HOSPICE NURSING FACILITY SERVICES AGREEMENT CHECKLIST · PDF fileSpecific Contract Terms Required for Hospice-Nursing Facility Agreements for the Routine Home Care Level of Care This

OBLIGATION & CITATION

HOSPICE NURSING FACILITY SERVICES AGREEMENT CHECKLIST(for Use With Agreements under which Nursing Homes Serve Hospice Patients

Receiving the Hospice Routine Home Level of Care)

Written Agreement

42 C.F.R. § 418.112(c)

42 C.F.R. § 483.75(t)(2)(ii)

The following Hospice-Nursing Facility Contracting Checklist (Checklist) is an excerpt from Reinhart Hospice and Palliative Care Practice Group's recently releasedEssential Hospice-Facility Contracting Resource: Inpatient, Respite, Nursing Home and Assisted Living Arrangements. The Checklist cites the federal hospice andnursing home regulatory requirements for contracts under which patients are receiving the routine home care level of hospice care, along with a brief description of therequirement. In addition, the Checklist includes in the third column a cross reference to the section where each obligation is addressed in the Template Hospice-Nursing Facility Services Agreement from The Essential Hospice-Facility Contracting Resource.

For hospices that have purchased The Essential Hospice-Facility Contracting Resource, the Checklist can be used to assist in evaluating whether any changes madeto the Template Hospice-Nursing Facility Services Agreement would impact compliance with the key legal requirements. The Checklist can also be used to verify thatthe regulatory requirements are addressed in another company's nursing facility services agreement that hospices may be provided and asked to sign.

BRIEF DESCRIPTION

If hospice care is furnished in a nursing facility, the nursing facility and hospice musthave a written agreement that is signed by authorized representatives of thehospice and nursing facility before the provision of hospice services and mustinclude the provisions identified in 42 C.F.R. §§ 418.112(c) and 483.75(t)(2)(ii).

SECTION(S) IN TEMPLATE

AGREEMENT

Entire Agreement

Manner of Communication

42 C.F.R. § 418.112(c)(1)

42 C.F.R. § 483.75(t)(2)(ii)(D)

The written agreement must include the manner in which the nursing facility and thehospice are to communicate with each other to ensure the needs of the patient areaddressed 24 hours per day, including how the communication will be documentedbetween the nursing facility and hospice.

2(e)(i)

Reporting of Violations

42 C.F.R. § 418.112(c)(8)

42 C.F.R. § 483.75(t)(2)(ii)(J)

Each party must report to the other party's administrator alleged violations involvingmistreatment, neglect and verbal, mental, sexual and physical abuse, includinginjuries of unknown source and misappropriation of patient property.

• The hospice must report such violations by anyone unrelated to the hospice within 24 hours of becoming aware of the violation.

• The nursing facility must report such violations by hospice personnel immediately when it becomes aware of the alleged violation.

9(g)

Specific Contract Terms Required for Hospice-Nursing Facility Agreements for the Routine Home Care Level of Care

This section of the Checklist outlines those obligations that are specifically required to be addressed in written agreements between a hospice and nursing homeunder the federal Hospice Conditions of Participation (Medicare Hospice Regulations) and/or the Medicare Long Term Care Facility Regulations related to hospiceservices at 42 C.F.R. § 483.75(t) (Medicare Facility Regulations).

*Those obligations denoted with an asterisk (*) arguably apply only if the hospice is purchasing a hospice service from a third party. Since nursing home room and board services are not a covered hospiceservice, one could argue these obligations do not apply to the arrangement unless the contract includes Purchased Hospice Services. With that said, these obligations are generally addressed in the templateagreement.


Nursing Facility Services

42 C.F.R. § 483.75(t)(2)(ii)(C)


BRIEF DESCRIPTION

The written agreement between the nursing facility and hospice must identify theservices the facility will continue to provide, based on each resident's plan of care.


AGREEMENT

1(a)2(a)(i)

Notification of Change in

Condition

42 C.F.R. § 483.75(t)(2)(ii)(E) 42

C.F.R. § 418.112(c)(2)

The written agreement between the nursing facility and hospice must include aprovision that the facility immediately notifies the hospice about the following:

• A significant change in the patient's physical, mental, social or emotional status;• Clinical complications that suggest a need to alter the plan of care;• A need to transfer the patient from the facility for any condition; and• A patient's death.

2(e)(iv)

24-Hour Room and Board

Care

42 C.F.R. § 483.75(t)(2)(ii)(G)

42 C.F.R. § 418.112(c)(4)

The written agreement between the nursing facility and hospice must set out anagreement that it is the nursing facility's responsibility to furnish 24-hour room andboard care, meet the resident's personal care and nursing needs in coordinationwith the hospice representative, and ensure that the level of care provided isappropriately based on the individual resident's needs.

2(a)(i)2(b)

Use of Nursing Facility

Personnel

42 C.F.R. § 483.75(t)(2)(ii)(I) 42

C.F.R. § 418.112(c)(7)

The written agreement between the nursing facility and hospice must set out aprovision that when facility personnel are responsible for the administration ofprescribed therapies, including those therapies determined appropriate by thehospice and delineated in the hospice plan of care, facility personnel mayadminister the therapies where permitted by state law and as specified by thefacility.

2(a)(i)

Bereavement Services to

Nursing Facility Staff

42 C.F.R. § 483.75(t)(2)(ii)(K)

42 C.F.R. § 418.112(c)(9)

The written agreement between the nursing facility and hospice must set out adelineation of the responsibilities of the hospice and the facility to providebereavement services to facility staff.

2(k)

From: The Essential Hospice-Facility Contracting Resource: Inpatient, Respite, Nursing Home and Assisted Living Arrangements; Authored by: Reinhart Hospice and Palliative Care Group, Meg Pekarske, chair© 2014 All Rights Reserved Reinhart Boerner Van Deuren s.c.

Professional Management

Responsibility

42 C.F.R. §§ 418.100(e) and

418.112(b)

The hospice must retain administrative and financial management and oversight ofstaff and services for all arranged hospice services to ensure the provision of qualitycare.

For patients receiving hospice care in a nursing facility, the hospice must assumeresponsibility for the professional management of the resident's hospice servicesprovided in accordance with the plan of care and the hospice conditions of participationand make any arrangements necessary for hospice related inpatient care.

3(b)(i)Exhibit A


Hospice Services

42 C.F.R. § 483.75(t)(2)(ii)(A)


BRIEF DESCRIPTION

The written agreement between the hospice and the nursing facility must set out theservices the hospice will provide.


AGREEMENT

1(f)

Hospice Plan of Care

42 C.F.R. § 483.75(t)(2)(ii)(B)

The written agreement between the hospice and the nursing facility must set out thehospice's responsibilities for determining the appropriate hospice plan of care asspecified in 42 C.F.R. § 418.112(d).

2(e)(ii)

Course of Hospice Care

42 C.F.R. § 418.112(c)(3)

42 C.F.R. § 483.75(t)(2)(ii)(F)

The written agreement between the hospice and the nursing facility must include aprovision that the hospice assumes responsibility for determining the appropriatecourse of hospice care, including the determination to change the level of servicesprovided.

2(e)(ii)

Delineation of Hospice's

Responsibilities

42 C.F.R. § 418.112(c)(6)

42 C.F.R. § 483.75(t)(2)(ii)(H)

The written agreement between the hospice and nursing facility must include adelineation of the hospice's responsibilities, including, but not limited to, providingmedical direction and management of the patient; nursing; counseling (includingspiritual, dietary and bereavement); social work; providing medical supplies, durablemedical equipment, and drugs necessary for the palliation of pain and symptomsassociated with the terminal illness and related conditions; and all other hospiceservices that are necessary for the care of the resident's terminal illness and relatedconditions.

1(f)


Level of Hospice Care

42 C.F.R. § 418.112(c)(5)

The written agreement between the hospice and the nursing facility must include aprovision that it is the hospice's responsibility to provide services at the same level andto the same extent as those services would be provided if the facility resident were inhis or her own home.

2(e)(ii)

Criminal Background Checks

42 C.F.R. § 418.114(d)

Hospice contracts must require that all contracted entities obtain criminal backgroundchecks on their contracted employees who have direct patient contact or access topatient records.

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

2(c)(ii)[b]


Inspection of Records by

Government*

42 C.F.R § 420.300


BRIEF DESCRIPTION

The facility shall make available until the expiration of five years from thetermination of the agreement, upon written request, to the Secretary of Health andHuman Services, and upon request, to the Comptroller General of the UnitedStates, or any of their duly authorized representatives, the agreement and any ofthe provider's books, documents and records necessary to certify the nature andcosts of Medicare reimbursable services provided under the agreement.

If and to the extent the facility carries out any of its duties under this agreementthrough a subcontract with a related organization having a value or cost of $10,000or more over a 12-month period, the facility shall ensure the subcontract contains aclause comparable to the clause above.


AGREEMENT

6(d)

Authorization by Hospice*

42 C.F.R. § 418.100(e)

Services must be authorized by the hospice. 2(a)(iii)3(b)(i)

Exhibit A


Safe and Effective Services*

42 C.F.R. § 418.100(e)(2)

Services must be furnished in a safe and effective manner by qualified personnel. 3(b)(ii)Exhibit A

Plan of Care*

42 C.F.R. § 418.100(e)(3)

Services must be delivered in accordance with the patient's plan of care. 2(a)(i)Exhibit A

General Obligations of Hospices and Nursing Facilities



Hospice Plan of Care

42 C.F.R. § 418.112(d)

BRIEF DESCRIPTION

In accordance with § 418.56, a written hospice plan of care must be establishedand maintained in consultation with SNF/NR or ICF/MR representatives.

All hospice care provided must be in accordance with this hospice plan of care.


AGREEMENT

1(e)2(e)(ii)3(b)(i)3(b)(ii)

Identification of

Hospice Services

42 C.F.R. § 418.112(d)(1)

The hospice plan of care must identify the care and services that are needed andspecifically identify which provider is responsible for performing the respectivefunctions that have been agreed upon and included in the hospice plan of care.

2(e)(ii)

Participation in Plan of Care

42 C.F.R. § 418.112(d)(2)

The hospice plan of care reflects the participation of the hospice, the nursing facility,and the patient and family to the extent possible.

1(e)2(e)(ii)

The following obligations from the Medicare Hospice Regulations and the Medicare Facility Regulations are not explicitly required to be included in a writtenagreement. Note that many of the hospice obligations are not specific to hospice-nursing facility relationships. However, it can be helpful to address some or all ofthese obligations in the contract so that the parties have a clear understanding of each party's obligations.

Approval of Plan of Care

42 C.F.R. § 418.112(d)(3)

Any changes in the hospice plan of care must be discussed with the patient orrepresentative, and nursing facility representatives, and must be approved by thehospice before implementation.

2(e)(iii)

Responsible IDG Member

42 C.F.R. § 418.112(e)(1)

The hospice must designate a member of each interdisciplinary group that isresponsible for a patient who is a resident of a nursing facility. The designated inter-disciplinary group member is responsible for:

• Providing overall coordination of the hospice care of the nursing facility resident with nursing facility representatives.

• Communicating with nursing facility representatives and other health care providers participating in the provision of care for the terminal illness and related conditions and other conditions to ensure quality of care for the patient and family.

3(d)

Communication from IDG

42 C.F.R. § 418.112(e)(2)

The hospice must ensure that the hospice IDG communicates with the nursing facilitymedical director, the patient's attending physician and other physicians participating inthe provision of care to the patient as needed to coordinate the hospice care of thehospice patient with the medical care provided by other physicians.

3(d)3(e)


Orientation and Training of

Nursing Facility Staff

42 C.F.R. § 418.112(f)


BRIEF DESCRIPTION

Hospice staff must assure orientation of nursing facility staff furnishing care tohospice patients in the hospice philosophy, including hospice policies andprocedures regarding methods of comfort, pain control, symptom management, aswell as principles about death and dying, individual responses to death, patientrights, appropriate forms and record keeping requirements.


AGREEMENT

3(c)

Standards for

Hospice Services

42 C.F.R. § 483.75(t)(2)(i)

A nursing facility that contracts with a hospice must ensure that the hospiceservices meet professional standards and principles that apply to individualsproviding services in the facility, and to the timeliness of services.

3(b)(ii)

Provision of Information from

Hospice to Nursing Facility

42 C.F.R. § 418.112(e)(3)

42 C.F.R. § 483.75(t)(3)(iv)

The hospice must provide the below information to the nursing facility. The facilitymust designate a member of its interdisciplinary group pursuant to 42 C.F.R.§483.75(t)(3) responsible for obtaining the below information:

• The most recent hospice plan of care specific to each patient.

• The hospice election form and any advance directives specific to each patient.

• The physician certification and recertifications of the terminal illness specific to each patient.

• The names and contact information for hospice personnel involved in hospice care of each patient.

• Instructions on how to access the hospice's 24-hour on-call system.

• Hospice medication information specific to each patient.

• Hospice physician and attending physician (if any) orders specific to each patient.

3(e)



Designation of Facility

Interdisciplinary Team Member

42 C.F.R. § 483.75(t)(3)


BRIEF DESCRIPTION

Each nursing facility arranging for the provision of hospice care under a writtenagreement must designate a member of the facility's interdisciplinary team who isresponsible for working with hospice representatives to coordinate care to theresident provided by the facility staff and hospice staff. The interdisciplinary teammember must have a clinical background, function within their state scope ofpractice act, and have the ability to assess the resident or have access to someonethat has the skills and capabilities to assess the resident. The designated interdisci-plinary team member is responsible for the following:


AGREEMENT

2(e)(v)

Collaborating with Hospice

42 C.F.R. § 483.75(t)(3)(i)

Collaborating with hospice representatives and coordinating nursing facility staffparticipation in the hospice care planning process for those residents receivingthese services.

2(e)(v)


Communicating with

Providers

42 C.F.R. § 483.75(t)(3)(ii)

Communicating with hospice representatives and other healthcare providersparticipating in the provision of care for the terminal illness, related conditions andother conditions to ensure quality of care for the patient and family.

2(e)(v)

Communicating with

Physicians

42 C.F.R. § 483.75(t)(3)(iii)

Ensuring that the nursing facility communicates with the hospice medical director,the patient's attending physician and other practitioners participating in theprovision of care to the patient as needed to coordinate the hospice care with themedical care provided by other physicians.

2(e)(v)

Obtaining Information

from Hospice

42 C.F.R. § 483(t)(3)(iv)

Obtaining the information listed at 42 C.F.R. § 483.75(t)(3)(iv). 2(e)(v)3(e)

Orientation for Hospice

42 C.F.R. § 483.75(t)(3)(v)

Ensuring that the nursing facility staff provides orientation in the policies andprocedures of the facility, including patient rights, appropriate forms and recordkeeping requirements, to hospice staff furnishing care to nursing facility residents.

2(e)(v)

Facility Care Plan

42 C.F.R. § 483.75(t)(4)

Each nursing facility providing hospice care under a written agreement must ensurethat each resident's written plan of care includes both the most recent hospice planof care and a description of the services furnished by the nursing facility to attain ormaintain the resident's highest practicable physical, mental and psychosocial well-being, as required at § 483.25.

2(e)(ii)


Training

42 C.F.R. §§ 418.100(g)

and 418.60(c)


BRIEF DESCRIPTION

The hospice must provide orientation about the hospice philosophy to all contractedstaff that have patient and family contact.

The hospice must assess the skills and competence of all individuals furnishingcare and, as necessary, provide in-service training and education programs whererequired. The hospice must have written policies and procedures describingmethods of assessment of competency.

The hospice must provide infection control education to contracted providers.


AGREEMENT

3(c)


Coordinating Care

42 C.F.R. § 418.56(e)

The hospice must develop and maintain a system of communication and integrationto:

• 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.

2(e)3(b)(i)3(b)(ii)

3(d)3(e)

Availability of

Hospice Services

42 C.F.R. § 418.100(c)(2)

Nursing services, physician services, and drugs and biologicals must be maderoutinely available on a 24-hour basis, 7 days per week. Other covered servicesmust be available on a 24-hour basis when reasonable and necessary to meet theneeds of the patient and family.

1(f)3(b)3(d)

Licensed Professional

Services

42 C.F.R. § 418.62

Licensed professionals must actively participate in the coordination of all aspects ofthe patient's hospice care, in accordance with current professional standards andpractice, including participating in ongoing interdisciplinary comprehensiveassessments, developing and evaluating the plan of care, and contributing topatient and family counseling and education. Licensed professionals mustparticipate in the hospice's quality assessment and performance improvementprogram and hospice sponsored in-service training.

1(f)3(b)3(d)


Standards of Practice

42 C.F.R. § 418.70


BRIEF DESCRIPTION

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


AGREEMENT

2(c)(i)


General Personnel

Qualifications

42 C.F.R. §§ 418.114(a)

and (c)

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

All personnel qualifications must be kept current at all times.

2(c)(ii)[b]

Compliance with Laws

42 C.F.R. § 418.116

Services must be furnished in compliance with all applicable federal, state and locallaws and regulations related to the health and safety of patients.

2(c)(i)

Licensed Professional

Services

42 C.F.R. § 418.62

Licensed professional services must be authorized, delivered and supervised onlyby health care professionals who meet the appropriate qualifications specifiedunder § 418.114 and who practice under the hospice's policies and procedures.

2(c)(ii)[b]

Patient Grievances

42 C.F.R. § 418.52(b)(1)(iii)

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

2(g)

QAPI

42 C.F.R. § 418.58

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

2(d)

Documents

HOSPICE NURSING FACILITY SERVICES AGREEMENT CHECKLIST · PDF fileSpecific Contract Terms Required for Hospice-Nursing Facility Agreements for the Routine Home Care Level of Care This