Hospice Nursing Facility Services Agreement Checklist

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)

The following Hospice-Nursing Facility Contracting Checklist (Checklist) is an excerpt from Reinhart Hospice and Palliative Care Practice Group's recently released Essential Hospice-Facility Contracting Resource: Inpatient, Respite, Nursing Home and Assisted Living Arrangements. The Checklist cites the federal hospice and nursing home regulatory requirements for contracts under which patients are receiving the routine home care level of hospice care, along with a brief description of the requirement. In addition, the Checklist includes in the third column a cross reference to the section where each obligation is addressed in the Template HospiceNursing 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 made to the Template Hospice-Nursing Facility Services Agreement would impact compliance with the key legal requirements. The Checklist can also be used to verify that the regulatory requirements are addressed in another company's nursing facility services agreement that hospices may be provided and asked to sign.

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 home under the federal Hospice Conditions of Participation (Medicare Hospice Regulations) and/or the Medicare Long Term Care Facility Regulations related to hospice services 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 hospice service, 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 template agreement.

OBLIGATION & CITATION

BRIEF DESCRIPTION

Written Agreement 42 C.F.R. ? 418.112(c) 42 C.F.R. ? 483.75(t)(2)(ii)

Manner of Communication 42 C.F.R. ? 418.112(c)(1)

42 C.F.R. ? 483.75(t)(2)(ii)(D)

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

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

SECTION(S) IN TEMPLATE AGREEMENT

Entire Agreement

2(e)(i)

Reporting of Violations

Each party must report to the other party's administrator alleged violations involving

9(g)

42 C.F.R. ? 418.112(c)(8)

mistreatment, neglect and verbal, mental, sexual and physical abuse, including

42 C.F.R. ? 483.75(t)(2)(ii)(J)

injuries 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.

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

OBLIGATION & CITATION

BRIEF DESCRIPTION

SECTION(S) IN TEMPLATE AGREEMENT

Nursing Facility Services 42 C.F.R. ? 483.75(t)(2)(ii)(C)

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

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)

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 include a provision 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.

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

2(e)(iv)

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 a provision that when facility personnel are responsible for the administration of prescribed therapies, including those therapies determined appropriate by the hospice and delineated in the hospice plan of care, facility personnel may administer the therapies where permitted by state law and as specified by the facility.

2(a)(i)

Bereavement Services to

The written agreement between the nursing facility and hospice must set out a

2(k)

Nursing Facility Staff

delineation of the responsibilities of the hospice and the facility to provide

42 C.F.R. ? 483.75(t)(2)(ii)(K)

bereavement services to facility staff.

42 C.F.R. ? 418.112(c)(9)

Professional Management Responsibility

42 C.F.R. ?? 418.100(e) and 418.112(b)

The hospice must retain administrative and financial management and oversight of staff and services for all arranged hospice services to ensure the provision of quality care.

For patients receiving hospice care in a nursing facility, the hospice must assume responsibility for the professional management of the resident's hospice services provided in accordance with the plan of care and the hospice conditions of participation and make any arrangements necessary for hospice related inpatient care.

3(b)(i) Exhibit A

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.

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

OBLIGATION & CITATION

BRIEF DESCRIPTION

Hospice Services 42 C.F.R. ? 483.75(t)(2)(ii)(A)

Hospice Plan of Care 42 C.F.R. ? 483.75(t)(2)(ii)(B)

Course of Hospice Care 42 C.F.R. ? 418.112(c)(3) 42 C.F.R. ? 483.75(t)(2)(ii)(F)

Delineation of Hospice's Responsibilities

42 C.F.R. ? 418.112(c)(6) 42 C.F.R. ? 483.75(t)(2)(ii)(H)

Level of Hospice Care 42 C.F.R. ? 418.112(c)(5)

Criminal Background Checks 42 C.F.R. ? 418.114(d)

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

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

The written agreement between the hospice and the nursing facility must include a provision that the hospice assumes responsibility for determining the appropriate course of hospice care, including the determination to change the level of services provided.

The written agreement between the hospice and nursing facility must include a delineation of the hospice's responsibilities, including, but not limited to, providing medical direction and management of the patient; nursing; counseling (including spiritual, dietary and bereavement); social work; providing medical supplies, durable medical equipment, and drugs necessary for the palliation of pain and symptoms associated with the terminal illness and related conditions; and all other hospice services that are necessary for the care of the resident's terminal illness and related conditions.

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

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

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

SECTION(S) IN TEMPLATE AGREEMENT

1(f) 2(e)(ii) 2(e)(ii)

1(f)

2(e)(ii)

2(c)(ii)[b]

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.

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

OBLIGATION & CITATION

BRIEF DESCRIPTION

Inspection of Records by Government*

42 C.F.R ? 420.300

Authorization by Hospice* 42 C.F.R. ? 418.100(e)

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

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

Services must be authorized by the hospice.

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.

Plan of Care* 42 C.F.R. ? 418.100(e)(3)

Services must be delivered in accordance with the patient's plan of care.

SECTION(S) IN TEMPLATE AGREEMENT

6(d)

2(a)(iii) 3(b)(i) Exhibit A 3(b)(ii) Exhibit A 2(a)(i) Exhibit A

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.

General Obligations of Hospices and Nursing Facilities

The following obligations from the Medicare Hospice Regulations and the Medicare Facility Regulations are not explicitly required to be included in a written agreement. 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 of these obligations in the contract so that the parties have a clear understanding of each party's obligations.

OBLIGATION & CITATION

BRIEF DESCRIPTION

Hospice Plan of Care 42 C.F.R. ? 418.112(d)

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

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

SECTION(S) IN TEMPLATE 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 and specifically identify which provider is responsible for performing the respective functions 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)

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 or representative, and nursing facility representatives, and must be approved by the hospice before implementation.

2(e)(iii)

Responsible IDG Member

The hospice must designate a member of each interdisciplinary group that is

3(d)

42 C.F.R. ? 418.112(e)(1)

responsible 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.

Communication from IDG

The hospice must ensure that the hospice IDG communicates with the nursing facility

3(d)

42 C.F.R. ? 418.112(e)(2)

medical director, the patient's attending physician and other physicians participating in

3(e)

the provision of care to the patient as needed to coordinate the hospice care of the

hospice patient with the medical care provided by other physicians.

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.

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download