| (a) A hospice must make inpatient care available when
needed for pain control, symptom management, and respite purposes.
(b) A hospice must ensure that inpatient care for pain
control and symptom management is provided in either:
(1) a hospice inpatient unit that meets the additional
standards in Division 7 of this subchapter (relating to Hospice Inpatient
Units) and the Medicare Conditions of Participation for providing
inpatient care directly as specified in 42 CFR §418.110; or
(2) a Medicare-certified hospital or skilled nursing
facility that also meets:
(A) the licensing standards specified in §558.870(b)(1)
and (2) of this subchapter (relating to Staffing in a Hospice Inpatient
Unit) regarding 24-hour nursing services, and in §558.871(d)(1)-(4)
of this subchapter (relating to Physical Environment in a Hospice
Inpatient Unit); and
(B) the federal Medicare standards specified in 42
CFR §418.110(b) and (e) regarding 24-hour nursing services and
patient areas.
(c) A hospice must ensure that inpatient care for respite
purposes is provided either by:
(1) a facility specified in subsection (b)(1) or (2)
of this section; or
(2) a Medicare-certified or Medicaid-certified nursing
facility that also meets the licensing standards specified in §558.871(d)(1)-(4)
of this subchapter regarding client areas and the federal Medicare
standards specified in 42 CFR §418.110(e) regarding patient areas.
(d) A facility providing respite care must provide
24-hour nursing services that meet the nursing needs of all clients
and are furnished in accordance with each client's plan of care. Each
client must receive all nursing services as prescribed and must be
kept comfortable, clean, well-groomed, and protected from accident,
injury, and infection.
(e) In addition to the requirements in §558.289(b)
of this chapter (relating to Independent Contractors and Arranged
Services), if a hospice has an agreement with a facility to provide
for inpatient care, there must be a written contract coordinated by
the hospice that specifies that:
(1) the hospice supplies the facility with a copy of
the client's plan of care and specifies the inpatient services to
be furnished;
(2) the facility has established client care policies
consistent with those of the hospice and agrees to abide by the plan
of care established by the hospice for each client and to follow the
hospice agency's protocols for supporting optimal quality of life
for its clients;
(3) the facility's clinical record for a hospice client
includes documentation of all inpatient services furnished and events
regarding care that occurred at the facility;
(4) a copy of the discharge summary be provided to
the hospice at the time of discharge;
(5) a copy of the inpatient clinical record is available
to the hospice at the time of discharge;
(6) the facility has identified a person within the
facility who is responsible for the implementation of the provisions
of the agreement;
(7) the hospice retains responsibility for ensuring
that the training of personnel who will be providing the client's
care in the facility has been provided and that a description of the
training and the names of those giving the training are documented;
and
(8) a method for verifying that the requirements in
paragraphs (1) - (7) of this subsection are met.
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