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Title: Section 794.8 Hospice care provided to residents of a Skilled Nursing Facility (SNF) or Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID)

Effective Date


Section 794.8 Hospice care provided to residents of a Skilled Nursing Facility (SNF) or Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID).  

(a) A hospice that provides hospice care to residents of a SNF or ICF/IID, hereafter referred to as the facility, must assume responsibility for professional management of the hospice services provided to the resident, in accordance with the hospice plan of care, including assessing, planning, monitoring, directing and evaluating the patient’s/resident’s hospice care across all settings. 

(b) The hospice and the facility must have a written agreement for the provision of hospice services between the two entities signed by an authorized representative of the hospice and the facility. The written agreement must include the following provisions:  

(1) the manner in which the facility and the hospice are to communicate with each other and document such communications to ensure that the needs of patients are addressed and met 24 hours a day;  

(2) that the facility immediately notifies the hospice if:  

(i) a significant change in a patient’s physical, mental, social, or emotional status occurs;  

(ii) clinical complications appear that suggest a need to alter the plan of care;  

(iii) a need to transfer a patient from the facility arises, and the hospice makes arrangements for, and remains responsible for, any necessary continuous care or inpatient care necessary which is related to the terminal illness and related conditions; or  

(iv) a patient dies;  

(3) that the hospice is responsible for determining the appropriate course of hospice care, including the determination to change the level of services provided;  

(4) that the facility is responsible for furnishing 24-hour room and board care; and for meeting the personal care and nursing needs that would have been provided by the primary caregiver at home and at the same level of care provided before hospice care was elected;  

(5) a delineation of the hospice’s responsibilities, which include, but are not limited to providing: 

(i) medical direction and management of the patient; 

(ii) core services including nursing and counseling (including spiritual, dietary and bereavement), as well as medical social services; medical supplies, durable medical equipment and drugs necessary for the palliation of pain and symptoms associated with the terminal illness and related conditions; and all other hospice services that are necessary for the care of the resident’s terminal illness and related conditions; and 

(iii) services at the same level and to the same extent as those services would be provided if the resident were in his or her own home;  

(6) that the hospice may use the facility nursing personnel where permitted by State and Federal law and as specified by the SNF or ICF/IID to assist in the administration of prescribed therapies included in the plan of care only to the extent that the hospice would routinely use the services of a hospice patient’s family in implementing the plan of care;  

(7) that the hospice must report all alleged violations involving mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of patient property by anyone unrelated to the hospice to the facility administrator within 24 hours of the hospice becoming aware of the alleged violation; and  

(8) a delineation of the responsibilities of the hospice and the SNF or ICF/IID to provide bereavement services to facility staff.  

(c) A written hospice plan of care must be established and maintained in consultation with facility representatives.  

(1) The hospice plan of care must identify the care and services that are needed and specifically identify which provider is responsible for performing the respective functions that have been agreed upon and included in the hospice plan of care.  

(2) The hospice plan of care should reflect the participation of the hospice, the facility staff, and the patient and family to the extent possible.  

(3) Based on collaboration between the hospice and the facility, the hospice plan of care should reflect: 

(i) a common problem list;  

(ii) palliative interventions;  

(iii) palliative outcomes;  

(iv) responsible discipline;  

(v) responsible provider; and  

(vi) patient goals.  

(4) The hospice must approve any changes in the hospice plan of care before implementation and discuss such changes with the patient or representative, and facility representatives.  

(d) For each patient, the hospice must designate a member of the interdisciplinary group who will be responsible for:  

(1) providing overall coordination of the hospice care of the resident with the facility representatives and communicating with facility representatives and other health care providers and physicians participating in the provision of care;  

(2) providing the facility, for each hospice patient, with:  

(i) the most recent hospice plan of care;  

(ii) the hospice election form and any advance directives;  

(iii) the physician certification and recertification of the terminal illness;  

(iv) the names and contact information for hospice personnel involved in hospice care;  

(v) hospice medication information;  

(vi) hospice physician and attending physician (if any) orders; and  

(vii) instructions on how to access the hospice’s 24-hour on-call system;  

(e) Hospice staff must orient facility staff furnishing care to hospice patients to the hospice philosophy; hospice policies and procedures regarding methods of comfort, pain control, and symptom management; principles about death and dying and individual responses to death; patient rights; appropriate forms; and record keeping requirements.  


VOLUME E (Title 10)