provided by the NF if the hospice assumes professional management
responsibility for the services and assures these services are performed
in accordance with the policies of the hospice and the recipient's
plan of care.
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| Source Note: The provisions of this §554.1926 adopted to be effective December 1, 2000, 25 TexReg 10374; amended to be effective January 1, 2002, 26 TexReg 10389; amended to be effective September 1, 2008, 33 TexReg 7264; transferred effective January 15, 2021, as published in the Texas Register December 11, 2020, 45 TexReg 8871 |
