DOH Hospice update

In-Home Services Rules The In-Home Services (IHS) rules (chapter 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? The department is required to regularly review and update all of its rules. The IHS rules are 13 years old (last updated in 2002). 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:  November 24, 2015 – location Tumwater DOH office  December 18, 2015 – location Tumwater DOH office  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 or (360) John will incorporate your comments into discussions during the

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 ListServ – please sign up! The link to the IHS ListServ is: bin/wa?A0=IN-HOME-SERVICEShttp://listserv.wa.gov/cgi- bin/wa?A0=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 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 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 RCW

WAC 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 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 – Volunteers COP – Interdisciplinary group, care planning and coordination of services COP – Patient’s rights COP – Organization/Administration of services COP – Compliance with Federal/State/local laws

COP Volunteers L643 – Training. Must provide/document appropriate orientation & training.

COP – Interdisciplinary group, care planning and coordination of services L555 – Ensure care/services provided based on plan of care.

COP Patient Rights L501 – Inform, promote & protect patient rights L517 – Free from mistreatment, neglect, or mental, sexual & physical abuse, injuries unknown source, misappropriation of property

COP – Organization/Administration of services L655 – Professional management responsibility. Written agreement for services under arrangement; Retain responsibilities for services to ensure quality of care.

COP – Compliance with Federal/State/local laws L798 – Operate in compliance with Federal/State/local laws.

Questions?

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