Mont. Medicaid Hospice Policy Manual, Policy 705

ORGANIZATION AND

ADMINISTRATION

OF SERVICES

The hospice must organize, manage, and administer its resources

to provide the hospice care and services to members, caregivers

and families necessary for the palliation and management of the

terminal illness and related conditions.

SERVING THE

HOSPICE MEMBER

AND FAMILY

The hospice must provide hospice care that:

1. Optimizes comfort and dignity; and

2. Is consistent with member and family needs and

goals, with member needs and goals as priority.

GOVERNING BODY

AND ADMINISTRATOR

A governing body (or designated persons so functioning) assumes

full legal authority and responsibility for the management of the

hospice, the provision of all hospice services, its fiscal operations,

and continuous quality assessment and performance improvement.

A qualified administrator appointed by and reporting to the

governing body is responsible for the day-to-day operation of the

hospice. The administrator must be a hospice employee and

possess education and experience required by the hospice's

governing body.

SERVICES

A hospice must be primarily engaged in providing the following

care and services and must do so in a manner that is consistent

with accepted standards of practice:

1. Nursing services;

2. Medical social services;

3. Physician services;

4. Counseling services, including spiritual counseling,

dietary counseling, and bereavement counseling;

5. Hospice aide, volunteer, and homemaker services;

6. Physical therapy, occupational therapy, and speech-language pathology services;

7. Short-term inpatient care; and

8. Medical supplies (including drugs and biologicals) and

medical appliances.

Nursing services, physician services, and drugs and biologicals

must be made routinely available on a 24-hour basis seven days a

week. Other covered services must be available on a 24-hour basis

when reasonable and necessary to meet the needs of the member

and family.

CONTINUATION

OF CARE

A hospice may not discontinue or reduce care provided to a

Medicare or Medicaid beneficiary because of the beneficiary's

inability to pay for that care.

PROFESSIONAL

MANAGEMENT

RESPONSIBILITY

A hospice that has a written agreement with another agency,

individual, or organization to furnish any services under

arrangement must retain administrative and financial management,

and oversight of staff and services for all arranged services, to

ensure the provision of quality care. Arranged services must be

supported by written agreements that require that all services be:

1. Authorized by the hospice;

2. Furnished in a safe and effective manner by qualified

personnel; and

3. Delivered in accordance with the member's plan of

care.

HOSPICE MULTIPLE

LOCATIONS

If a hospice operates multiple locations, it must meet the following

requirements:

1. Medicaid approval:

a. All hospice multiple locations must be

approved by Medicaid before providing hospice

care and services to Medicaid members;

b. The multiple locations must be part of the

hospice and must share administration,

supervision, and services with the hospice

issued the certification number;

c. The lines of authority and professional and

administrative control must be clearly

delineated in the hospice's organizational

structure and in practice, and must be traced to

the location which was issued the certification

number; and

d. The determination that a multiple location does

or does not meet the definition of a multiple

location, as set forth in this part, is an initial

determination by the Department.

2. The services provided at all of its locations to hospice

must continually monitor and manage all ensure that

services are delivered in a safe and effective manner

and to ensure that each member and family receives

the necessary care and services outlined in the plan

of care.

TRAINING

1. A hospice must provide orientation about the hospice

philosophy to all employees and contracted staff that

has member and family contact.

2. A hospice must provide an initial orientation for each

employee that addresses the employee's specific job

duties.

3. A hospice must assess the skills and competence of

all individuals furnishing care, including volunteers

furnishing services, and, as necessary, provide in-service training and education programs where

required. The hospice must have written policies and

procedures describing its method(s) of assessment of

competency and maintain a written description of the

in-service training provided during the previous 12

months.