Idaho Medicaid Provider Handbook, Home Health and Hospice Services § 4.2.5

A Medicare-certified skilled nursing facility (SNF) is eligible to provide hospice services for

pain control, symptom management and respite purposes. A member of the interdisciplinary

group responsible for the participant must provide coordination of hospice care between the

SNF and agency. They must communicate with the involved health care providers to ensure

quality of care.

The hospice must provide the SNF:

•

The most recent plan of care;

•

The hospice election form and any advance directives specific to the participant;

•

The names and contact information for the hospice personnel responsible for the

participant’s care;

•

The physician certification and recertification of the terminal illness;

•

Directions of accessing the hospice’s 24-hour on-call system;

•

Medication for hospice care; and

•

Any physician or attending physician orders.

The SNF must provide 24-hour nursing care. The facility must be capable of meeting all the

patient’s nursing needs and furnish them in accordance with the plan of care. The patient

must be kept comfortable, clean, well-groomed, and protected from accidents, injury, and

infection. If any patients are receiving general inpatient care on the floor, there must be a

registered nurse (RN) on duty who provides direct care.

The SNF must provide physical space for private patient and family visiting, or bereavement

after the patient’s death. Accommodations for family members to remain with the patient

throughout the night must also be available. Visitors must be allowed at any hour, including

infant and children visitors.

A plan of care must be developed between the hospice and SNF that delineates the

responsibility for each service. The plan of care and any changes must be made with the

review of the patient, Hospice agency and SNF representatives. The hospice agency must

approve the plan before implementation.

A written agreement must be developed by the hospice agency that explains the hospice

provider’s professional management responsibilities for the individual’s hospice care and the

facility’s agreement to provide room and board to the individual. The facility’s responsibilities

under room and board includes all assistance in the activities of daily living, socializing

activities, administration of medication, maintaining the cleanliness of a resident’s room, and

supervision and assisting in the use of durable medical equipment and prescribed therapies.

The level of hospice care must be at the same as if provided in the home.

The agreement must include the method and documentation of communication between the

two providers. Communication is required in the event of a significant change in the patient’s

physical, mental or social state, there’s a need to alter the plan of care due to complications,

the patient needs to be transferred, or the patient dies. In the event of a transfer, the hospice

retains responsibility for the terminal illness and related conditions. There must be an

agreement on the responsibility of bereavement services for SNF staff.

The hospice must provide the plan of care to the facility and an acknowledgement from the

participant of their agreement to palliative care. The agreement must enforce the hospice

agency’s responsibility for providing medical direction and management of the patient;

nursing; counseling (including spiritual, dietary and bereavement); social work; provision of

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. The hospice may utilize facility staff to meet their responsibilities but only at the

level of assistance that would be requested of a family member.

A provision in the agreement must state that the hospice will report all alleged violations of

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 SNF/NF administrator within 24 hours of the hospice becoming aware of the alleged

violation.

The facility must agree to provide inpatient records to the hospice agency. There must be an

agreed upon point of contact from the facility that is responsible for implementation of the

agreement. The hospice retains responsibility for ensuring personnel providing care to the

patient are trained appropriately to their condition, in the hospice philosophy, including

hospice policies and procedures regarding methods of comfort, pain control, symptom

management, principles about death and dying, individual responses to death, patient rights,

appropriate forms, and record keeping requirements. Finally, the agreement must include a

method for determining compliance.

(a)

References: Skilled Nursing Facilities

(i) Federal Regulations

Condition of Participation: Hospices that Provide Hospice Care to Residents of a SNF/NF or

ICF/IID, 42 CFR §418.112 (2019). Government Printing Office,

https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-D/section-418.112.

Condition of Participation: Hospices that Provide Inpatient Care Directly, 42 CFR §418.110

(2016). Government Printing Office, https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-D/section-418.110.

Condition of Participation: Short-term Inpatient Care, 42 CFR §418.108 (2016).

Government Printing Office, https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-D/section-418.108.

“Definitions” Social Security Act, Sec. 1905(o) (1935). Social Security Administration,

https://www.ssa.gov/OP_Home/ssact/title19/1905.htm.