DOH Hospice update InHome Services Rules The InHome

DOH Hospice update

In-Home Services Rules • The In-Home Services (IHS) rules (chapter 246 -335 WAC) are now open for updating. • The IHS rules includes regulations for Home Care, Home Health, and Hospice agencies. • The last time the rules were thoroughly reviewed and updated was 2002.

In-Home Services Rules • Why are we updating the rules now in 2015? ü The department is required to regularly review and update all of its rules. ü The IHS rules are 13 years old (last updated in 2002). ü Over the years, licensees, the industry, and department staff have identified numerous areas of the rules that need clarification or updating.

In-Home Services Rules • The department will host a series of rules workshops on the following dates: Ø November 24, 2015 – location Tumwater DOH office Ø December 18, 2015 – location Tumwater DOH office Ø Additional workshops will be scheduled in early 2016

In-Home Services Rules • At the workshops, department staff will review each section of the In-Home Services rules and lead group discussions on how best to clarify or update the requirements. • If you want to participate in updating the rules but cannot attend the rules workshops, send your comments to John Hilger, Program Manager at John. Hilger@doh. wa. gov or (360) 236 -2929. John will incorporate your comments into discussions during the workshops.

In-Home Services Rules • The department is hoping to have a good cross-section of participation from licensees, association representatives, department staff, DSHS representatives and anyone who is interested in updating the rules. • We anticipate the rule updating process will take approximately 18 months to complete.

In-Home Services Rules • The department will primarily communicate with stakeholders through the In-Home Services List. Serv – please sign up! • The link to the IHS List. Serv is: http: //listserv. wa. gov/cgibin/wa? A 0=IN-HOME-SERVICES • This link is also on the Hospice Agencies webpage on the DOH website.

Updates from…. . • Ramiro Cantu, Executive Director, Office of Investigation and Inspection • Robin Bucknell, In-Home Services Survey Manager, Office of Investigation and Inspection Brief updates on: • CMS • Hospice IMPACT Act • Number of licensed hospice agencies and care centers • Staffing

Updates… • The IMPACT Act of 2014: Under the IMPACT Act of 2014, each Medicare certified hospice must be surveyed no less frequently than every 36 months. • The statutory requirement moves these surveys into Tier 1 priority. This mostly affects non-deemed facilities. • By FFY 2018, all hospices should have been surveyed under the three-year timeframe. • DOH is currently responsible for surveying 29 Medicare certified hospice agencies. Plan to get into compliance by 2018: • FFY 2015 – 12 Medicare surveys completed • FFY 2016 – 11 • FFY 2017 – 6

Updates… • In Washington, there are 36 licensed Hospice agencies. • 33 are Medicare certified and 4 are state licensed only. • 9 have Hospice Care Centers. Staffing update: The In-Home Services team is fully staffed and trained with 5 surveyors and 1 OASIS Coordinator for Home Health. Let’s meet the team!!!!

In-Home Services Survey Team • Lori Barney, RN, MN • Sarah Benson, BSN, RN • Suzanne Kinchen, RN, MPH, BSN • Jada Lynn, RN, BSN • Patricia Terry, MPA, RN

Frequent Hospice WAC Citations • WAC 246 -335 -075 Bill of rights (1) An in-home services licensee at the time of admission must provide each patient or client, or designated family member with a written bill of rights affirming each individual’s right to: (c) A description of the process for submitting and addressing complaints; (d) Submit complaints without retaliation and to have the complaint addressed by the licensee; (e) Be informed of the state complaint hotline number

Frequent Hospice WAC Citations • WAC 246 -335 -085 Hospice Plan of Care (1) Hospice licensees must, except as provided in subsection (2) of this section: (b) Assure each plan of care is developed by appropriate agency personnel and is based on a patient and family assessment (c)(vii) Assure the hospice plan of care includes: Special nutritional needs and food allergies (c)(xii) Resuscitation status of the patient according to documentation consistent with the Natural Death Act and advance directives, chapter 70. 122 RCW

WAC 246 -335 -085 cont…. (d)(i) Develop and implement a system to: Assure and document the plan of care is reviewed by the appropriate interdisciplinary team members within the first week of admission and every two weeks thereafter (d)(iv) Develop and implement a system to: Inform the authorizing practitioner regarding changes in the patients condition that indicates a need to change the plan of care (v) Obtain approval from the authorizing practitioner for additions and modifications

Frequent Hospice WAC Citations • WAC 246 -335 -100 Supervision of hospice care (5) The licensee must document supervision including, but not limited to: (b) Licensed nurse supervision of home health aide services during an on-site visit with or without the home health aide present once a month to evaluate compliance with the plan of care an patient and family satisfaction with care

Frequent Hospice L-Tags • COP 418. 78 – Volunteers • COP 418. 56 – Interdisciplinary group, care planning and coordination of services • COP 418. 52 – Patient’s rights • COP 418. 100 – Organization/Administration of services • COP 418. 116 – Compliance with Federal/State/local laws

COP 418. 78 - Volunteers • L 643 – Training. Must provide/document appropriate orientation & training.

COP 418. 56 – Interdisciplinary group, care planning and coordination of services • L 555 – Ensure care/services provided based on plan of care.

COP 418. 52 Patient Rights • L 501 – Inform, promote & protect patient rights • L 517 – Free from mistreatment, neglect, or mental, sexual & physical abuse, injuries unknown source, misappropriation of property

COP 418. 100 – Organization/Administration of services • L 655 – Professional management responsibility. Written agreement for services under arrangement; Retain responsibilities for services to ensure quality of care.

COP 418. 116 – Compliance with Federal/State/local laws • L 798 – Operate in compliance with Federal/State/local laws.

Questions?

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