CMS SOM App. M, Tag L502

(1) During the initial assessment visit in advance of furnishing care the hospice must

provide the patient or representative with verbal (meaning spoken) and written

notice of the patient's rights and responsibilities in a language and manner that the

patient understands.

Interpretive Guidelines §418.52(a)(1)

When reference is made to “patient” in the Guidelines, it also refers to any person who

may, under State law, act on the patient’s behalf when the patient is unable to act for him

or herself. That person is referred to as the patient’s surrogate or representative. If a court

has formally declared the patient incompetent, the surrogate or representative is

whomever the court guardian, conservator, or committee appointed. The hospice should

verify that the representative has the necessary authority. For example, a court-appointed

conservator might have the power to make financial decisions, but not health care

decisions.

All hospice patients should be aware of their rights and responsibilities before the hospice

begins to provide care. The hospice must verbally explain the patient rights and

responsibilities to all patients accepted for care (or explain the rights to the patient’s

representative if the patient is physically or mentally incapacitated).

There must be evidence that the hospice conscientiously tried, within the constraints of

the individual situation, to inform the patient/family both verbally (spoken) and in writing

of patient rights and responsibilities. If a patient is able to read and understand written

materials without assistance, an oral summary, along with the complete written

documentation is acceptable.

For the patient who does not speak or understand English, hospices should make all

reasonable efforts to secure a professional, objective translator for hospice-patient

communications, including those involving the notice of patient rights and

responsibilities. The hospice may only use family and friends as translators for the

patient when the hospice cannot secure an objective translator or if the patient

specifically requests this approach. Hospices should make all reasonable efforts to have

written copies of the notice of rights and responsibilities available in the language(s) that

are commonly spoken in the hospice’s service area. For those patients who speak

languages in areas where professional translators for those languages are not readily

available, using family and friends of the patient is an acceptable option if the patient

agrees.

Further information on this topic is available from the Department of Health and Human

Services, Office for Civil Rights Policy Guidance: Title VI Prohibition Against National

Origin Discrimination Affecting Limited English Proficiency Persons