Title: Section 793.2 - Eligibility, Election, Admission and Discharge

Effective Date

08/31/2016

793.2 Eligibility, Election, Admission and Discharge.  

The governing authority shall ensure that: 

(a) except as prohibited by Article 45 of the Public Health Law or any other law or regulation, a patient referred to a hospice may be accepted from any source; 

(b) policies and procedures for admission and discharge are developed and implemented; 

(c) any individual admitted to hospice is certified as being terminally ill consistent with state and/or federal definitions. Written certification of terminal illness is required for each election period defined in paragraph (d)(4) of this section. If the hospice cannot obtain the written certification within 2 calendar days after the election period begins, it must obtain an oral certification within 2 calendar days and the written certification before it submits a claim for payment.  

(1) Initial certification of terminal illness must be obtained from either the medical director of the hospice or the physician member of the hospice interdisciplinary group provided for in section 793.4 of this Part, and also from the individual's attending physician, if the individual has an attending physician. In connection with the initial certification, the medical director or physician designee must consider the following: 

(i) diagnosis of the primary terminal condition, along with any supporting current clinically relevant information;  

(ii) related diagnoses, if any, along with any supporting current clinically relevant information;  

(iii) current subjective and objective medical findings;  

(iv) current medication and treatment orders; and  

(v) information about the medical management of any of the patient’s conditions unrelated to the terminal illness.  

(2) Subsequent certifications of terminal illness are obtained from the medical director of the hospice or the physician member of the hospice interdisciplinary group and must be based on the certifying individual’s clinical judgment regarding the normal course of the individual’s illness. 

(3) All certifications must: 

(i) specify that the individual's prognosis is for a life expectancy consistent with applicable state and federal statutes for purposes of payment;  

(ii) include clinical information and other documentation that support the medical prognosis; and  

(iii) be filed in the clinical record.  

(d) an individual who meets the hospice eligibility requirements files an election statement with a particular hospice. If the individual is physically or mentally incapacitated, his or her representative as provided for in subdivision (b) of section 793.1 of this Part may file the election statement;  

(1) The election statement shall remain in effect as long as the individual remains in the care of a hospice unless the individual revokes the election in accordance with paragraph 3 of this subdivision or is discharged from the hospice in accordance with subdivision (e) of this section. He/she may at any time file an election if again eligible for hospice care. 

(2) The signed election statement must:  

(i) identify the hospice that will provide care; 

(ii) include the individual's or representative's acknowledgment that he or she has been given a full understanding of the palliative rather than curative nature of hospice care; and 

(iii) include the effective date of the election, which may be the first day of hospice care or a later date, but no earlier than the date of the election statement. 

(3) An individual or representative may revoke the election of hospice care at any time by filing a signed and dated revocation statement with the hospice. This statement must include the effective date for the revocation. 

(4) An individual may elect to receive hospice care during one or more of the following election periods, which are available in the order listed and may be selected separately at different times: 

(i) an initial 90-day period; 

(ii) a subsequent 90-day period;  

(iii) an unlimited number of subsequent 60-day periods. 

(e) a patient is discharged only if: 

(1) the patient moves out of the hospice's service area or transfers to another hospice; 

(2) the hospice determines that the patient no longer meets the eligibility criteria set forth in subdivision (c) of this section; or 

(3) the hospice determines, under a policy set by the hospice for the purpose of addressing discharge for cause that the patient's (or other persons in the patient's home) behavior is disruptive, abusive, or uncooperative to the extent that delivery of care to the patient or the ability of the hospice to operate effectively is seriously impaired.  

(i) The hospice must do the following before it seeks to discharge a patient for cause: 

(a) advise the patient that a discharge for cause is being considered; 

(b) make a serious effort to resolve the problem(s) presented by the patient's behavior or situation; 

(c) ascertain that the patient's proposed discharge is not due to the patient's use of necessary hospice services; and 

(d) document the problem(s) and efforts made to resolve the problem(s) and enter this documentation into the clinical record. 

(ii) prior to discharging a patient, a written discharge order must be obtained from the hospice medical director. If a patient has an attending physician involved in his or her care, this physician should be consulted before discharge and his or her review and decision included in the discharge note. 

(iii) prior to discharging a patient or transferring the patient from one hospice to another, continuing care and services shall be arranged and a discharge summary completed as specified in section 794.4 of this Title. 

Volume

VOLUME E (Title 10)

up