Administration and Staffing Requirements

(A) Governing Body. The hospice provider must have a governing body that assumes full legal responsibility for determining, implementing, and monitoring policies governing the hospice's total operation. The governing body must designate a person who is responsible for the day-to-day management of the hospice program. (B) Medical Director. The medical director must be a doctor of medicine or osteopathy and assume overall responsibility for the medical component of the hospice's patient-care program. (C) Hospice Interdisciplinary Team. The hospice provider must designate a hospice interdisciplinary team composed of hospice personnel, including a registered nurse, whose role is to provide coordination of care, including in-home supports, continuous assessment of member and family needs, and implementation of the interdisciplinary plan of care. (1) Composition of Team. The hospice interdisciplinary team must include at least the following individuals who are employees of the hospice, except in the case of the physician described in 130 CMR 437.421(C)(1)(a), who may be under contract with the hospice: (a) a doctor of medicine or osteopathy; (b) a registered nurse; (c) a social worker; and (d) a pastoral or other counselor. (2) Role of Team. The hospice interdisciplinary team must provide the care and services offered by the hospice. The hospice must designate a registered nurse that is a member of the interdisciplinary team to provide coordination of care and to ensure continuous assessment of each patient's and family's needs and implementation of the interdisciplinary plan of care. The team in its entirety must also supervise care and services by (a) establishing a written, individualized plan of care for members and families that includes all services necessary for the palliation and management of the terminal illness and related conditions; (b) providing for an ongoing sharing of information with other non-hospice healthcare providers furnishing services unrelated to the terminal illness and related conditions; (c) ensuring that the plan of care is coordinated with any services the member may be authorized to receive from the MassHealth Personal Care Attendant Program or the MassHealth Adult Foster Care Program and any in-home support services available to the member from a home- and community-based service network; (d) reviewing and revising the individualized plan of care as frequently as the member's condition requires, but no less frequently than every 15 calendar days; and (e) establishing the policies governing the day-to-day provision of hospice services to members, families, and caregivers. (D) Contracted Services. A hospice provider may arrange for the provision of certain services on a contract basis, including highly specialized nursing services that are provided so infrequently that the provision of such services by direct hospice employees would be impractical and prohibitively expensive. These services may not include routine nursing services, medical social services, and counseling services specified in 130 CMR 437.000, except in circumstances in 42 CFR 418.64. If the other covered services listed in 130 CMR 437.423 (physician services; physical, occupational, and speech/language therapy; homemaker/home health aide services; drugs; durable medical equipment and supplies; and short-term inpatient care) are provided by contract personnel, the hospice provider must meet the following requirements. (1) Written Agreement. The hospice provider must have a written agreement with the contractor that (a) identifies the services to be provided on a contract basis; (b) stipulates that services may be provided only with the express authorization of the hospice provider; (c) states how the contracted services will be coordinated, supervised, and evaluated by the hospice provider; (d) delineates the role of the hospice provider and the contractor in the admission process, member/family assessment, and the interdisciplinary team-care conferences; (e) specifies requirements of documenting that the contracted services are furnished in accordance with the agreement; and (f) details the required qualifications for contract personnel. (2) Professional Management Responsibility. The hospice provider must ensure that contracted services are authorized by the hospice provider, furnished in a safe and effective manner by qualified personnel, and delivered in accordance with each member's plan of care. (3) Financial Responsibility. The hospice provider is responsible for paying contract personnel who have provided hospice-approved services according to the member's plan of care. (4) Inpatient Care. The hospice provider must ensure that inpatient care is furnished in a MassHealth-participating facility that meets the requirements specified in 42 CFR 418.108 or is a hospice inpatient facility as defined in 130 CMR 437.402. The hospice provider must have a written agreement with the facility that specifies (a) that the hospice provider must furnish the inpatient provider with a copy of the member's plan of care that specifies the inpatient services to be provided; (b) that the inpatient provider has established policies consistent with those of the hospice provider and agrees to abide by the patient-care protocols established by the hospice provider for its patients; (c) that the medical record includes a record of all inpatient services and events and that a copy of the discharge summary and, if requested, a copy of the medical record are provided to the hospice provider; (d) that the inpatient facility has identified an individual within the facility who is responsible for the implementation of the provision of ; and (e) that the hospice provider retains responsibility for ensuring that the training of personnel who will be providing the member’s care in the inpatient facility has been provided. (5) Room and Board in a Nursing Facility or ICF/IID. The hospice provider and the nursing facility or ICF/IID must enter into a written agreement under which the hospice provider takes full responsibility for the professional management of the member’s hospice services and the nursing facility or ICF/IID agrees to provide room and board to the member. Room and board includes performance of personal care services, including assistance in activities of daily living, socializing activities, administration of medication, maintaining the cleanliness of the member's room, and supervision and assistance in the use of durable medical equipment and prescribed therapies. In addition to all other applicable requirements established under 130 CMR 437.421(D), the written agreement between the hospice provider and the nursing facility or IFC/IID must also include: (a) The manner in which the nursing facility or ICF/IID and the hospice provider are to communicate with each other and document such communications to ensure that the needs of members are addressed and met 24 hours a day; and (b) A provision that the nursing facility or ICF/IID immediately notifies the hospice of any significant change in the member’s physical, mental, social, or emotional status, clinical needs or health insurance coverage. (E) Volunteer Services. The hospice provider must use volunteers in administrative or direct patient-care roles. The hospice provider must appropriately train volunteers and document its ongoing efforts to recruit and retain volunteer staff. The hospice provider must complete the same personnel screenings for volunteer staff that are required for paid employees of the hospice provider. (1) Level of Activity. A hospice provider must document that it maintains a volunteer staff sufficient to provide administrative or direct patient care that, at a minimum, equals five percent of the patient-care hours of all paid hospice employees and contract staff. The hospice provider must document the continuing level of volunteer activity and must record any expansion of care and services achieved through the use of volunteers, including the type of services and the time worked. (2) Proof of Cost Savings. The hospice provider must document (a) positions occupied by volunteers; (b) work time spent by volunteers occupying those positions; and (c) estimates of the dollar costs that the hospice would have incurred if paid employees occupied the volunteer positions.