Illinois Hospice

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Illinois Hospice Palliative Care Organization
and Illinois Department of Public HealthAudio
ConferenceMarch 14, 2008

• New and Amended Hospice Program Rules

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Presenters

• Jeri Conboy, PhD, LCSW Blessing Hospice
  Palliative Care
• Kathie Nash, RN, BA Heartland Home Health Care
  Hospice

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Presenters

• Available for QA from the IL Dept of Public
  Health
• William A. Bell, Acting Deputy Director, Office
  of Health Care Regulations, and
• Karen Senger, RN, BSN, Central Office Operations
  Administrator, Health Care Facilities Programs

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Process of Adoption

• Notice of proposal published in IL Register
• February 2, 2007
• Changes made in response to comments received
  during the first notice and public comment period
• Further changes made in response to comments and
  suggestions to JCAR
• Adopted Amendments published in IL Register
  February 8, 2008
• Effective date January 23, 2008

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General Comments

• The rules have been re-organized
• -more logical order
• -some language updated
• -few new rules
• Provide consumer clarification on comprehensive
  and volunteer hospice programs

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General Comments

• Align Illinois hospice regulations with changes
  in hospice regulations on a federal level
• -use Medicare Hospice Benefit language, when
  possible, citing administrative code so that
  changes on the federal level will continue to be
  consistent with the state

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Illinois Hospice Regulations

• Sub Part A LICENSURE
• 280.1000 - 280.1060
• Includes definitions
• Sub Part B HOSPICE SERVICES
• 280.2000 - 280.3000
• Sub Part C INPATIENT CARE
• 280.4000 - 280.4040

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Licensure280.1000 Definitions

• Attending Physician (new)
• -Who has most significant role in determining and
  delivery of care?
• -A Certified Nurse Practitioner can function in
  the role of attending physician

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Licensure280.1000 Definitions

• Advance Nurse Practitioner (new)
• -May not serve as medical director
• -May not act as physician member of
  interdisciplinary group
• -May not certify the terminal diagnosis

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Licensure280.1000 Definitions

• Comprehensive Hospice (new)
• (old rules- full hospice)
• a program that provides hospice services and
  meets the minimum standards for certification
  under the Medicare program set forth in the
  Conditions of Participation in 42 CFR 418 but is
  not required to be Medicare certified. (Section
  3(h-10)of the Act)

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Licensure280.1000 Definitions

• Counselor (changed)
• Change total supervised work experience must
  equal at least one year in a clinical or health
  care setting. (old- five years)
• Employee (new)
• Paid or unpaid member of the staff (includes
  volunteers)

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Licensure280.1000 Definitions

• Hospice Care (new)
• a program of palliative care that provides for
  the physical, emotional, and spiritual care needs
  of a terminally ill patient and his or her
  family. The goal of such care is to achieve the
  highest quality of life as defined by the patient
  and his or her family through the relief of
  suffering and the control of symptoms

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Licensure280.1000 Definitions

• Hospice Care Team (changed)
• Interdisciplinary group who provides or
  supervises care and services offered by the
  hospice.

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Licensure280.1000 Definitions

• Hospice Program (new)
• -a licensed public agency, private organization
  or subdivision of either
• -primarily engaged in providing care to
  terminally ill individuals
• -home care or inpatient care or both provided
• -utilizing a medically directed interdisciplinary
  team of professionals or volunteers or both
• -may be licensed as a comprehensive hospice or a
  volunteer hospice program

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Licensure280.1000 Definitions

• Hospice Residence (changed)
• -separately licensed
• -owned operated by person licensed to operate as
  a comprehensive hospice

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Licensure280.1000 Definitions

• Hospice Services (changed)
• Professional and supportive services may include,
  but are not limited to
• Physician, nursing, medical social work,
  spiritual counseling, bereavement services and
  volunteer services.

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Licensure280.1000 Definitions

• Palliative Care (changed)
• -management of pain distressing symptoms
• -incorporates medical nursing, psychosocial and
  spiritual care
• -according to needs, values, beliefs and
  culture(s) of patient and family
• -patient-centered care, with focus on family unit
  in decision making

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Licensure280.1000 Definitions

• Representative (new-old rules called it Patient
  Representative)
• -Individual authorized under State law to
  terminate an individuals medical care or to
  elect or revoke the election of hospice care on
  behalf of a terminally ill individual who is
  mentally or physically incapacitated.

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Licensure280.1010 Incorporated Reference
Materials

• References added
• Federal
• -42 CFR 418 (Conditions of Participation)2004
• -Medicare Prescription Drug Improvement and
  Modernization Act of 2003

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Licensure280.1010 Incorporated Reference
Materials

• State statutes
• -Health Care Worker Background Check Act
• -Nurse Practice Act
• -Home Health, Home Services, and Home Nursing
  Agency Licensing Act
• -General Not for Profit Corporation Act of 1986
• -Counties Code
• -Medical Practice Act of 1987
• -Clinical Social Work and Social Work Practice Act

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Licensure280.1010 Incorporated Reference
Materials

• Additional State Rules referenced
• -Department of Public Health Illinois Home Health
  Agency Code
• -Department of Public Health, Skilled Nursing
  Intermediate Care Facilities Code
• -Department of Public Health, Illinois Plumbing
  Code
• -Department of Public Health, Health Care Workers
  Background Check Code

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Licensure280.1015 Licensure Applicability (new)

• Hospice program may be licensed as comprehensive
  or volunteer hospice program
• Use of hospice or hospice programs applies to
  both.
• Need a license to conduct a hospice program
• No advertising as hospice without a license
• Hospice residence may only operate at the
  locations listed on the license

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Licensure280.1050 Licensure Applicability (new)

• Comprehensive hospice owning or operating a
  hospice residence is not subject to the
  provisions of the Nursing Home Care Act
• Provisional license

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Licensure280.1020 Licensure Procedures

• Section a 2 (new)
• -Application or renewal must include if
  comprehensive or volunteer hospice program
• Section b (changed)
• -Increased fees for licensure
• Comprehensive 500, Volunteer 250

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Hospice Services280.2000 Hospice Service Plan

• Section b (new)
• -Comprehensive hospices that operate from
  multiple hospice locations
• -supervision and control at each location to
  assure all care and services
• -each location must provide full range of
  services
• -each patient assigned to specific care team

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Hospice Services280.2000 Hospice Service Plan

• Section b (new)
• -Comprehensive hospice programs with multiple
  hospice locations
• -hospice medical director assumes overall
  responsibility for medical component of hospice
  patients at all locations
• -each location is responsible to the same
  governing body
• -clinical records requested by surveyors must be
  available at the hospice site to which the
  license was issued

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Hospice Services280.2010 Hospice Services

• Section a 1 (new)
• Foster independence of patient and family by
  providing training, encouragement and support so
  patient and family can care for themselves as
  much as possible.

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Hospice Services280.2010 Hospice Services

• The following hospice services are required to
  be in accordance with the standards for
  certification under the Medicare program set
  forth in the Conditions of Participations in 42
  CFR 418 for BOTH comprehensive and volunteer
  hospice programs
• -Functioning hospice care teams (Section 8(c) of
  the Act)

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Hospice Services280.2010 Hospice Services

• Required to be in accordance with Medicare
• 42 CFR 418 continued
• -Plan of care (Section 8 (c-5)of the Act)
• -Hospice program services (Section 8(a) of the
  Act)
• -24 Hour availability of services (Section 8(a)
  of the Act)

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Hospice Services280-2010 Hospice Services

• Required to be in accordance with Medicare
• 42 CFR 418 continued
• Bereavement services (Section 8 (e) of the Act)
• -Volunteer services (Section 8 (j) of the Act)

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Hospice Services280.2010 Hospice Services

• In addition (for BOTH comprehensive and
  volunteer hospices)
• Functioning hospice care teams
• -written plan of care for each patient
• -plan updated based on ongoing assessments
• -plan provides for involvement of family
• -for hospices providing both home and inpatient
  care, written policies to share plan between both

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Hospice Services280.2010 Hospice Services

• In addition (for BOTH comprehensive and
  volunteer hospices)
• Hospice Program Services
• -include nursing, medical social work,
  bereavement and volunteer services
• -coordinated by attending physician
• -substantially provided by hospice program
  volunteers

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Hospice Services280.2010 Hospice Services

• In addition (for BOTH comprehensive and
  volunteer hospices)
• 24 Hour Services
• -nursing, medical social work, volunteer and
  bereavement available 24 hours to the extend
  necessary to meet patient needs.

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Hospice Services280.2010 Hospice Services

• Section 6 (new)
• Home care component shall be the primary form of
  care
• Section 8 (new)
• Nutritional Evaluation (was Dietary Services)
• by a qualified individual, including but not
  limited to a dietician or nurse.

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Hospice Services280.2010 Hospice Services

• ADDITIONAL REQUIREMENTS (new)
• For comprehensive hospice programs
• -meet the minimum standards for certification
  under the Medicare program set forth in the
  Conditions of Participation in 42 CFR 418.
• (Section 8.5 of the Act)

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Hospice Services280.2010 Hospice Services

• ADDITIONAL REQUIREMENTS (new)
• For volunteer hospice programs
• -provide hospice care to patients regardless of
  ability to pay with emphasis on utilization of
  volunteers. May also use paid staff.
• -provide services in accordance with generally
  accepted standards of practice in accordance
  with local, State, and federal laws.

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Hospice Services280.2010 Hospice Services

• ADDITIONAL REQUIREMENTS (new)
• For volunteer hospice programs
• -include word Volunteer in corporate name and
  in all verbal and written communication
• -provide information regarding other hospice
  care providers available in service area

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Hospice Services280.2020 Administration

• Section a (new)
• Each hospice program shall have a governing body
• -ensure all services provided are in accordance
  with accepted standards
• -assume full legal responsibility for
  determining, implementing and maintaining hospice
  programs total operation

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Hospice Services280.2030 Policies Procedures

• Section b (new)
• -must have clearly defined admission criteria
• -must have informed consent

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Hospice Services280.2035 Health Care Worker
Background Check (new)

• Must comply with Health Care Worker Background
  Check Act

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Hospice Services280.2040 Personnel Policies

• Section d (new)
• -where applicable, every hospice program
  employee must be licensed, certified or
  registered in accordance with federal, State and
  local laws.

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Hospice Services280.2040 Personnel Policies

• Section e (new)
• -Hospice shall provide ongoing training and
  education of employees appropriate to
  responsibilities
• Section j (new)
• -Hospice shall utilize trained volunteers in
  accordance with Conditions of Participation 42
  CFR 418

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Hospice Services280.2060 Clinical Records

• -Accurate clinical records on all hospice
  patients in accordance with standards for
  certification under the Medicare program set
  forth in the Conditions of Participation in 42
  CFR 418
• EXCEPT
• Hospice patients receiving care at no charge do
  not have to complete Medicare/Medicaid election
  form

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Hospice Services280.2060 Clinical Records

• Several changes especially related to electronic
  records, including
• -authentication of identification of author
• -faxed copies, dated authenticated
• -all signatures include initials of signers
  credentials
• -policy for electronic signature, unique
  identifiers and confidential access codes.

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Hospice Services280.2070 Medical Director

• Section a (changed)
• -Each hospice program shall have a medical
  director
• Section b (changed)
• -Medical director have overall responsibility for
  medical direction of patient care and shall
  consult an cooperate with the patents attending
  physician.
• Section 5 (changed)
• -Review active medical and palliative care in
  home and inpatient setting in which hospice has
  provided patient services

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Hospice Services280.2080 Hospice Program Care

• Sections a-f (new)
• -must coordinate services with professional and
  non-professional services already in the
  community
• -may contract out, hospice has responsibility
  for direct patient contact and overall
  coordination

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Hospice Services280.2080 Hospice Program Care

• -contracts must specify responsibilities
• -contracts must comply with the Act
• -no charges for duplicated services
• -must disclose to patient prior to admission if
  patient is eligible under a third party payer
  (Medicare, Medicaid, VA, Private Insurance)

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Hospice Services280.2080 Hospice Program Care

• Section h 1 (new)
• Comprehensive hospice program composed of
  attending physician, a nurse, a social worker, a
  counselor and trained volunteers. (Patient and
  family also considered members of the team)

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Hospice Services280.2080 Function of Hospice
Care Team

• Section h 2 (new)
• Volunteer hospice care team
• -staff for each service provided
• -attending physician and family part of care team
• -care team participate in development of patient
  care plan
• -review plan ongoing and at least monthly

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Hospice Services280.2090 Quality Assurance Plan

• Section a (new)
• Hospice program must conduct a quality assurance
  program in accordance with the standards for
  certification under the Medicare Program set
  forth in the Conditions of Participation in 42
  CFR 418 (Section (m) of the Act)

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Hospice Services280.3000 Research or
Experimental Programs

• Overall section minimal changes, some re-wording
  for clarification
• Section 9 (new)
• A written review procedure for approval by the
  Institutional Review Board of the sponsoring
  organization or approval of the Hospice
  Interdisciplinary Review Committee established by
  the hospice program to assure compliance with the
  policy for protection of human subjects of the US
  Department of Health and Human Services (42 CFR
  2.52(2004)

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Inpatient Care280.4000 Inpatient Care Facilities

• Minimal wording changes
• Section e (changed)
• -hospice shall have a written, dated and signed
  agreement with inpatient facility with clearly
  defined responsibilities
• -agreement not necessary if hospice residence is
  under jurisdiction of same governing body as the
  hospice

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Inpatient Care20.4010 Licensure of Hospice
Residence

• Minimal wording changes
• Section e (changed)
• -certificate valid for two years with process for
  an additional year for a total of three years.
• Section A (changed)
• -Hospice residence means a separately licensed

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• End of Overview
• Questions and Answers