State operations manual appendix m




















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Has someone from the hospice given you a chance to talk about your religious or spiritual beliefs or concerns? Have you ever needed to call the hospice on weekends, evenings, nights, or holidays? What was your experience with this?

Have you received care in any other setting while under hospice care? If so, what was your experience? Since you have been receiving care from the hospice, have you had any out-ofpocket expenses for your health care? If yes, what kind? How satisfied are you with the services provided? Do you have any suggestions for improvement?

Would you recommend this hospice? Additional general information about facility personnel accompanying surveyors and physical contact of patients by surveyors is included in A and B of this manual. Discontinue the interview if: The patient shows signs of being uncomfortable or seems reluctant to talk, and if after asking the patient, they would rather discontinue the discussion; or The patient appears tired, overly concerned, agitated, etc. Task 4 - Information Analysis A General The information analysis process requires surveyors to review the information gathered during the survey and make judgments about the compliance of the hospice.

Do not make an evaluation of whether a finding constitutes a deficiency or whether a condition level deficiency exists until all necessary information has been collected.

Additional activities and investigation through record review, home visit observations and interviews should substantiate and support any findings of non-compliance with the CoPs. Review all your findings and use your professional judgment to decide whether further information gathering is necessary. B Analysis Analyze your findings relative to each requirement for the:. An isolated incident that has little or no effect on the delivery of patient services may not warrant a deficiency citation.

Conversely, a condition may be considered out of compliance for one or more deficiencies if, in your judgment, the deficiency constitutes a significant or serious problem that adversely affects, or has the potential to adversely affect the patient s. A deficiency must be based on the statute or the regulations. Citation of a deficiency must not be based on a violation of a guideline alone. In each case you must determine, based on the facts and circumstances existing at the time and any further investigation as may be warranted, whether a deficiency exists based on the applicable statutory or regulatory provision.

The surveyor s role is to assess the quality of care and services the hospice provides and relate those findings to the statutory and regulatory requirements. When deficiencies are found during a survey, the surveyor should explain to the provider what the deficiency is so the provider understands why the requirement is not met.

It is not the surveyor s job to provide consultation on how to fix the deficiencies. See for further information on the regulatory role of the surveyor. Task 5 - Exit Conference The exit conference is held at the end of the survey in accordance with The purpose of the exit conference is to inform the hospice of observations and preliminary findings of the survey. Because of ongoing dialogue between the surveyor s and hospice staff during the survey, there should be few instances where the hospice is not aware of the surveyor concerns prior to the exit conference.

Implement the following guidelines during the conference: Conduct the exit conference with the hospice administrator, clinical supervisors and other staff invited by the hospice; Describe the regulatory requirements that the hospice does not meet and the findings that substantiate these deficiencies. Avoid using data tag numbers when referring to your findings; Present the Form CMS onsite, or in accordance with the State agency s policy, but no later than 10 working days after the exit conference, and Provide instructions and time frame for submitting a plan of correction.

The plan of correction must be submitted to the SA within 10 calendar days after receipt of the Form CMS Refer to and for additional information. Furthermore, except where CMS regulations explicitly require an interpretation in accordance with State law, wherever the text of a regulation or associated guidance uses the above terms or includes a reference to a patient s representative, surrogate, support person, next-of-kin, or similar term in such a manner as would normally implicitly or explicitly include a spouse, the terms are to be interpreted consistent with the guidance above.

A hospice is expected to recognize all lawful marriages and spouses for purposes of compliance with the Conditions of Participation, regardless of any laws to the contrary of the state or locality or other jurisdiction where the hospice is located or where the spouse lives Definitions. For the purposes of this part Attending physician means a 1 i Doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which he or she performs that function or action; or ii Nurse practitioner who meets the training, education, and experience requirements as described in b of this chapter.

Bereavement counseling means emotional, psychosocial, and spiritual support and services provided before and after the death of the patient to assist with issues related to grief, loss, and adjustment.

Comprehensive assessment means a thorough evaluation of the patient s physical, psychosocial, emotional and spiritual status related to the terminal illness and related conditions.

This includes a thorough evaluation of the caregiver s and family s willingness and capability to care for the patient. Dietary counseling means education and interventions provided to the patient and family regarding appropriate nutritional intake as the patient s condition progresses.

Dietary counseling is provided by qualified individuals, which may include a registered nurse, dietitian or nutritionist, when identified in the patient s plan of care. Employee means a person who: 1 works for the hospice and for whom the hospice is required to issue a W-2 form on his or her behalf; or 2 if the hospice is a subdivision of an agency or organization, an employee of the agency or organization who is assigned to the hospice; or 3 is a volunteer under the jurisdiction of the hospice.

Hospice means a public agency or private organization or subdivision of either of these that is primarily engaged in providing hospice care as defined in this section. Initial assessment means an evaluation of the patient s physical, psychosocial and emotional status related to the terminal illness and related conditions to determine the patient s immediate care and support needs.

Multiple location means a Medicare-approved location from which the hospice provides the same full range of hospice care and services that is required of the hospice issued the certification number. A multiple location must meet all of the conditions of participation applicable to hospices.

Palliative care means patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information, and choice. Physician means an individual who meets the qualifications and conditions as defined in Section r of the Act and implemented at of this chapter.

Physician designee means a doctor of medicine or osteopathy designated by the hospice who assumes the same responsibilities and obligations as the medical director when the medical director is not available. Representative means an individual who has the authority under State law whether by statute or pursuant to an appointment by the courts of the State to authorize or terminate medical care or to elect or revoke the election of hospice care on behalf of a terminally ill patient who is mentally or physically incapacitated.

This may include a legal guardian. Restraint means 1 Any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely, not including devices, such as orthopedically prescribed devices, surgical dressings or bandages, protective helmets, or other methods that involve the physical holding of a patient for the purpose of conducting routine physical examinations or tests, or to protect the patient from falling out of bed, or to permit the patient to participate in activities without the risk of physical harm this does not include a physical escort ; or 2 A drug or medication when it is used as a restriction to manage the patient s behavior or restrict the patient s freedom of movement and is not a standard treatment or dosage for the patient s condition.

Seclusion means the involuntary confinement of a patient alone in a room or an area from which the patient is physically prevented from leaving. Terminally ill means that the individual has a medical prognosis that his or her life expectancy is 6 months or less if the illness runs its normal course.

L a Standard: Notice of rights and responsibilities. Interpretive Guidelines a 1 When reference is made to patient in the Guidelines, it also refers to any person who may, under State law, act on the patient s behalf when the patient is unable to act for him or herself. That person is referred to as the patient s surrogate or representative. If a court has formally declared the patient incompetent, the surrogate or representative is whomever the court guardian, conservator, or committee appointed.

The hospice should verify that the representative has the necessary authority. For example, a court-appointed conservator might have the power to make financial decisions, but not health care decisions.

All hospice patients should be aware of their rights and responsibilities before the hospice begins to provide care. The hospice must verbally explain the patient rights and responsibilities to all patients accepted for care or explain the rights to the patient s representative if the patient is physically or mentally incapacitated.

Table of Contents iv Your signature below. Hospice care services Summary of change: Effective February 1, , hospice services will be a covered benefit covered by Amerigroup Louisiana, Inc. Amerigroup Louisiana, Inc.

Identify the mechanism for providing government regulated care in the facility. Identify the Hospice policy and. Statutory basis. Please check our web site for updates. This provider manual outlines policy and claims submission guidelines for claims submitted to the North Dakota.

If you have been a family caregiver for a while,. Patient Bill of Rights and Responsibilities The patient or the patient s legal representative has the right to be informed of the patient s rights and responsibilities as a patient through effective means. Hospice care is end-of-life care provided by health professionals and volunteers.

Hospice care is an approach to caring. For more information, or to locate a hospice in your area, contact Caring Connections: www. Principle: Ensuring compliance with applicable laws, regulations and professional standards of practice implementing systems and processes that prevent fraud and abuse. Chiplin, Jr. Department of Health and Human Services share responsibility for ensuring that Minnesota s nursing. Article 1. Definitions Administrator. Administrator means a person who is appointed in writing by the governing body of the program to organize and direct the services and functions of the hospice.

Introduction This Patient and Family Guide to Hospice Care is designed to be a practical source of information about hospice care. It introduces you to the history and philosophy of the hospice movement. Section R Objectives At the end of the session, participants. Medicare policy. Hospice care focuses on improving the quality of life for persons.



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