Hospice Inpatient Services

2084 - Hospice Inpatient Services (Rev. 73, Issued: 12-02-11 Effective: 12-02-11, Implementation: 12-02-11) Hospices must make inpatient care available for pain control, symptom management, and respite purposes. This inpatient care may be provided directly by the hospice or indirectly under arrangements made by the hospice. If services are provided under arrangements, the hospice must ensure that the services are in full compliance with all applicable standards relating to inpatient care found at 42 CFR 418.110 and 42 CFR 418.108. 2084A - Hospice Provides Inpatient Care Directly (Rev. 73, Issued: 12-02-11 Effective: 12-02-11, Implementation: 12-02-11) When the hospice provides inpatient care directly, it may do so either in space that it owns or leases or in space shared with a Medicare certified hospital, SNF, or Medicaid certified nursing facility (NF). • If the hospice provides care in its own inpatient facility, the care may be provided in space that the hospice either owns or leases from another facility or building. The inpatient unit may consist of several beds, a group of beds, or a wing and must meet all applicable Federal and State requirements and be surveyed for compliance with 42 CFR 418.110 prior to providing inpatient care to patients. This survey includes a Life Safety Code survey (which has currently adopted the 2000 edition of the Life Safety Code of the National Fire Protection Association) that must be done both at the time of initial certification of the inpatient facility and at the time of recertification surveys. • If the hospice provides care directly with hospice staff in space shared with a Medicare-certified Hospital, SNF, or a Medicaid certified NF (for respite care only), the SA reviews the agreement and patient files for compliance with 42 CFR 418.110(b) and 42 CFR 418.110(e) since the location already meets the remaining requirements of 42 CFR 418.110 as a Medicare/Medicaid participating facility. 2084B - Hospice Provides Inpatient Services Under Arrangements (Rev. 73, Issued: 12-02-11 Effective: 12-02-11, Implementation: 12-02-11) When the hospice provides inpatient services under arrangements with a Medicare participating hospital or SNF, a Medicaid participating NF (for respite care only), or an inpatient unit of another Medicare-certified hospice, a separate survey of each site is not required. In these cases, the SA reviews the agreement and patient files to assure that the standards in 42 CFR 418.110(b) regarding 24-hour nursing service and 42 CFR 418.110(e) regarding comfort and privacy of patient and family members are satisfied. However, if in reviewing contracts and other documentation (e.g., clinical records, plans of care), questions arise concerning the contract arrangements, the SA conducts an onsite visit to the institution providing the inpatient services to review the care provided under arrangements, not to inspect the facility. This includes hospitals that are accredited by The Joint Commission or the American Osteopathic Association that are providing inpatient services under arrangements. Applicability of Inpatient Care CoP 42 CFR 418.110 Location Where Inpatient Care is Provided Applicability of Condition Hospice freestanding inpatient facility Survey for compliance with 42 CFR 418.110. Medicare certified hospital or SNF and/or Medicaid certified NF (for respite care only.) Survey for compliance with 42 CFR 418.110(b) and 42 CFR 418.110(e). The institution already meets the remaining requirements of 42 CFR 418.110 as a Medicare/Medicaid certified hospital or SNF/NF. A hospice freestanding inpatient facility is defined in this context as a facility that is not a part of another Medicare/Medicaid certified facility (e.g., hospital or SNF/NF).