Chapter 3701-19 Hospice Care Programs

3701-19-01 Definitions.

As used in this chapter:

(A) "Advanced Practice Nurse" means a registered nurse authorized to practice as a certified nurse specialist, certified registered nurse anesthetist, certified nurse midwife or certified nurse practitioner in accordance with section 4723.41 of the Revised Code;

(B) "Applicant" means a person or public agency that submits an application for a license to provide a hospice care program under rule 3701-19-03 of the Administrative Code.

(C) "Attending physician" means the physician identified by the hospice patient or the hospice patient's family as having primary responsibility for the hospice patient's medical care.

(D) "Dietitian" means an individual licensed under Chapter 4759. of the Revised Code to practice dietetics.

(E) "Director" means the director of health or any official or employee of the department of health designated by the director of health.

(F) "Governing body" means the entity that has ultimate responsibility and authority for the overall operation of a hospice care program, as specified in rule 3701-19-08 of the Administrative Code.

(G) "Home health aide" means an individual who, in accordance with rule 3701-19-16 of the Administrative Code, provides home care services for hospice patients and their families.

(H) "Hospice aide," for the purpose of this chapter, means a home health aide who has successfully completed a training and competency evaluation program approved by the director under division (A) of section 3721.31 of the Revised Code and Chapter 3701-18 of the Administrative Code, is currently listed in good standing on the state nurse aide registry, and is employed by a hospice care program.

(I) "Hospice care program" or "program" means a coordinated program of home, outpatient, and inpatient care and services that is operated by a person or public agency and that provides the following care and services to hospice patients, including services as indicated below to hospice patients' families, through a medically directed interdisciplinary team, under interdisciplinary plans of care established pursuant to section 3712.06 of the Revised Code and rule 3701-19-11 of the Administrative Code, in order to meet the physical, psychological, social, spiritual, and other special needs that are experienced during the final stages of illness, dying, and bereavement:

(1) Nursing care by or under the supervision of a registered nurse;

(2) Physical, occupational, or speech or language therapy, unless waived by the department of health pursuant to paragraph (B) of rule 3701-19-19 of the Administrative Code;

(3) Medical social services by a social worker under the direction of a physician;

(4) Services of a home health aide;

(5) Medical supplies, including drugs and biologicals, and the use of medical appliances;

(6) Physician's services which include medical services provided by a physician or an advanced practice nurse acting within his or her scope of practice, as defined in section 4723.01 of the Revised Code;

(7) Short-term inpatient care, including both palliative and respite care and procedures;

(8) Counseling for hospice patients and hospice patients' families;

(9) Services of volunteers under the direction of the provider of the hospice care program;

(10) Bereavement services for hospice patients' families.

(J) "Hospice patient" or "patient" means a patient who has been diagnosed as terminally ill, has an anticipated life expectancy of six months or less, and has voluntarily requested and is receiving care from a person or public agency licensed under Chapter 3712. of the Revised Code and this chapter to provide a hospice care program.

(K) "Hospice patient's family" or "family" means a hospice patient's immediate family members, including a spouse, brother, sister, child, or parent, and any other relative or individual who has significant personal ties to the patient and who is designated as a member of the patient's family by mutual agreement of the patient, the relative or individual, and the patient's interdisciplinary team.

(L) "Inpatient facility" means a facility that either is operated by or under contract with a hospice care program for the purpose of providing inpatient care to the program's patients.

(M) "Inpatient hospice facility" means a building or leased unit operated by a hospice care program that is separate and distinct from another licensed or certified facility where the hospice program directly provides accommodations and hospice services for its hospice patients.

(N) "Interdisciplinary plan of care" or "plan of care" means the interdisciplinary plan for care of a hospice patient and his or her family prepared under rule 3701-19-11 of the Administrative Code.

(O) "Interdisciplinary team" means a working unit composed of professional and lay persons that includes at least a physician, a registered nurse, a social worker, a member of the clergy or a counselor, and a volunteer.

(P) "Licensed practical nurse" means a person licensed under Chapter 4723. of the Revised Code to practice nursing as a licensed practical nurse.

(Q) "Nurse" means a registered nurse or licensed practical nurse.

(R) "Palliative care" means treatment for a patient with a serious or life-threatening illness directed at controlling pain, relieving other symptoms, and enhancing the quality of life of the patient and the patient's family rather than treatment for the purpose of cure . Nothing in this section shall be interpreted to mean that palliative care can be provided only as a component of a hospice care program.

(S) "Person" means an individual, corporation, business trust, estate, trust, partnership, and association.

(T) "Physician" means a person authorized under Chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery.

(U) "Respite care" means hospice care program services provided by the program to give temporary relief to a hospice patient's family or other caregivers.

Interpretive guideline: respite care may be provided in the patient's home or in an inpatient facility when the patient's family or other caregiver needs relief from the daily demands of caring for the patient.

(V) "Registered nurse" means a person registered under Chapter 4723. of the Revised Code to practice professional nursing.

(W) "Social worker" means a person licensed under Chapter 4757. of the Revised Code to practice as a social worker or independent social worker.

(X) "Volunteer" means a lay or professional person who offers and provides his or her services to a hospice care program without compensation.

Effective: 06/20/2010
R.C. 119.032 review dates: 03/18/2010 and 08/15/2014
Promulgated Under: 119.03
Statutory Authority: 3712.03
Rule Amplifies: 3712.01 , 3712.03 , 3712.04 , 3712.05 , 3712.06 , 3712.07 , 3712.08 , 3712.09
Prior Effective Dates: 12/31/1990, 10/17/99, 1/1/05, 8/23/09

3701-19-02 Applicability of licensure requirements.

(A) Every person or public agency that proposes to provide a hospice care program shall apply to the director for a license in accordance with rule 3701-19-02 of the Administrative Code.

(B) A hospital, nursing home, home for the aged, county medical care facility, or other health facility or agency that provides a hospice care program shall be licensed to provide a hospice care program under Chapter 3712. of the Revised Code and this chapter.

(C) A nursing home licensed under Chapter 3721. of the Revised Code that does not hold itself out to be a hospice, does not hold itself out as providing a hospice care program, does not use the term "hospice" to describe or refer to its activities or facilities, and that does not provide all of the services enumerated in division (A) of section 3712.01 of the Revised Code and paragraph (I) of rule 3701-19-01 of the Administrative Code is not subject to the licensing provisions of Chapter 3712. of the Revised Code and this chapter.

(D) No person or public agency, other than a person or public agency licensed under section 3712.04 of the Revised Code and this chapter, shall hold itself out as providing a hospice care program, or provide a hospice care program, or use the term "hospice" or any term containing "hospice" to describe or refer to a health program, facility, or agency.

(1) A hospital, a home providing nursing care, or a home health agency that provides services under contract with a person or public agency providing a hospice care program that is licensed under section 3712.04 of the Revised Code and this chapter shall not be considered as providing a hospice care program in violation of paragraph (D) of this rule.

(2) Paragraph (D) of this rule does not apply to the activities of regional, state, or national nonprofit organizations of which providers of hospice care programs, individuals interested in hospice care programs, or both are members and that do not provide or represent that they provide hospice care programs.

(3) As used in paragraph (D) of this rule, "person" does not include a member of an interdisciplinary team, as defined in paragraph (Q) of rule 3701-19-01 of the Administrative Code, or any individual who is employed by a person or public agency licensed under section 3712.04 of the Revised Code and this chapter.

Effective: 06/20/2010
R.C. 119.032 review dates: 03/18/2010 and 08/15/2014
Promulgated Under: 119.03
Statutory Authority: 3712.03
Rule Amplifies: 3712.03 , 3712.04 , 3712.05
Prior Effective Dates: 12/31/1990, 1/1/05

3701-19-03 Initial license application process.

(A) This rule prescribes the procedures for applying for a license to provide a hospice care program. Application shall be made on forms prescribed and provided by the director, shall include such information as the director requires, including the information prescribed by paragraph (C) of this rule, and shall be accompanied by a non-refundable license fee of six hundred dollars in the form of a cashier's check or a postal money order payable to the "Treasurer, State of Ohio."

(B) Any person or public agency seeking to be licensed to provide a hospice care program shall submit an application for licensure at least sixty days prior to the requested date for the inspection required by paragraph (A) of rule 3701-19-05 of the Administrative Code.

(C) An application for a license to provide a hospice care program shall include:

(1) The name, address, and business telephone number of the hospice care program.

A hospice care program that operates from multiple locations shall include the addresses and telephone numbers for all locations on the application for license. The application shall indicate which location is to be issued the license;

(2) The names and addresses of the persons having an ownership or control interest in the hospice care program and other information pertaining to ownership or control of the program;

(3) The corporate name of the hospice care program, if any, and the names, titles, addresses, and telephone numbers of its officers and statutory agent;

(4) A list of the services which are or will be provided by the hospice care program either directly or indirectly through written contracts, the identities of any contractors and the services they will provide, and the date the program will be operational;

(5) A description of the geographic area in which the hospice care program will provide services;

(6) If the applicant is requesting a waiver of the requirement for providing physical therapy, occupational therapy, or speech or language therapy services pursuant to paragraph (B) of rule 3701-19-19 of the Administrative Code, the documentation required by that paragraph.

(7) If a hospice care program operates an inpatient hospice facility, documentation of compliance with the building code standards required by paragraph (C) of rule 3701-19-27 of the Administrative Code.

(D) The applicant or an authorized representative shall sign an affidavit included in the application certifying that, to the best of his or her knowledge, the information in the application and any accompanying material is true and accurate. If a representative signs the affidavit, he or she shall include documentation that he or she is the applicant's authorized representative.

(E) When reviewing a license application, the director may request, in writing, that an applicant furnish any additional information that the director determines to be necessary to assess compliance with Chapter 3712. of the Revised Code and this chapter. The applicant shall furnish any requested information within fourteen days after the mailing of the director's request.

(F) Licensure of a hospice care program providing services from multiple locations in Ohio.

(1) Except as prohibited by section 3712.08 of the Revised Code, the director may grant a license to a hospice care program which provides services from multiple locations in Ohio, if the applicant complies with all the following:

(a) Each location provides the same full range of services that is required of the hospice care program location issued the license;

(b) Each location is responsible to the same governing body and central administration that governs the hospice care program location issued the license, and the governing body and central administration is able to adequately manage each location;

(c) The hospice care program maintains clinical records for all patients served by the hospice care program regardless of where services are provided; and

(d) All hospice patients' clinical records requested by the director during an inspection are available at the hospice care program location issued the license.

(2) A hospice location that does not comply with the requirements of paragraph

(F)(1) of this rule is operating as a separate hospice care program and shall obtain a separate license and pay the appropriate license fee.

(G) A hospice care program operating in another state seeking to provide services to patients in Ohio shall establish an administrative office in Ohio and comply with the rules of Chapter 3701-19 of the Administrative Code in order to obtain a license. All Ohio hospice patients' clinical records shall be maintained at the Ohio administrative office.

Effective: 06/20/2010
R.C. 119.032 review dates: 03/18/2010 and 08/15/2014
Promulgated Under: 119.03
Statutory Authority: 3712.03
Rule Amplifies: 3712.03 , 3712.04
Prior Effective Dates: 12/31/1990, 10/17/99, 1/1/05, 8/23/09

3701-19-04 Issuance and revocation of licenses.

(A) The director shall grant a license for provision of a hospice care program to an applicant that complies with Chapter 3712. of the Revised Code and this chapter.

(B) Upon written request, the director may grant a variance from any requirement of this chapter, that is not a statutory requirement, if the person or public agency requesting the variance establishes that because of practical difficulties or other special conditions, strict application of the requirement will cause unusual or unnecessary hardship and that the variance will not jeopardize the health, safety, or welfare of any hospice patient or hospice patient's family.

(C) The director shall mail written notice to the applicant either granting or proposing to deny a license within thirty days after receiving all information necessary to determine compliance with Chapter 3712. of the Revised Code and this chapter, including the reports of the inspection conducted pursuant to paragraph (A) of rule 3701-19-05 of the Administrative Code. This thirty-day period shall be extended if the director has received a complaint concerning an applicant. In such a case, the director shall conduct a complaint investigation within thirty days after receipt of the complaint and shall mail written notice of the determination regarding the license application within thirty days after completion of the complaint investigation.

(D) If the applicant meets the requirements for licensure prescribed in paragraph (A) of this rule, the director shall issue a license to the applicant which shall:

(1) Indicate the name and address of the hospice care program location to which the applicant requested the license be issued. The names and addresses of additional locations operating under the same license shall be maintained on file;

(2) Be valid for three years only for the hospice care program at the address and additional locations indicated in the application except as provided for in paragraph (F) of this rule; and

(3) Be posted in a conspicuous place in the hospice care program location issued the license.

(E) Subject to Chapter 119. of the Revised Code, the director may deny, suspend, or revoke a license if the licensee made any material misrepresentation in the application for licensure or no longer meets the requirements of Chapter 3712. of the Revised Code or this chapter.

(F) A hospice care program that seeks to transfer its license to another or new location shall submit a written request to the director of health to transfer its license. The request shall indicate the name and address of the hospice care location issued the license and the address to which the hospice seeks to transfer the license. The request must be received by the director no later than ninety days prior to the current license expiration date or thirty days prior to the proposed transfer or relocation, whichever occurs sooner.

(1) When reviewing a request for transfer of a license, the director may request any additional written information he or she determines necessary to assess whether the criteria in paragraph (F)(2) of this rule are met.

(2) The director shall allow a license to be transferred if the following criteria are met:

(a) The hospice care program currently meets all of the licensing requirements and there are no pending complaints under investigation. Any pending complaints shall be investigated within thirty days of the request for transfer;

(b) The hospice care program is not undergoing any enforcement action at the time of the transfer or relocation or proposed transfer or relocation;

(c) The transfer or relocation is not due to a change in ownership or control;

(d) The transfer or relocation does not diminish the current geographic area being served by the hospice care program;

(e) The hospice care program continues to provide the same full range of services at the new location that was required of the hospice care program location that was issued the license;

(f) All hospice patients' clinical records are available, upon request of the director, at the new location to which the hospice license is to be transferred;

(g) If the hospice care program provides inpatient care directly, the transfer of the license does not involve either the establishment of an inpatient facility, or relocation of an existing inpatient facility, where the hospice care program provides inpatient care directly;

(h) The approval to transfer the license may be granted with no less than sixty-one days remaining prior to the expiration of the current license; and

(i) If the hospice care program obtained its license pursuant to paragraph (C) of rule 3701-19-06 of the Administrative Code, the hospice care program is currently in compliance with the applicable accreditation or certification standards

(3) The director shall notify the hospice care program of whether or not the license may be transferred. If the director determines that the license is not transferable, the director shall provide the hospice care program with an opportunity for a reconsideration:

(a) The hospice care program shall request a reconsideration in writing within thirty days of the mailing of the notice of determination.

(b) The request shall include any written documentation or other information not previously submitted to the director that the hospice care program wishes to refute the determination.

(c) The director's final determination is not appealable under Chapter 119. of the Revised Code.

(d) The hospice care program shall obtain a license for the new location prior to commencing services at the new location.

Effective: 08/23/2009
R.C. 119.032 review dates: 05/19/2009 and 08/15/2014
Promulgated Under: 119.03
Statutory Authority: 3712.03
Rule Amplifies: 3712.03 , 3712.04 , 3712.05
Prior Effective Dates: 12/31/1990, 10/17/99, 1/1/05

3701-19-05 Inspections.

(A) Prior to issuing a license for a hospice care program, the director shall conduct an announced inspection of the applicant's facilities and services.

(B) Except for hospice care programs licensed under paragraph (C) of rule 3701-19-06 of the Administrative Code, the director shall conduct an unannounced inspection of each licensed hospice care program's facilities and services at a minimum frequency of once every three years. The director may conduct additional inspections of any licensed hospice care program at any other time he or she considers necessary including, but not limited to, investigating complaints.

(C) The fees for inspections conducted by the director pursuant to section 3712.03 of the Revised Code and paragraphs (A) and (B) of this rule shall be as follows:

(1) Licensing inspection $1, 625.00

(2) Complaint inspection $ 850.00

(3) Follow-up inspection $ 350.00

For purposes of this paragraph, "follow-up inspection" means an inspection, which may include on-site and off-site activities, conducted by the department to determine whether the hospice care program has corrected a violation or violations cited on a previous inspection.

(D) For purposes of inspections by the director, each hospice care program shall provide access to its premises and staff at all times and to pertinent records upon request. The program shall ensure that the director has access to all parts of its facilities, services, and records, including the inpatient facilities operated by or under contract with the program. The inspections may include visits to hospice patients' homes and direct interaction with patients and their families, with the patients' or families' consent.

(E) If an inspection of an applicant's hospice care program or of a licensed program reveals a violation or violations of Chapter 3712. of the Revised Code or of Chapter 3701-19 or 3701-13 of the Administrative Code, the director, in his or her discretion, may require submission of a plan of correction for each violation. The hospice care program shall submit the plan within ten days after receiving the director's notification that a plan of correction is required.

(F) When a hospice care program provides services at more than one location under one license, a violation found at any location shall constitute a violation for the entire hospice care program.

Effective: 10/12/2009
R.C. 119.032 review dates: 05/19/2009 and 05/27/2014
Promulgated Under: 119.03
Statutory Authority: 3712.03
Rule Amplifies: 3712.03 , 3712.04 , 3712.05 , 3712.06
Prior Effective Dates: 12/31/1990, 10/17/99, 1/1/05

3701-19-06 Renewal of licenses.

(A) An application for renewal of a license shall be made at least ninety days prior to the expiration of the license. The application shall be made and a renewal fee paid in accordance with paragraph (A) of rule 3701-19-03 of the Administrative Code in the same manner as for an initial license. A hospice care program that operates an inpatient hospice facility shall submit documentation of continued compliance with the state fire code required by paragraph (B) of rule 3701-19-27 of the Administrative Code, and a certificate of occupancy required by paragraph (C) of rule 3701-19-27 of the Administrative Code only if it is different than the one previously submitted to the director. The director shall renew the license if the program continues to meet the requirements of Chapter 3712. of the Revised Code and Chapters 3701-19 and 3701-13 of the Administrative Code. If the program does not meet the requirements, the director may deny renewal of the license, in accordance with Chapter 119. of the Revised Code.

(B) In addition to submitting the application and renewal fee required by paragraph (A) of rule 3701-19-03 of the Administrative Code, an applicant applying for a license renewal pursuant to paragraph (C) of this rule shall also submit:

(1) Evidence of the program's current medicare certification pursuant to Title XVIII of the Social Security Act, 49 Stat. 620 (1935), 42 U.S.C. 301 , as amended, with its expiration date noted; and

(2) If the program is certified or accredited by an entity other than the secretary of the United States department of health and human services (medicare certification under Title XVIII of the Social Security Act, 49 Stat. 620 (1935), 42 U.S.C. 301 , as amended), a copy of the most recent accreditation decision report.

(C) The director shall renew licenses to persons or public agencies to provide hospice care programs that are accredited or certified to provide such programs by an entity whose standards for accreditation or certification equal or exceed those provided for licensure set forth in Chapter 3712. of the Revised Code and this chapter.

(1) For purposes of this paragraph, the standards for medicare certification set forth in Title XVIII of the Social Security Act, 49 Stat. 620 (1935), 42 U.S.C. 301 , as amended, shall be considered to equal or exceed the requirements for licensure set forth in Chapter 3712. of the Revised Code and this chapter. If an applicant seeks license renewal pursuant to this paragraph on the basis of accreditation or certification by another entity, the director shall review the entity's certification or accreditation standards and shall determine whether they equal or exceed the standards set forth in Chapter 3712. of the Revised Code and this chapter.

(2) If the certification or accreditation of a person or public agency providing a hospice care program that was granted a license renewal pursuant to paragraph (C) of this rule is terminated or expires and is not renewed:

(a) The hospice care program shall send written notification of the termination or expiration to the director prior to the effective date of the termination, expiration, or non-renewal of the certification or accreditation or within five business days after receipt of such notice of termination, expiration, or non-renewal, which ever is sooner; and

(b) The director shall inspect the program to determine whether it otherwise meets the requirements of Chapter 3712. of the Revised Code and this chapter. After conducting the inspection, the director may take whatever action concerning the program's license that he or she considers appropriate.

Effective: 08/23/2009
R.C. 119.032 review dates: 05/19/2009 and 08/15/2014
Promulgated Under: 119.03
Statutory Authority: 3712.03
Rule Amplifies: 3712.03 , 3712.04 , 3712.06
Prior Effective Dates: 12/31/1990, 10/17/99, 1/1/05

3701-19-07 General requirements for hospice care programs after licensure.

(A) Any person or public agency licensed under section 3712.04 of the Revised Code and this chapter to provide a hospice care program shall:

(1) Provide a planned and continuous hospice care program, the medical components of which shall be under the direction of a physician;

(2) Ensure that care is available twenty-four hours a day and seven days a week;

(3) Establish an interdisciplinary plan of care for each hospice patient and his family that:

(a) Is coordinated by one designated individual who shall ensure that all components of the plan of care are addressed and implemented;

(b) Addresses maintenance of patient-family participation in decision making; and

(c) Is periodically reviewed by the patient's attending physician and by the patient's interdisciplinary team.

Interpretive guideline: specific requirements relating to the interdisciplinary team and the plan of care are prescribed by rule 3701-19-11 of the Administrative Code;

(4) Have an interdisciplinary team or teams that provide or supervise the provision of care and establish the policies governing the provision of the care;

(5) Provide bereavement counseling for hospice patients' families. Interpretive guideline: specific requirements relating to bereavement counseling are prescribed by rule 3701-19-18 of the Administrative Code;

(6) Not discontinue care because of a hospice patient's inability to pay for the care;

(7) Maintain central clinical records on all hospice patients under its care.

Interpretive guideline: specific requirements relating to central clinical records are prescribed by rule 3701-19-23 of the Administrative Code; and

(8) Provide care in individual's homes, on an outpatient basis, and on a short-term inpatient basis.

Interpretive guideline: specific requirements relating to home care and inpatient care are prescribed, respectively, by rules 3701-19-16 and 3701-19-24 of the Administrative Code.

A component or components of the care provided by a hospice care program may be provided under a written contract with another person or public agency, pursuant to rule 3701-19-12 of the Administrative Code.

(B) After receiving a license, a hospice care program shall comply with all requirements of Chapter 3712. of the Revised Code and Chapters 3701-13 and 3701-19 of the Administrative Code.

(C) Each licensed hospice care program shall notify the director, in writing, of any of the following:

(1) Any change in any of the information specified in the license application under paragraphs (C)(1) to (C)(3) of rule 3701-19-03 of the Administrative Code no later than fifteen days after the change;

(2) Any other change that would render the information submitted in the license application inaccurate at least twenty-one days prior to the effective date of the change; and

(3) Any intent to cease operation at least sixty days prior to ceasing operation. This notification shall include a plan for assuring continuity of care for the program's patients and their families after the program ceases operation.

Interpretive guideline: the following procedures for assuring continuity of care are recommended:

(a) Provision of written notice of the proposed closure of the program, at least sixty days prior to ceasing operation, to each patient or patient's family;

(b) Development of a written discharge plan to be placed in each patient's record to assist the person or public agency that will be responsible for care of the patient and his or her family after the program ceases operation; and

(c) Obtaining from each patient or his or her authorized representative written approval of any transfer to another licensed hospice care program and written authorization to release pertinent clinical record information to such a program or another person or public agency that will assume responsibility for the patient's and family's care.

R.C. 119.032 review dates: 05/27/2009 and 05/27/2014

Promulgated Under: 119.03

Statutory Authority: 3712.03

Rule Amplifies: 3712.01 , 3712.04 , 3712.05 , 3712.06

Prior Effective Dates: 12/31/1990; 10/17/99

3701-19-08 Governing body.

The overall conduct and operation of the hospice care program, including the quality of care and the provision of services, shall be the full legal responsibility of a clearly defined, organized governing body which shall perform the following functions:

(A) Establish and review policies for the management, operation, and evaluation of the hospice care program, including, but not limited to:

(1) Qualifications of employees and independent contractors; and

(2) Policies and procedures to receive and respond to patient grievances regarding medical treatment, quality of care, the lack of respect for person or property, mistreatment, neglect, verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of patient property by any individual furnishing services on behalf of the hospice care program. The policies and procedures developed by the governing body shall, at a minimum, include:

(a) Notification procedures for hospice patients, employees and contracted staff to report alleged violations to the hospice program administration;

(b) Requirements for the immediate investigation of alleged violations;

(c) Documentation requirements for reported alleged violations, including time frames for response; and

(d) Procedures for the reporting of verified violations to the appropriate state licensing authority and/or local authorities where appropriate; and

(e) Requirements for timely corrective actions for all verified violations.

(B) Arrange for a physician to serve as medical director for the hospice care program.

Interpretive guideline: The physician serving as medical director:

(1) Should be knowledgeable about the psychological, social, and medical aspects of hospice care as the result of training, experience, and interest;

(2) Also may serve as the physician representative on an interdisciplinary team or teams or as an attending physician; and

(3) Shall designate a physician to act in his or her absence.

(C) Appoint a qualified individual to serve as the director of the hospice care program.

Interpretive guideline: The director of the hospice care program shall perform the following duties:

(1) Be responsible for the day-to-day management of the program and for assuring compliance with Chapter 3712. of the Revised Code, Chapter 3701-13, and this chapter of the Administrative Code;

(2) Implement the hospice care program's policies and procedures regarding all activities and services provided by the hospice care program;

(3) Designate an individual to act in his or her absence;

(4) Implement the hospice care program's quality assessment and performance improvement program under rule 3701-19-22 of the Administrative Code; and

(5) Implement the hospice care program's patient grievance program established under paragraph (A)(2)of this rule.

(D) Ensure that all services provided are consistent with accepted standards of practice for hospice care.

(E) Evaluate the hospice care program's quality assessment and performance improvement program on an annual basis.

Effective: 08/23/2009
R.C. 119.032 review dates: 05/19/2009 and 08/15/2014
Promulgated Under: 119.03
Statutory Authority: 3712.03
Rule Amplifies: 3712.01 , 3712.06
Prior Effective Dates: 12/31/1990, 9/5/97, 10/17/99

3701-19-09 General requirements for hospice care program personnel.

(A) Each hospice care program shall utilize personnel that have appropriate training and qualifications for the services that they provide. Any staff member, including a volunteer, who functions in a professional capacity shall meet the standards applicable to that profession, including but not limited to possessing current Ohio licensure, registration, or certification, if required by law, and practicing within the applicable scope of practice.

(B) The hospice care program shall provide each staff member, including volunteer and contracted staff members, with a written job description delineating his or her responsibilities. The program shall assure that all staff members, including volunteers, provide services to hospice patients and their families in compliance with all of the following standards:

(1) Services are provided in accordance with the patients' plans of care;

(2) Services are provided in accordance with the policies and procedures developed by the interdisciplinary team;

(3) Services are provided in accordance with current and accepted standards of practice;

(4) Services are provided by staff members who comply with the program's employee health policies; and

Interpretive guideline: The hospice care program shall have written employee health policies which include the following requirements for any staff member, including a volunteer, temporary agency employee, or paid consultant used by the hospice care program who has direct hospice patient contact.

(a) The hospice care program shall have a written plan to ensure the health and safety of hospice patients that includes policies and procedures regarding screening of staff for communicable diseases.

(b) The hospice care program shall have written policies and procedures regarding measures taken to prevent staff with direct hospice patient contact who have been diagnosed with a communicable disease from transmitting this disease to patients, care givers or other staff. The policies shall indicate when infected or ill staff must not render direct patient care.

(c) The hospice care program shall document, as applicable, compliance with U.S. department of labor's occupational safety and health administration (OSHA), U.S. centers for disease control and prevention (CDC) and applicable Ohio department of health standards concerning health requirements for staff provision of services in health care settings, including requirements for maintaining tuberculosis control.

(5) All services are documented in the patient's central clinical record.

(C) Each hospice care program shall ensure that all personnel treat each patient and his or her property with respect, not abuse or neglect patients, and not misappropriate a patient's property.

(D) Each hospice care program shall employ personnel without discrimination on the basis of sex, age, race, creed, national origin, or handicap.

(E) Each hospice care program shall provide an ongoing training program for its personnel, including volunteers.

Interpretive guideline: The program shall provide both orientation and continuing training to all staff members. The orientation shall be appropriate to the tasks that each staff member will be expected to perform. Continuing training shall be designed to assure maintenance of appropriate skill levels and that personnel are informed of changes in techniques, philosophies, goals, and similar matters. The continuing training may include attending and participating in professional meetings and seminars.

(F) Each hospice care program shall evaluate the performance of each staff member regularly.

(G) Except as provided in Chapter 3701-13 of the Administrative Code, no hospice care program shall employ a person who applies on or after January 27, 1997, for a position that involves the provision of direct care to an older adult, if the person:

(1) Has been convicted of or pleaded guilty to an offense listed in division (C)(1) of section 3712.09 of the Revised Code; or

(2) Fails to complete the form(s) or provide fingerprint impressions as required by division (B)(3) of section 3712.09 of the Revised Code.

Effective: 08/23/2009
R.C. 119.032 review dates: 05/19/2009 and 08/15/2014
Promulgated Under: 119.03
Statutory Authority: 3712.03
Rule Amplifies: 3712.01 , 3712.06 , 3712.09
Prior Effective Dates: 12/31/1990, 9/5/97, 10/17/99

3701-19-10 Medical director.

The medical director of a hospice care program shall have overall responsibility for the medical component of the program.

Interpretive guideline: The medical director shall be a physician who is either a paid or contractual staff member or volunteer whose duties shall include:

(A) Participating as a member of the interdisciplinary team or teams in the development of individual plans of care or assuring that one or more other qualified physicians participate on the team or teams;

(B) Reviewing patient medical eligibility for hospice care services;

(C) Consulting with attending physicians, when appropriate, regarding pain and symptom management;

(D) Assuring overall continuity of the hospice care program's medical services, including availability of physician services for routine and emergency situations;

(E) Acting as liaison between patients' attending physicians and the interdisciplinary team or teams;

(F) Establishing health policies for employees of the hospice care program; and

(G) Serving as liaison with community physicians, medical schools, and hospitals.

Effective: 08/23/2009
R.C. 119.032 review dates: 05/19/2009 and 08/15/2014
Promulgated Under: 119.03
Statutory Authority: 3712.03
Rule Amplifies: 3712.01 , 3712.06
Prior Effective Dates: 12/31/1990, 10/17/99

3701-19-11 Interdisciplinary team and interdisciplinary plan of care.

(A) Each hospice care program shall have an interdisciplinary team or teams that provides or supervises the provision of hospice care and services. The governing body of the hospice care program shall designate a registered nurse that is a member of an interdisciplinary team to coordinate the overall functioning of that interdisciplinary team to ensure all of the following.

(1) There is ongoing assessment of the hospice patient's and family's needs;

(2) That all components of the plan of care are addressed by the interdisciplinary team; and

(3) The plan of care is implemented in accordance with its terms.

(B) The interdisciplinary team or teams shall perform the following functions:

(1) Establish policies and procedures governing the provision of care.

Interpretive guideline: If the hospice care program has more than one interdisciplinary team, it shall designate which team is to be responsible for establishing the policies and procedures or it shall specify particular areas for which each team is to establish policies and procedures;

(2) Establish an interdisciplinary plan of care for each patient and family;

(3) Review the interdisciplinary plan of care on a periodic basis no less frequently than every fifteen days.

(4) Encourage and foster active involvement of the patient and family in the development and implementation of the interdisciplinary plan of care; and

(5) Evaluate the hospice care and services provided and monitor the continuity of care across all settings for the hospice care program's patients and their families.

(C) A hospice care program shall ensure that each patient's attending physician, if any, periodically reviews the patient's plan of care.

Intepretive guideline: The requirement for periodic review by the attending physician may be satisfied by review whenever there is a significant change in the patient's condition or every ninety days, whichever is sooner.

Effective: 08/23/2009
R.C. 119.032 review dates: 05/19/2009 and 08/15/2014
Promulgated Under: 119.03
Statutory Authority: 3712.03
Rule Amplifies: 3712.01 , 3712.06
Prior Effective Dates: 12/31/1990

3701-19-12 Contracted services.

(A) A provider of a hospice care program may arrange for another person or public agency to furnish a component or components of the hospice care program pursuant to a written contract in compliance with 42 C.F.R. 418.64 .

(B) Any contract executed under paragraph (A) of this rule, including a contract to which paragraph (C) of this rule applies, shall be legally binding on both parties and shall do all of the following:

(1) Identify the services that may be provided;

(2) Stipulate that services may be provided only with the express authorization of the hospice care program;

(3) Describe the manner in which the contracted services are coordinated, supervised, and evaluated by the hospice care program;

(4) Delineate the role or roles of the hospice care program and the contractor in the admission process, patient and family assessment, and the interdisciplinary team reviews;

(5) Stipulate the requirements for documenting that services are furnished in accordance with the contract and the requirements of Chapter 3712. of the Revised Code, Chapter 3701-13 and this chapter of the Administrative Code;

(6) Set forth the qualifications of the personnel providing the services; and

(7) Stipulate that the hospice care program shall provide hospice care orientation and training, in accordance with paragraph (E) of rule 3701-19-09 of the Administrative Code, to the contractor's personnel who provide the care under the contract.

(C) When a provider of a hospice care program arranges for a hospital, a home providing nursing care, or home health agency to furnish a component or components of the hospice care program to its patient, the care shall be provided by a licensed, certified, or accredited hospital, home providing nursing care, or home health agency pursuant to a written contract under which:

(1) The provider of hospice care program furnishes to the contractor a copy of the hospice patient's interdisciplinary plan of care that is established under division (C) of section 3712.06 of the Revised Code and rule 3701-19-11 of the Administrative Code and specifies the care that is to be furnished by the contractor;

(2) The regimen described in the established plan of care is continued while the hospice patient receives care from the contractor, subject to the patient's needs, and with approval of the coordinator of the interdisciplinary team designated pursuant to division (C)(1) of section 3712.06 of the Revised Code and paragraph (A) of rule 3701-19-11 of the Administrative Code.

Interpretive guideline: If compliance with the plan of care or provision of care in accordance with hospice philosophies requires that the contractor not comply with a requirement of its licensure, certification, or accreditation standards, it is recommended that the contractor seek appropriate waivers or variances of those standards to cover its provision of care to hospice patients and their families;

(3) All care, treatment, and services furnished by the contractor are entered into the hospice patient's medical record;

(4) The designated coordinator of the interdisciplinary team ensures conformance with the established plan of care.

Interpretive Guideline: It is recommended that the hospice care program assure that the coordinator is on call at all times to communicate with the contractor concerning implementation of the plan of care;

(5) A copy of the contractor's medical record and discharge summary is retained as part of the hospice patient's medical record; and

(6) The contractor complies with the requirements of Chapter 3712. of the Revised Code, and this chapter as applicable to the contracted service.

(D) The hospice care program shall encourage any hospital contracting for inpatient care to offer temporary limited privileges to the hospice patient's attending physician while the hospice patient is receiving inpatient care from the hospital.

(E) The hospice care program shall assure the continuity of patient and family care in the home, outpatient, and inpatient settings.

(F) The hospice care program shall retain professional management responsibility for contracted services and shall ensure that those services are furnished in a safe and effective manner, by persons meeting the qualifications prescribed by Chapter 3701-13 and this chapter of the Administrative Code, and in accordance with the patient's plan of care and the other requirements of this chapter.

(G) The hospice care program shall retain responsibility for payment for services provided by a contractor which are related to the palliation and management of the terminal illness.

(H) The hospice care program may contract with a durable medical equipment supplier, only if that supplier meets the medicare supplier quality and accreditation standards at 42 C.F.R. 424.57 .

Effective: 08/23/2009
R.C. 119.032 review dates: 05/19/2009 and 08/15/2014
Promulgated Under: 119.03
Statutory Authority: 3712.03 , 3712.09
Rule Amplifies: 3712.01 , 3712.06 , 3712.09
Prior Effective Dates: 12/31/1990, 9/5/97

3701-19-13 Volunteer services.

(A) Each hospice care program shall use trained volunteers to assist with the provision of administrative or direct patient care services and shall have trained volunteers available to hospice patients and hospice patients' families as needed. Volunteers shall provide services under the supervision of a designated qualified and experienced hospice staff member.

(B) Each hospice care program shall provide orientation and training to the volunteers it uses that is consistent with acceptable standards of hospice practice.

INTERPRETIVE GUIDELINE: the orientation and training for volunteers shall address at least the following items:

(1) The hospice care program's goals and services;

(2) Confidentiality and the protection of patient and family rights;

(3) Procedures for responding to medical emergencies or deaths;

(4) The physiological and psychological aspects of terminal illness;

(5) Family dynamics, coping mechanisms, and psychosocial issues surrounding terminal illness, death, and bereavement;

(6) Safety policies and procedures; and

(7) General communication skills.

(C) The hospice care program shall document active and ongoing efforts to recruit and retain volunteers.

R.C. 119.032 review dates: 05/27/2009 and 05/27/2014

Promulgated Under: 119.03

Statutory Authority: 3712.03

Rule Amplifies: 3712.01 to 3712.06

Prior Effective Dates: 12/31/1990

3701-19-14 Nursing services.

(A) Each hospice care program shall provide nursing care and services by or under the supervision of a registered nurse. The program shall direct and staff nursing services to meet the nursing needs of all of the hospice care program's patients. The program shall specify the patient care responsibilities of nursing personnel.

(B) INTERPRETIVE GUIDELINES:

(1) A registered nurse shall be responsible for the supervision and oversight of all nursing services. It is recommended that the nursing services supervisor have education or experience or both in the nursing care needs of hospice patients and the needs of hospice patients' families.

(2) As used in this rule, "supervision" means monitoring and directing the provision of nursing care and services by record review, written or verbal instructions, review of interdisciplinary care plans, or direct observation.

(3) The hospice care program shall ensure that nursing care is available twenty-four hours a day and seven days a week.

(4) The hospice care program shall ensure that all of its policies and procedures are available and accessible to all nursing personnel.

(5) The registered nurse who provides or supervises nursing services also may serve as the interdisciplinary team coordinator or team member.

R.C. 119.032 review dates: 09/21/2004 and 07/15/2009

Promulgated Under: 119.03

Statutory Authority: 3712.03

Rule Amplifies: 3712.01 to 3712.06

Prior Effective Dates: 12/31/1990

3701-19-15 Medical social services.

(A) Each hospice care program shall make medical social services available to each patient and his or her family as needed. Medical social services shall be provided by a social worker under the direction of a physician.

(B) INTERPRETIVE GUIDELINES:

(1) For the purposes of this rule, a physician's approval of a patient's interdisciplinary plan of care shall constitute direction.

(2) The medical social service needs of each hospice patient and his or her family shall be considered in conjunction with other services when the interdisciplinary team reviews the patient's and family's status.

(3) Medical social services shall be provided in a timely manner in accordance with hospice care program's policy.

R.C. 119.032 review dates: 05/27/2009 and 05/27/2014

Promulgated Under: 119.03

Statutory Authority: 3712.03

Rule Amplifies: 3712.01 to 3712.06

Prior Effective Dates: 12/31/1990

3701-19-16 Home care services.

(A) Each hospice care program shall provide or make available home care services in the scope and frequency required to meet the needs of its patients and their families. Home care services include assistance with activities of daily living, personal care, ambulation and exercise, household services essential to health care at home, assistance with self-administration of medications, and preparation of meals. The patient and family shall be informed of any limitations on home care services as required by paragraph (E) of rule 3701-19-20 of the Administrative Code.

(B) Home care services shall be provided by home health aides or hospice aides who have been selected on the basis of such factors as a sympathetic attitude toward patients and their families, ability to read, write, and carry out instructions, and maturity and ability to cope with the demands of the job.

(C) The hospice care program shall ensure that home health aides or hospice aides providing home care services have been trained in methods of assisting patients to achieve maximum self-reliance, principles of nutrition and meal preparation, the aging process and emotional problems of illness, procedures for maintaining a clean, healthful, and pleasant environment, changes in a patient's condition that should be reported, the philosophy of hospice care and of the hospice care program, ethics, confidentiality, and recordkeeping.

(D) A registered nurse from the patient's interdisciplinary team shall prepare for each home health aide or hospice aide written instructions for patient care which are consistent with the interdisciplinary plan of care.

(E) The registered nurse responsible for preparing written instructions for home health aides and hospice aides shall make and document a supervisory visit to the patient's residence at least every two weeks when home health aide or hospice aide services are being provided to assess the provision of the home health aide or hospice aide services.

Interpretive guideline: The supervisory visit may be made either when the aide is present or when the aide is absent. The purpose of the visit shall be to observe and assist the aide, if present, to assess the patient's and family's relationship with the home health aide or hospice aide, and to determine whether the patient's and family's needs and goals are being met. The supervisory visit may be conducted in conjunction with a visit for other purposes.

Effective: 08/23/2009
R.C. 119.032 review dates: 05/19/2009 and 08/15/2014
Promulgated Under: 119.03
Statutory Authority: 3712.03
Rule Amplifies: 3712.01 , 3712.03 , 3712.06
Prior Effective Dates: 12/31/1990

3701-19-17 Medical services.

(A) A hospice care patient may identify their own attending physician or may designate the hospice care program medical director to be their attending physician.

(B) Each hospice care program shall provide:

(1) Effective palliation and management of terminal illness and related conditions; and

(2) Medical services which meet the medical needs of the patient that are not otherwise met by the patient's attending physician or an advanced practice nurse, acting within his or her scope of practice and working in collaboration with an attending physician.

(C) Interpretive guidelines:

(1) Oversight of the provision of medical services generally is the responsibility of the hospice care program's medical director, pursuant to rule 3701-19-10 of the Administrative Code. The medical director also complements the attending physician's care by providing or arranging for the provision of care to meet the patient's needs that are not met by the attending physician.

(2) All medical orders for treatment, procedures, tests, and medications shall be signed by a physician or an advanced practice nurse, who is acting within his or her scope of practice and who is working in collaboration with a physician.

Effective: 08/23/2009
R.C. 119.032 review dates: 05/19/2009 and 08/15/2014
Promulgated Under: 119.03
Statutory Authority: 3712.03
Rule Amplifies: 3712.01 , 3712.03 , 3712.06
Prior Effective Dates: 12/31/1990, 10/17/99, 1/1/05

3701-19-18 Counseling and bereavement services.

(A) Each hospice care program shall make available counseling services to the hospice patient and the hospice patient's family. Counseling services shall include dietary, spiritual, bereavement and any other necessary counseling services while the patient is enrolled in the hospice care program. Counseling services shall be provided by a qualified interdisciplinary team member or one or more other qualified individuals, as determined by the hospice care program.

Intrepretive guidelines: Counseling services shall be organized to meet the needs of the hospice patients and their families.

(1) The program shall assess the needs of patients and families for spiritual counseling, in accordance with their religious preferences.

(2) The hospice care program shall provide dietary counseling. Dietary counseling shall include use of food and mealtime to promote quality of life for hospice patients and to meet their needs for symptom control. Dietary counseling also may include counseling of family members to enable them to prepare food for the hospice patient. Dietary counseling shall be planned and provided by or under the supervision of a dietitian or, if the program is unable to obtain the services of a dietitian, by a nurse.

(B) The hospice care program shall make reasonable efforts to arrange for visits of clergy and other members of religious organizations in the community to patients who request visits and shall apprise patients of this opportunity.

(C) Each hospice care program shall provide bereavement services, as needed, for hospice patients' families. These services shall be provided for up to one year after the patient's death. Bereavement services shall be provided under the supervision of a designated qualified professional.

Interpretive guidelines:

(1) The professional designated to supervise bereavement services shall have education or experience or both in providing those services.

(2) Bereavement services shall be based on an assessment of the family's needs and its ability to cope with grief.

(3) The plan of care for bereavement services shall reflect family needs and shall specify the frequency services are to be delivered and the persons furnishing the services.

Effective: 08/23/2009
R.C. 119.032 review dates: 05/19/2009 and 08/15/2014
Promulgated Under: 119.03
Statutory Authority: 3712.03
Rule Amplifies: 3712.01 , 3712.03 , 3712.06
Prior Effective Dates: 12/31/1990

3701-19-19 Physical therapy, occupational therapy, and speech therapy services.

(A) Each hospice care program shall provide or arrange for the provision of physical therapy, occupational therapy, or speech or language therapy unless the provision of those services is waived by the director pursuant to division (A)(4) of section 3712.03 of the Revised Code and paragraph (B) of this rule. The services shall be adequate in frequency to meet the needs of the hospice patients.

Interpretive guideline: Physical therapy services, occupational therapy services and speech or language therapy services must be offered in a manner consistent with accepted standards of practice for the provision of service to hospice patients.

(B) The director may waive the requirement for providing physical therapy, occupational therapy, or speech or language therapy when the requirement would create a hardship because the therapy is not readily available in the geographic area served by the provider of the hospice care program. A request for a waiver under this paragraph shall be submitted to the director in writing and shall be accompanied by documentation of the number and location of therapists in the area served by the program and of the efforts that the program has made to engage those therapists and to encourage other therapists to serve the area.

(C) Physical therapy shall be provided by a person who is licensed as a physical therapist under Chapter 4755. of the Revised Code and who meets the requirements under Chapter 3701-13 of the Administrative Code.

(D) Occupational therapy shall be provided by a person who is licensed as an occupational therapist under Chapter 4755. of the Revised Code and who meets the requirements under Chapter 3701-13 of the Administrative Code.

(E) Speech or language therapy shall be provided by a person who is licensed as a speech pathologist or audiologist under Chapter 4753. of the Revised Code and who meets the requirements under Chapter 3701-13 of the Administrative Code.

Eff 12-31-90; 10-17-99; 1-1-05
Rule promulgated under: RC 119.03
Rule authorized by: RC 3712.03
Rule amplifies: RC 3712.01 , 3712.04 , 3712.05 , 3712.06
R.C. 119.032 review dates: 05/27/2009 and 05/27/2014

3701-19-20 Admission of patients to the hospice care program.

(A) A hospice care program shall not admit any individual who does not meet the definition of a hospice patient.

(B) A hospice care program shall admit patients, provide care and services, and discharge or transfer patients without discrimination on the basis of sex, age, race, creed, national origin, or handicap.

(C) A hospice care program shall require that the patient, or the patient's authorized representative, sign an informed consent form. This form shall include an acknowledgement by signature of the patient or patient's representative, that they have been given a full explanation of the palliative rather than curative nature of hospice care as it relates to the patient's terminal illness and have been informed that the patient may withdraw consent at any time.

(D) A hospice care program shall permit a hospice patient to withdraw consent for hospice care at any time.

(E) A hospice care program shall provide a patient or the patient's representative with information regarding the scope of services provided by the hospice care program, including any limitations of the hospice care program and charges for the services.

(F) Prior to or within forty-eight hours after admission of each patient, a hospice care program shall obtain an oral statement from the patient's attending physician, if any, and the medical director of the hospice care program or the physician member of the interdisciplinary team certifying that the patient is terminally ill. The program shall obtain written confirmation of the oral statement after admission. The written certification statement shall be signed by the patient's attending physician, if any, and the medical director of the hospice care program or the physician member of the interdisciplinary team.

Interpretive guidelines: it is recommended that the hospice care program also take the following measures:

(1) The program should obtain the following information orally from the patient's attending physician if any, prior to or within forty eight hours of admission, and confirm the oral communication in writing, within twenty one days or within other acceptable written standards of practice guidelines:

(a) Information about current medical findings;

(b) Dietary restrictions;

(c) Medication orders;

(d) Treatment orders; and

(e) Other patient orders;

(2) The program should obtain from each patient's attending physician, if any, designation of an alternate physician to contact for emergency care of the patient or review of the patient's plan of care when the attending physician is not available; and

(3) The hospice care program should obtain written confirmation of the oral statement certifying that the patient is terminally ill within a reasonable period of time after admission, which is recommended to be not more than twenty-one days or within other acceptable written standards of practice guidelines.

Effective: 08/23/2009
R.C. 119.032 review dates: 05/19/2009 and 08/15/2014
Promulgated Under: 119.03
Statutory Authority: 3712.03
Rule Amplifies: 3712.01 , 3712.03 , 3712.06
Prior Effective Dates: 12/31/1990, 10/17/99

3701-19-21 Medical supplies, drugs, and biologicals.

(A) Each hospice care program shall arrange for provision of medical supplies, appliances, drugs, and biologicals to hospice patients as needed for the palliation and management of the patient's terminal illness and related conditions. The program shall ensure that drugs and biologicals are available at all times.

(B) Each hospice care program shall ensure that drugs and biologicals are administered only by the following individuals:

(1) A registered nurse, a licensed practical nurse, or a physician;

(2) A patient or a family member if approved by the attending physician; or

(3) Any other individual authorized by the Revised Code to perform this task.

The individuals authorized to administer drugs or biologicals under paragraphs (B)(2) and (B)(3) of this rule and the drugs or biologicals they are authorized to administer shall be specified in the patient's plan of care.

(C) Each hospice care program shall have a policy for disposing of controlled drugs maintained in the patient's home when those drugs no longer are needed by the patient.

Interpretive guideline: The policy for disposing of controlled drugs shall be in writing. Drugs no longer may be needed by the patient because they have been discontinued by the physician or because they remain at the time of death. The program's policy may vary depending upon the patient and the home environment but shall account for the fact that the drugs legally have been dispensed to the patient and remain under his or her legal control.

(D) Each hospice care program shall ensure that the patient, patient's representative, and the patient's family receive a copy of the hospice care program's written policies and procedures along with education on the management and disposal of controlled drugs when a controlled substance is ordered, and document such actions in the patient's clinical record.

Effective: 08/23/2009
R.C. 119.032 review dates: 05/19/2009 and 08/15/2014
Promulgated Under: 119.03
Statutory Authority: 3712.03
Rule Amplifies: 3712.01 , 3712.03 , 3712.06
Prior Effective Dates: 12/31/1990

3701-19-22 Quality assessment and performance improvement.

(A) Each hospice care program governing body shall conduct an ongoing, comprehensive, integrated, self-assessment of the quality and appropriateness of care provided by the program, including inpatient care, home care, and care provided under contracts with other persons or public agencies.

Interpretive guideline: This assessment should include all services that were indicated and provided, and the patients' and caregivers' response or outcome to those services.

(B) The hospice care program shall designate an individual or individuals to be responsible for the quality assessment and performance improvement program. The designee or designees shall implement and report on activities and mechanisms for monitoring the quality of care, identify and resolve problems, and make suggestions for improving care. The designee or designees shall provide their reports to the governing body of the program.

(C) The hospice care program shall use the findings of the quality assessment and performance improvement program to correct identified problems and to revise hospice care program policies if necessary.

Effective: 08/23/2009
R.C. 119.032 review dates: 05/19/2009 and 08/15/2014
Promulgated Under: 119.03
Statutory Authority: 3712.03
Rule Amplifies: 3712.01 , 3712.03 , 3712.06
Prior Effective Dates: 12/31/1990, 1/1/05

3701-19-23 Central clinical record.

(A) Each hospice care program shall establish and maintain a central clinical record for each hospice patient receiving care and services from the program and his or her family. The record shall be established and maintained in accordance with accepted standards of practice.

(B) The clinical record shall be a comprehensive compilation of information that is documented promptly for all services provided. The record shall be organized systematically to facilitate retrieval of information. Entries to the clinical record shall be made and signed by the person providing the service. All services, whether furnished by employees, persons under contract, or volunteers, shall be documented in the clinical record.

Interpretive guideline: entries in the clinical record shall be dated and shall be made within a reasonable period of time after the services are provided, which is recommended to be not more than twenty-one days or within other acceptable written standards of practice guidelines.

(C) Each clinical record shall contain at least the following information:

(1) Identification data;

(2) Pertinent medical history, including the physician's diagnosis of terminal illness;

(3) Consent and authorization forms;

(4) Initial and subsequent assessments.

Interpretive guideline: the assessments should include evaluations of physical, psychosocial, and spiritual needs and the need for volunteer and bereavement services;

(5) The interdisciplinary plan of care;

(6) Documentation of all services and events, such as evaluations, treatments, and progress notes;

(7) A statement of whether or not the patient, if an adult, has prepared an advanced directive. "Advanced directive" has the same meaning as "declaration" as defined in section 2133.01 of the Revised Code; and

(8) Transfer and discharge summaries.

(D) The hospice care program shall provide for storage of the central clinical records to protect them against loss, destruction, and unauthorized use. The program also shall have policies and procedures to ensure the confidentiality of records.

(E) A hospice care program which maintains a patient's clinical record electronically shall use an electronic signature system that meets the requirements specified under division (B) of section 3701.75 of the Revised Code. Electronic patient clinical records shall be accessible to the director during inspections.

Effective: 08/23/2009
R.C. 119.032 review dates: 05/19/2009 and 08/15/2014
Promulgated Under: 119.03
Statutory Authority: 3712.03
Rule Amplifies: 3712.01 , 3712.03 , 3712.06
Prior Effective Dates: 12/31/1990, 10/17/99

3701-19-24 Short-term inpatient care.

(A) Each hospice care program shall provide or arrange for the provision of short-term inpatient care to patients who require it for pain control, symptom management, or respite care. The program may operate its own inpatient facility or may contract with one or more other persons or public agencies that operate inpatient facilities for provision of inpatient care. The inpatient facility or facilities that the program uses to provide inpatient care shall be licensed, certified, or accredited in accordance with applicable Ohio law and, in addition, shall meet the requirements of rules 3701-19-25 and 3701-19-26 of the Administrative Code.

Interpretive guidelines: the type of inpatient setting selected for a particular episode shall depend on the needs of the patient. The program shall not place patients in an inpatient facility for the convenience of the program.

(B) Inpatient care for pain control and symptom management shall be provided in a hospice inpatient facility, hospital or a skilled nursing facility. Any such facility used by a hospice care program shall be certified under Title XVIII of the Social Security Act, 49 Stat. 620 (1935), 42 U.S.C. 301 , as amended, accredited by an organization that the United States centers for medicare and medicaid services (CMS) has given deeming authority.

(C) Inpatient care for respite purposes shall be provided:

(1) In a hospice inpatient facility, a hospital, a skilled nursing facility or nursing facility certified under Title XVIII or XIX of the Social Security Act, or a nursing home or residential care facility licensed under Chapter 3721. of the Revised Code; and

(2) Only on an occasional basis and not for more than seven consecutive days unless further limited by payor.

Effective: 08/23/2009
R.C. 119.032 review dates: 05/19/2009 and 08/15/2014
Promulgated Under: 119.03
Statutory Authority: 3712.03
Rule Amplifies: 3712.01 , 3712.04 , 3712.05 , 3712.06
Prior Effective Dates: 12/31/1990, 10/17/99

3701-19-25 Twenty-four hour nursing services in inpatient facilities.

(A) A hospice care program shall ensure that nursing services are available twenty-four hours per day and seven days a week in each inpatient facility used to provide inpatient care to its patients.

(1) Each inpatient facility used by a hospice care program to provide inpatient care to its patients for pain control and symptom management shall provide nursing services twenty-four hours a day. These services shall be sufficient to meet the total nursing needs of the hospice patients residing in the facility. Each shift shall be staffed by a registered nurse who provides direct patient care.

Interpretive guideline: a registered nurse shall be available at all times to render direct "hands-on" care to hospice patients.

(2) Each inpatient facility used by a hospice care program to provide inpatient care to its patients for respite purposes shall provide nursing services twenty-four hours a day or the hospice care program shall provide or arrange for nursing services twenty-four hours a day. These services shall be sufficient to meet the total nursing needs of the hospice patients residing in the facility.

(B) An inpatient facility shall provide each patient's treatments, medications, and diets as prescribed. The facility shall keep each patient comfortable, clean, well-groomed, and protected from accident, injury, and infection.

Interpretive guideline: the number and type of personnel shall be sufficient to meet the total needs of the hospice patients in terms of:

(1) Protecting them from accident and injury by appropriate safety measures;

(2) Assuring that their routine, special, and emergency needs are met at all times; and

(3) Promptly responding to patient calls.

R.C. 119.032 review dates: 05/27/2009 and 05/27/2014

Promulgated Under: 119.03

Statutory Authority: 3712.03

Rule Amplifies: 3712.01 , 3701.04 , 3712.05 , 3712.06

Prior Effective Dates: 12/31/1990, 12/17/99

3701-19-26 Patient areas in inpatient care facilities.

Each inpatient facility used by a hospice care program to provide inpatient care to its patients shall meet the following requirements:

(A) The facility shall have patient areas that are designed and equipped for the comfort and privacy of the patients and their family members.

INTERPRETIVE GUIDELINES: the facility shall ensure comfort by:

(1) Maintaining adequate lighting levels in the patient areas and designing patient areas that are devoid of glare and reflecting surfaces that produce discomfort;

(2) Minimizing the sound level;

(3) Maintaining a comfortable temperature. It is recommended that temperatures not exceed eighty-nine degrees Fahrenheit or fall below seventy-one degrees Fahrenheit, unless a higher or lower temperature is medically indicated, as documented by a physician in the patient's record, or the patient chooses a higher or lower temperature. If such a patient shares his or her room with other patients, the facility should make arrangements to accommodate the needs and desires of the other patients; and

(4) Providing adequate ventilation.

(B) The facility shall have physical space for private patient and family visiting;

(C) The facility shall provide accommodations for family members to remain with the patient throughout the night;

(D) The facility shall provide accommodations for family privacy after a patient's death;

(E) The patient areas in the facility shall have decor which is homelike in design and function.

INTERPRETIVE GUIDELINE: patients shall be permitted to bring personal items into the patient areas.

(F) Patients shall be permitted to receive visitors at any hour, including small children.

INTERPRETIVE GUIDELINE: it is recommended that patients also be permitted to receive visits from pets.

R.C. 119.032 review dates: 05/27/2009 and 05/27/2014

Promulgated Under: 119.03

Statutory Authority: 3712.03

Rule Amplifies: 3712.01 to 3712.06

Prior Effective Dates: 12/31/1990

3701-19-27 Standards for inpatient hospice facilities.

In addition to meeting the other requirements of this chapter, inpatient hospice facilities must meet the following requirements:

(A) Each new inpatient hospice facility shall be inspected by the director to determine compliance with provisions of this rule. The new inpatient hospice facility shall not admit patients until the director has determined that the facility is in compliance with the requirements of this chapter of the Administrative Code.

(B) The inpatient hospice facility shall meet all applicable provisions of the state fire code, adopted pursuant to section 3737.82 of the Revised Code.

(C) The building or buildings in which an inpatient hospice facility is located shall comply with the applicable provisions of the Ohio building code adopted by the board of building standards pursuant to Chapters 3781., 3783., and 3791. of the Revised Code, and have a certificate of use and occupancy issued by the appropriate building authority.

(D) Each new inpatient hospice facility not using a public sewage disposal system shall have its facility sewage disposal system inspected and approved by the local health department, in accordance with Chapter 3701-29 of the Administrative Code.

(E) Each new inpatient hospice facility shall comply with the following requirements:

(1) Each facility shall maintain appropriate space providing optimal comfort and privacy for patients and family members;

Interpretive guidelines: The facility must design and equip areas for the comfort and privacy of each patient and family members by:

(a) Providing decor which is homelike in design and function;

(b) Providing accommodations for family members to remain with the patient;

(c) Ensuring physical space for private patient and family visiting and allowing patients to receive visitors, including small children, at any hour;

(2) Each facility shall maintain appropriate patient rooms.

Interpretive guidelines: Patient rooms must be designed and equipped for adequate nursing care, comfort and privacy of patients. Each room must:

(a) Be equipped with or conveniently located near toilet and bathing facilities;

(b) Be at or above grade level;

(c) Contain an appropriate bed and other appropriate furniture;

(d) Have closet space providing security and privacy for clothing and personal belongings;

(e) Contain no more than four beds;

(f) Measure at least one hundred square feet for a single patient room or eighty square feet for each patient for a multipatient room;

(g) Be equipped for calling the staff member on duty.

(3) Each facility shall maintain appropriate bathroom facilities and plumbing.

Interpretive guidelines: The facility must provide:

(a) An adequate supply of hot water at all times for patient use;

(b) Plumbing fixtures with control valves that automatically regulate the temperature of the hot water used by patients.

(4) Each facility shall provide appropriate linens.

Interpretive guidelines: The hospice care program operating the facility must provide at all times:

(a) A quantity of linen for proper care and comfort of patients; and

(b) Linens must be handled, stored, processed and transported in a manner that prevents the spread of infection.

(5) Each facility shall have provisions for isolating patients with infectious diseases.

(6) Each facility must provide meal service; Interpretive guidelines: The hospice facility providing its own meal service must:

(a) Obtain an appropriate food service license, unless exempt in accordance with section 3717.42 of the Revised Code, or contracting with another licensed food service provider;

(b) Serve at least three meals or their equivalent each day at regular times, with not more than fourteen hours between a substantial evening meal and breakfast;

(c) Procure, store, prepare, distribute and serve all food under sanitary conditions;

(d) Have a staff member trained or experienced in food management or nutrition who is responsible for:

(i) Planning menus that meet the nutritional needs of each patient, following the orders of the patient's physician and, to the extent medically possible, the dietary allowances recommended by the national academy of sciences;

(ii) Supervising the meal preparation and service to ensure that the menu plan is followed;

(e) If the hospice has patients who require medically prescribed special diets, have the menus for those patients planned by a dietician who supervises the preparation and serving of meals to ensure that the patient accepts the special diet.

(7) Each facility must provide pharmaceutical services.

Interpretive guidelines: The facility must:

(a) Provide appropriate methods and procedures for dispensing, administering and disposing of drugs and biologicals;

(i) The facility is responsible for drugs and biologicals for its patients, whether drugs or biologicals are obtained from community or institutional pharmacists or stocked by the facility;

(ii) The facility must ensure that pharmaceutical services are provided in accordance with accepted professional principles and appropriate federal, state and local laws;

(b) Employ a pharmacist or have a formal agreement with a licensed pharmacist to advise the facility on ordering, storage, administration, disposal and recordkeeping of drugs and biologicals;

(c) Ensure that orders for medications are given by a physician or an advanced practice nurse acting within his or her scope of practice;

(i) If the medication order is verbal, the physician or advanced practice nurse must give it only to a licensed nurse, pharmacist, or another physician; and

(ii) The individual receiving the order must record and sign it immediately and have the prescribing physician or advanced practice nurse sign it in a manner consistent with good medical practice.

Effective: 08/23/2009
R.C. 119.032 review dates: 05/19/2009 and 08/15/2014
Promulgated Under: 119.03
Statutory Authority: 3712.03
Rule Amplifies: 3712.01 , 3712.03 , 3712.06
Prior Effective Dates: 1/1/2005

3701-19-28 Variances; waivers.

(A) The director may grant a variance or waiver from any requirement established by Chapter 3701-19 of the Administrative Code, unless the requirement is mandated by statute.

(B) A hospice care program seeking a variance or waiver must submit a written request to the director. Such written request must include the following information:

(1) The rule requirement for which the variance or waiver is requested, with a reference to the relevant Administrative Code provision;

(2) The specific nature of the request, and the rationale for the request;

(3) The time period for which the variance or waiver is requested;

(4) If the request is for a variance, a statement of how the hospice care program will meet the intent of the requirement in an alternative manner; and

(5) If the request is for a waiver, a statement regarding why application of the requirement will cause undue hardship to the hospice care program and why granting the waiver will not jeopardize the health and safety of any patient.

(C) The decision regarding a variance or waiver is a discretionary act by the director and an informal procedure not subject to Chapter 119. of the Revised Code. Upon written request by a hospice care program, the director may grant:

(1) A variance if the director determines that the requirement has been met in an alternative manner; or

(2) A waiver if the director determines that the strict application of the license requirement would cause an undue hardship to the hospice care program and that granting the waiver would not jeopardize the health and safety of any patient.

(D) The director may stipulate a time period for which a variance or a waiver is to be effective and may establish conditions that the hospice care program must meet for the variance or waiver to be operative. Such time period may be different than the time period sought by the hospice care program in the written variance or waiver request.

(E) The director may establish conditions that the hospice care program must meet for the variance or waiver to be operative. The director may, in his discretion, rescind the waiver or variance at any time upon determining that the hospice care program is not meeting such conditions.

(F) The granting of a variance or waiver by the director shall not be construed as constituting precedence for the granting of any other variance or waiver. All variance and waiver requests shall be considered on a case-by-case basis.

(G) The provider whose request for a waiver or variance under this rule is denied may request reconsideration of the decision by the director. A request for reconsideration must:

(1) Be received in writing by the director within thirty days of receipt of the director's denial of a waiver or variance request;

(2) Present significant, relevant information not previously submitted to the director by the provider because it was not available to the provider at the time the waiver or variance request was filed; or

(3) Demonstrate that there have been significant changes in factors or circumstances relied upon by the director in reaching the initial decision

(H) A decision on an appropriately filed request for reconsideration shall be issued within forty-five days of the director's receipt of the request for reconsideration and all information determined necessary by the director to make a decision.

(I) The reconsideration process is an informal procedure not subject to Chapter 119. of the Revised Code. The director's decision on reconsideration is final.

Effective: 11/25/2012
R.C. 119.032 review dates: 05/27/2014
Promulgated Under: 119.03
Statutory Authority: 3712.03
Rule Amplifies: 3712.04 , 3712.06

3701-19-30 Definitions.

As used in rules 3701-19-30 to 3701-19-52 of the Administrative Code:

(A) "Advanced Practice Nurse" means a registered nurse authorized to practice as a certified nurse specialist, certified registered nurse anesthetist, certified nurse midwife or certified nurse practitioner in accordance with section 4723.41 of the Revised Code;

(B) "Applicant" means a person or public agency that submits an application for a license to provide a pediatric respite care program under rule 3701-19-32 of the Administrative Code.

(C) "Attending physician" means the physician identified by the pediatric respite care patient or the pediatric respite care patient's family as having primary responsibility for the pediatric respite care patient's medical care.

(D) "Child Life Specialist" means an individual who has a minimum of a bachelor's degree in child life, child development and other related field.

(E) "Dietitian" means an individual licensed under Chapter 4759. of the Revised Code to practice dietetics.

(F) "Director" means the director of health or any official or employee of the department of health designated by the director of health.

(G) "Governing body" means the entity that has ultimate responsibility and authority for the overall operation of a pediatric respite care program, as specified in rule 3701-19-37 of the Administrative Code.

(H) "Inpatient facility" means a facility that either is operated by or under contract with a pediatric respite care program for the purpose of providing inpatient care to the program's patients.

(I) "Inpatient pediatric respite care facility" means a building or leased unit operated by a pediatric respite care program where the pediatric respite care program directly provides accommodations and pediatric respite care services for its pediatric respite care patients.

(J) "Interdisciplinary plan of care" or "plan of care" means the interdisciplinary plan for care of a pediatric respite care patient and his or her family prepared under rule 3701-19-40 of the Administrative Code.

(K) "Interdisciplinary team" means a working unit composed of professional and lay persons that includes at a minimum a physician, a registered nurse, a social worker, a child life specialist, and a member of the clergy or a counselor.

(L) "Licensed Practical Nurse" means a person licensed under Chapter 4723. of the Revised Code to practice nursing as a licensed practical nurse.

(M) "Nurse" means a registered nurse or licensed practical nurse.

(N) "Palliative care" means treatment for a patient with a serious or life-threatening illness directed at controlling pain, relieving other symptoms, and enhancing the quality of life of the patient and the patient's family rather than treatment for the purpose of cure. Nothing in this section shall be interpreted to mean that palliative care can be provided only as a component of a pediatric respite care program.

(O) "Pediatric respite care patient" or "patient" means a patient, other than a hospice patient, who is less than twenty-seven years of age who has been diagnosed with a disease or condition prior to the age of eighteen that is life threatening and is expected to shorten the life expectancy that would have applied to the patient absent the patient's diagnosis, regardless of whether the patient is terminally ill, who has voluntarily requested and is receiving care from a licensed pediatric respite care program.

(P) "Pediatric respite care program" means a program operated by a person or public agency that provides inpatient respite care and related services, including all of the following services, only to pediatric respite care patients and pediatric respite care patients' families, in order to meet the physical, psychological, spiritual, and other special needs that are experienced during or leading up to the final stages of illness, dying, and bereavement:

(1) Short-term inpatient care, including both palliative and respite care and procedures;

(2) Nursing care by or under the supervision of a registered nurse;

(3) Physicians' services;

(4) Medical social services by a social worker under the director of a physician;

(5) Medical supplies, including drugs and biologicals, and the use of medical appliances;

(6) Counseling for pediatric respite care patients and pediatric respite care patients' families; and

(7) Bereavement services for respite care patients' families.

(Q) "Pediatric respite care program patient's family" or "family" means a pediatric respite care program patient's immediate family members, including a spouse, brother, sister, child, parent, and any other relative or individual who has significant personal ties to the patient and who is designated as a member of the patient's family by mutual agreement of the patient, the relative or individual, and the patient's interdisciplinary team.

(R) "Person" means an individual, corporation, business trust, estate, trust, partnership, limited liability company, and association.

(S) "Physician" means a person authorized under Chapter 4731. of the Revised Code to practice medicine and surgery or osteopathic medicine and surgery.

(T) "Registered nurse" means a person registered under Chapter 4723. of the Revised Code to practice professional nursing.

(U) "Respite care" means inpatient care services provided by the pediatric respite care program to give temporary relief to a pediatric respite care patient's family or other caregivers.

(V) "Short-term" means a period of respite care up to and including, twenty-eight days.

(W) "Social worker" means a person licensed under Chapter 4757. of the Revised Code to practice as a social worker or independent social worker.

(X) "Volunteer" means a lay or professional person who provides his or her services to a pediatric respite care program without compensation.

Effective: 12/26/2013
R.C. 119.032 review dates: 12/01/2018
Promulgated Under: 119.03
Statutory Authority: 3712.031
Rule Amplifies: 3712.031 , 3712.041 , 3712.051 , 3712.061 , 3712.09 , 3712.99

3701-19-31 Applicability of licensure requirements.

(A) Every person or public agency that proposes to provide a pediatric respite care program shall apply to the director for a license in accordance with rule 3701-19-31 of the Administrative Code.

(B) Except as provided in paragraph (C) of this rule, no person or public agency, other than a person or public agency licensed under section 3712.041 of the Revised Code and this chapter, shall hold itself out as providing a pediatric respite care program, or provide a pediatric respite care program, or use the term "pediatric respite care" or any term containing "pediatric respite care" to describe or refer to a health program, facility, or agency.

(C) Paragraph (A) of this rule does not apply to any of the following:

(1) A hospital;

(2) A nursing home or residential care facility, as those terms are defined in section 3721.01 of the Revised Code;

(3) A home health agency, if it provides services under contract with a person or public agency providing a pediatric respite care program licensed under section 3712.041 of the Revised Code;

(4) A regional, state, or national nonprofit organization whose members are providers of pediatric respite care programs, individuals interested in pediatric respite care programs, or both, as long as the organization does not provide or represent that it provides pediatric respite care programs;

(5) A person or government entity certified under section 5123.161 of the Revised Code as a supported living provider;

(6) A residential facility licensed under section 5123.19 of the Revised Code;

(7) A respite care home certified under section 5126.05 of the Revised Code;

(8) A person providing respite care under a family support services program established under section 5126.11 of the Revised Code; or

(9) A person or government entity providing respite care under a medicaid waiver component that the department of developmental disabilities administers pursuant to section 5111.871 of the Revised Code.

Effective: 12/26/2013
R.C. 119.032 review dates: 12/01/2018
Promulgated Under: 119.03
Statutory Authority: 3712.031
Rule Amplifies: 3712.031 , 3712.041 , 3712.051 , 3712.061 , 3712.09 , 3712.99

3701-19-32 License application, amended license, and renewal procedures.

(A) Application for license as a pediatric respite care program shall be made on forms prescribed and provided by the director shall include such information as the director requires, including the information prescribed by paragraph (C) of this rule, and shall be accompanied by a non-refundable license fee of six hundred dollars in the form of a check or money order payable to the 'Treasurer, State of Ohio."

(B) Any person or public agency seeking to be licensed to provide a pediatric respite care program shall submit an application for licensure at least sixty days prior to the requested date for the inspection required by paragraph (A) of rule 3701-19-34 of the Administrative Code.

(C) An application for a license to provide a pediatric respite care program shall include:

(1) The name, address, and business telephone number of the pediatric respite care program;

(2) The names and addresses of the persons having an ownership or control interest in the pediatric respite care program and other information pertaining to ownership or control of the program;

(3) The corporate name of the pediatric respite care program, if any, and the names, titles, addresses, and telephone numbers of its officers and statutory agent;

(4) A list of the services which are or will be provided by the pediatric respite care program either directly or indirectly through written contracts;

(5) If services are to be provided through contract, the identities of any contractors and the services they will provide;

(6) The number of pediatric respite care patient rooms in the pediatric respite care program facility; and

(7) Documentation of compliance with the building code standards required by paragraph (C) of rule 3701-19-48 of the Administrative Code.

(D) The applicant or an authorized representative shall sign an affidavit included in the application certifying that, to the best of his or her knowledge, the information in the application and any accompanying material is true and accurate. If a representative signs the affidavit, he or she shall include documentation that he or she is the applicant's authorized representative.

(E) An application for renewal of a license shall be made at least ninety days prior to the expiration of the license. The application shall be made and a renewal fee paid in accordance with paragraph (A) of this rule in the same manner as for an initial license. A pediatric respite care program shall submit documentation of continued compliance with the Ohio fire code required by paragraph (C) of rule 3701-19-48 of the Administrative Code, and a certificate of occupancy required by paragraph (C) of rule 3701-19-48 of the Administrative Code only if it is different than the one previously submitted to the director. The director shall renew the license if the program continues to meet the requirements of Chapter 3712. of the Revised Code and Chapters 3701-19 and 3701-13 of the Administrative Code. If the program does not meet the requirements, the director may deny renewal of the license, in accordance with Chapter 119. of the Revised Code.

(F) When reviewing a license application, the director may request, in writing, that an applicant furnish any additional information that the director determines to be necessary to assess compliance with Chapter 3712. of the Revised Code and this chapter. The applicant shall furnish any requested information within fourteen days after the mailing of the director's request.

(G) A pediatric respite care program operating in another state seeking to provide services to patients in Ohio shall establish an administrative office in Ohio and comply with the rules of Chapter 3701-19 of the Administrative Code in order to obtain a license. All pediatric respite patients' clinical records shall be maintained at the Ohio administrative office.

(H) Each licensed pediatric respite care program shall notify the director, in writing, of any of the following:

(1) Any change in any of the information specified in the license application under paragraphs (C)(1) to (C)(5) of this rule no later than fifteen days after the change;

(a) A change of ownership shall require the submission of a change of ownership application on forms prescribed and provided by the director; and

(b) A non-refundable fee of two hundred dollars in the form of a check or money order payable to the "Treasurer, State of Ohio."

(2) Any other change that would render the information submitted in the license application inaccurate at least twenty-one days prior to the effective date of the change; and

(3) Any intent to cease operation at least sixty days prior to ceasing operation. This notification shall include a plan for assuring continuity of care for the program's patients and their families after the program ceases operation. The plan shall include procedures for assuring continuity of care for all pediatric respite care patients that includes the folowing:

(a) Provision of written notice of the proposed closure of the program, at least sixty days prior to ceasing operation, to each patient or patient's family;

(b) Development of a written discharge plan to be placed in each patient's record to assist the person or public agency that will be responsible for care of the patient and the patient's family after the program ceases operation; and

(c) Obtaining from each patient or the patient's authorized representative written approval of any transfer to another licensed pediatric respite care program and written authorization to release pertinent clinical record information to such a program or another person or public agency that will assume responsibility for the patient's and family's care.

(I) Each licensed pediatric respite care program that seeks to increase or decrease the number of pediatric respite care patient rooms as reported under paragraph (C)(6) of this rule, shall apply for an amended license.

(1) Application for an amended license shall be made on forms prescribed and provided by the director, shall include such information as the director requires, and shall be accompanied by a non-refundable amended license fee in the form of a check or money order payable to the "Treasurer, State of Ohio" in the following amounts:

(a) A decrease in the number of patient rooms not involving a renovation, a fee of two hundred dollars;

(b) An increase in the number of patient rooms not involving a renovation, a fee of two hundred dollars; or

(c) An increase in the number of patient rooms involving a renovation, a fee of six hundred dollars.

(2) Any increase in the number of pediatric respite care patient rooms shall require an inspection in accordance with rule 3701-19-34 of the Administrative Code.

Effective: 12/26/2013
R.C. 119.032 review dates: 12/01/2018
Promulgated Under: 119.03
Statutory Authority: 3712.031
Rule Amplifies: 3712.031 , 3712.041 , 3712.051 , 3712.061 , 3712.09 , 3712.99

3701-19-33 Issuance, denial, transfer, and revocation of a license.

(A) The director shall grant a license for provision of a pediatric respite care program to an applicant that complies with Chapter 3712. of the Revised Code and this chapter. A pediatric respite care program is licensed to provide:

(1) Short-term inpatient care, including both palliative and respite care and procedures;

(2) Nursing care by or under the supervision of a registered nurse;

(3) Physicians' services;

(4) Medical social services by a social worker under the director of a physician;

(5) Medical supplies, including drugs and biologicals, and the use of medical appliances;

(6) Counseling for pediatric respite care patients and pediatric respite care patients' families; and

(7) Bereavement services for respite care patients' families.

(B) The director shall provide electronic or written notice to the applicant granting a license or provide written notice of proposal to deny a license, within thirty days after receiving all information necessary to determine compliance with Chapter 3712. of the Revised Code and this chapter, including the reports of the inspection conducted pursuant to paragraph (A) of rule 3701-19-34 of the Administrative Code. This thirty-day period shall be extended if the director has received a complaint concerning an applicant. In such a case, the director shall conduct a complaint investigation within thirty days after receipt of the complaint and shall mail written notice of the determination regarding the license application within thirty days after completion of the complaint investigation.

(C) The license shall:

(1) Indicate the name and address of the pediatric respite care program location to which the applicant requested the license be issued;

(2) Indicate the facility patient capacity;

(3) Be valid for three years for the pediatric respite care program at the address indicated in the application except as provided for in paragraph (F) of this rule; and

(4) Be posted in a conspicuous place in the pediatric respite care program location issued the license.

(D) Subject to Chapter 119. of the Revised Code, the director may deny, suspend, or revoke a license if the licensee made any material misrepresentation in the application for licensure or if the pediatric respite care program no longer meets the requirements of Chapter 3712. of the Revised Code or this chapter.

(E) A pediatric respite care program that seeks to transfer its license to another or new location shall submit a license application and license application fee in accordance with paragraph (A) of rule 3701-19-32 of the Administrative Code. The application shall include all information required by paragraph (C) of rule 3701-19-21 of the Administrative Code and must be received by the director no later than ninety days prior to the current license expiration or ninety days prior to the proposed transfer or relocation, whichever occurs sooner.

(1) When reviewing a request for transfer of a license, the director may request any additional written information the director determines necessary to assess compliance with Chapter 3712. of the Revised Code and this chapter are met.

(2) The director shall allow a license to be transferred if the following criteria are met:

(a) The new location to which the pediatric respite care program license is to be transferred successfully passes a licensure inspection conducted in accordance with rule 3701-19-34 of the Adminsitrative Code;

(b) The pediatric respite care program currently meets all of the licensing requirements and there are no pending complaints against the pediatric respite care program under investigation. Any pending complaints shall be investigated within thirty days of the request for transfer and must be completed before any transfer of the license may occur;

(c) The pediatric respite care program is not undergoing any enforcement action at the time of the transfer or relocation or proposed transfer or relocation;

(d) The transfer or relocation is not due to a change in ownership or control;

(e) The pediatric respite care program continues to provide the full range of services at the new location that were required of the pediatric respite care program location that was issued the license;

(f) All pediatric respite patients' clinical records are available, upon request of the director, at the new location to which the pediatric respite license is to be transferred; and

(g) The approval to transfer the license may be granted with no less than sixty-one days remaining prior to the expiration of the current license.

(3) The director shall notify the pediatric respite care program of whether or not the license may be transferred. If the director determines that the license is not transferable, the director shall provide the pediatric respite care program with an opportunity for a reconsideration:

(a) The pediatric respite care program shall request a reconsideration in writing within thirty days of the mailing of the notice of determination.

(b) The request shall include any written documentation or other information not previously submitted to the director that the pediatric respite care program wishes to refute the determination.

(c) The director's final determination is not appealable under Chapter 119. of the Revised Code.

(d) The pediatric respite care program shall obtain a license for the new location prior to commencing services at the new location.

(F) Upon written request, the director may grant a variance from any requirement of this chapter, that is not a statutory requirement, if the person or public agency requesting the variance establishes that because of practical difficulties or other special conditions, strict application of the requirement will cause unusual or unnecessary hardship and that the variance will not jeopardize the health, safety, or welfare of any pediatric respite patient or pediatric respite patient's family.

Effective: 12/26/2013
R.C. 119.032 review dates: 12/01/2018
Promulgated Under: 119.03
Statutory Authority: 3712.031
Rule Amplifies: 3712.031 , 3712.041 , 3712.051 , 3712.061 , 3712.09 , 3712.99

3701-19-34 Inspections.

(A) Prior to issuing a license for a pediatric respite care program, the director shall conduct an announced licensure inspection of the applicant's facilities and services.

(B) The director shall conduct an unannounced licensure inspection of each licensed pediatric respite care program's facilities and services at a minimum frequency of once every three years. The director may conduct additional inspections of any licensed pediatric respite care program at any other time he or she considers necessary including, but not limited to, investigating complaints.

(C) Prior to issuing an amended license for an increase in pediatric respite care patient rooms, the director shall conduct an announced licensure inspection of all pediatric respite care patient rooms being added to the license;

(D) For purposes of this paragraph, "follow-up inspection" means an inspection, which may include on-site and off-site activities, conducted by the department to determine whether the pediatric respite care program has corrected a violation or violations cited on a previous inspection. The fees for inspections conducted by the director pursuant to section 3712.031 of the Revised Code and paragraphs (A) and (B) of this rule shall be as follows:

(1) Licensure inspection fee of one thousand six hundred twenty-five dollars;

(2) Amended license inspection for an increase in pediatric respite care patient rooms fee of eight hundred twenty-five dollars;

(3) Complaint inspection fee of eight hundred fifty dollars;

(4) Follow-up inspection fee of three hundred fifty dollars; and

(5) Desk audit or compliance review inspection fee of two hundred fifty dollars.

(E) Each pediatric respite care program shall provide the director access to its premises and staff at all times and to pertinent records upon request. The program shall ensure that the director has access to all parts of its facilities, services, and records, including any services provided under contract with the program. The inspections may include direct interaction with patients and their families, with the patients' or families' consent.

(F) If an inspection of an applicant's pediatric respite care program or of a licensed program reveals a violation or violations of Chapter 3712. of the Revised Code or of Chapter 3701-19 or 3701-13 of the Administrative Code, the director, in his or her discretion, may require submission of a plan of correction for each violation. The pediatric respite care program shall submit the plan within fourteen days after receiving the director's notification that a plan of correction is required.

Effective: 12/26/2013
R.C. 119.032 review dates: 12/01/2018
Promulgated Under: 119.03
Statutory Authority: 3712.031
Rule Amplifies: 3712.031 , 3712.041 , 3712.051 , 3712.061 , 3712.09 , 3712.99

3701-19-35 Compliance actions and operating without a license.

(A) The department of health shall petition the court of common pleas of any county in which a person or public agency, without a license granted under section 3712.041 of the Revised Code, is holding itself out as providing a pediatric respite care program, is providing a pediatric respite care program, or is representing a health program, facility, or agency as a pediatric respite care program, for an order enjoining that person or public agency from conducting those activities without a license. The court has jurisdiction to grant injunctive relief upon a showing that the respondent named in the petition is conducting those activities without a license.

(B) Any person or public agency may request the department to petition the court for injunctive relief under this division, and the department shall do so if it determines that the person or public agency named in the request is violating paragraph (A) of this rule.

Effective: 12/26/2013
R.C. 119.032 review dates: 12/01/2018
Promulgated Under: 119.03
Statutory Authority: 3712.031
Rule Amplifies: 3712.031 , 3712.041 , 3712.051 , 3712.061 , 3712.09 , 3712.99

3701-19-36 General requirements for pediatric respite care programs.

(A) Any person or public agency licensed under section 3712.041 of the Revised Code and this chapter to provide a pediatric respite care program shall:

(1) Provide a planned and continuous pediatric respite care program, the medical components of which shall be under the direction of a physician;

(2) Ensure that care is available twenty-four hours a day and seven days a week;

(3) Establish an interdisciplinary plan of care for each pediatric respite patient and their family as prescribed by rule 3701-19-40 of the Administrative Code that:

(a) Is coordinated by one designated individual who shall ensure that all components of the plan of care are addressed and implemented;

(b) Addresses maintenance of patient-family participation in decision making; and

(c) Is periodically reviewed by the patient's attending physician and by the patient's interdisciplinary team.

(4) Have an interdisciplinary team or teams that provide or supervise the provision of care and establish the policies governing the provision of the care;

(5) Provide bereavement counseling as prescribed by rule 3701-19-46 of the Administrative Codefor pediatric respite patients' families if requested;

(6) Maintain clinical records as prescribed by rule 3701-19-50 of the Administrative Code on all pediatric respite patients under its care in a central location.

(B) A component or components of the care provided by a pediatric respite care program may be provided under a written contract with another person or public agency, pursuant to rule 3701-19-41 of the Administrative Code.

(C) After receiving a license, a pediatric respite care program shall comply with all requirements of Chapter 3712. of the Revised Code, Chapter 3701-13 of the Adminsitrative Code, and Chapter 3701-19 of the Administrative Code.

(D) Interpretive guidelines for pediatric respite care programs are available at www.odh.ohio.gov/odhprograms/chcf/PedRsptCare.aspx.

Effective: 12/26/2013
R.C. 119.032 review dates: 12/01/2018
Promulgated Under: 119.03
Statutory Authority: 3712.031
Rule Amplifies: 3712.031 , 3712.041 , 3712.051 , 3712.061 , 3712.09 , 3712.99

3701-19-37 Governing body; quality assessment and performance improvement.

(A) The overall conduct and operation of the pediatric respite care program, including the quality of care and the provision of services, shall be the full legal responsibility of a clearly defined, organized governing body.

(B) The governing body of a licensed hospice care program may also provide governance for a pediatric respite care program if the programs are dually licensed and meet all requirements set forth in this rule and chapter.

(C) The governing body shall:

(1) Establish and review policies for the management, operation, and evaluation of the pediatric respite program, including, but not limited to:

(a) Qualifications of employees and independent contractors; and

(b) Policies and procedures to receive and respond to patient grievances regarding medical treatment, quality of care, the lack of respect for person or property, mistreatment, neglect, verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of patient property by any individual furnishing services on behalf of the pediatric respite care program. The policies and procedures developed by the governing body shall, at a minimum, include:

(i) Notification procedures for pediatric respite care patients, employees and contracted staff to report alleged violations to the pediatric respite care program administration;

(ii) Requirements for the immediate investigation of alleged violations;

(iii) Procedures for the reporting of verified violations to the appropriate state licensing authority and/or local authorities where appropriate; and

(iv) Requirements for timely corrective actions for all verified violations.

(2) Arrange for a physician to serve as medical director for the pediatric respite care program who:

(a) Should be knowledgeable about the psychological, social, and medical aspects of pediatric respite care as the result of training, experience, and interest; and

(b) Shall designate a physician to act in his or her absence; and

(c) The medical director may also may serve as the physician representative on an interdisciplinary team or teams or as an attending physician.

(3) Appoint a qualified individual to serve as the director of the pediatric respite care program who shall perform the following duties:

(a) Be responsible for the day-to-day management of the program and for assuring compliance with Chapter 3712. of the Revised Code, Chapter 3701-13, and this chapter of the Administrative Code;

(b) Implement the pediatric respite care program's policies and procedures regarding all activities and services provided by the pediatric respite care program;

(c) Designate an individual to act in his or her absence;

(d) Implement the pediatric respite care program's quality assessment and performance improvement program under rule 3701-19-52the Administrative Code; and

(e) Implement the pediatric respite care program's patient grievance program established under paragraph (A)(2) of this rule.

(4) Ensure that all services provided are consistent with accepted standards of practice for pediatric respite care.

(5) Evaluate the pediatric respite care program's quality assessment and performance improvement program on an annual basis.

(D) Each pediatric respite care program governing body shall conduct an ongoing, comprehensive, integrated, self-assessment of the quality and appropriateness of care provided by the program, including care provided under contracts with other persons or public agencies.

(E) The pediatric respite care program governing body shall designate an individual or individuals to be responsible for the quality assessment and performance improvement program. The designee or designees shall implement and report on activities and mechanisms for monitoring the quality of care, identify and resolve problems, and make suggestions for improving care. The designee or designees shall provide their reports to the governing body of the program. The pediatric respite care program shall use the findings of the quality assessment and performance improvement program to correct identified problems and to revise pediatric respite care program policies if necessary.

(F) The pediatric respite care program governing body shall use the findings of the quality assessment and performance improvement program to correct identified problems and to revise pediatric respite care program policies if necessary.

Effective: 12/26/2013
R.C. 119.032 review dates: 12/01/2018
Promulgated Under: 119.03
Statutory Authority: 3712.031
Rule Amplifies: 3712.031 , 3712.041 , 3712.051 , 3712.061 , 3712.09 , 3712.99

3701-19-38 General requirements for pediatric respite care program personnel.

(A) Each pediatric respite care program shall utilize personnel that have appropriate training and qualifications for the services that they provide. Any staff member, including a volunteer, who functions in a professional capacity, shall meet the standards applicable to that profession, including but not limited to possessing current Ohio licensure, registration, or certification, if required by law, and practicing within the applicable scope of practice.

(B) The pediatric respite care program shall provide each staff member, including volunteer and contracted staff members, with a written job description delineating his or her responsibilities. The program shall ensure that the services provided by staff members, including volunteers and contracted staff, are provided:

(1) In accordance with the patients' plans of care;

(2) In accordance with the policies and procedures developed by the interdisciplinary team;

(3) In accordance with current and accepted standards of practice;

(4) Documented in the patient's central clinical record; and

(5) By staff members who comply with the program's employee health policies.

(a) The pediatric respite care program shall have written employee health policies which include the following requirements for any staff member, including a volunteer, temporary agency employee, or paid consultant used by the pediatric respite care program who has direct pediatric respite patient contact;

(b) The pediatric respite care program shall have a written plan to ensure the health and safety of pediatric respite patients that includes policies and procedures regarding screening of staff, including volunteers, for communicable diseases.

(c) The pediatric respite care program shall have written policies and procedures regarding measures taken to prevent staff, including volunteers, with direct pediatric respite patient contact who have been diagnosed with a communicable disease from transmitting this disease to patients, care givers or other staff. The policies shall indicate when infected or ill staff must not render direct patient care; and

(d) The pediatric respite care program shall document, as applicable, compliance with U.S. department of labor's occupational safety and health administration, U.S. centers for disease control and prevention and applicable Ohio department of health standards concerning health requirements for staff provision of services in health care settings, including requirements for maintaining tuberculosis control.

(C) Each pediatric respite care program shall ensure that all personnel treat each patient and the patient's property with respect, not abuse or neglect patients, and not misappropriate a patient's property.

(D) Each pediatric respite care program shall provide both orientation and onging training for its personnel, including volunteers if the pediatric respite care program utilizes volunteers.

(E) Each pediatric respite care program shall evaluate the performance of each staff member regularly.

(F) Except as provided in Chapter 3701-13 of the Administrative Code, no pediatric respite care program shall employ a person who applies on or after January 27, 1997, for a position that involves the provision of direct care, if the person:

(1) Has been convicted of or pleaded guilty to an offense listed in division (C)(1) of section 3712.09 of the Revised Code; or

(2) Fails to complete the form(s) or provide fingerprint impressions as required by division (B)(3) of section 3712.09 of the Revised Code.

(G) Nothing in this rule shall prohibit the continuation of care or provision of services by a home health agency, hospice care program, or other personal care services provider that is under contract with the pediatric respite care patient or the pediatric respite care patient's family while the pediatric respite care patient is at the respite facility. If a pediatric respite care patient or pediatric respite care patient's family wishes to have privately contracted services continue while the pediatric respite care patient is in the repsite facility, the pediatric respite care program shall:

(1) Enter into a written agreement with each of the following:

(a) The pediatric respite care patient, the pediatric respite care patient's family, or both; and

(b) The provider of the identified service.

(2) The written agreement required by this paragraph shall include a statement signed by all parties acknowledging that they understand the agreement and that the pediatric respite care patient's needs will be met while the pediatric respite care patient is in the respite facility. The agreement shall not be complete without this signed statement. Additionally, the agreement shall include a statement:

(a) Identifying the services to be provided;

(b) That all care shall be provided within the provider's scope of practice;

(c) That all care provided shall be documented and made part of the pediatric respite care patient's medical record; and

(d) That all services will be furnished in accordance with the requirements of Chapter 3712. of the Revised Code and Chapters 3701-13 and 3701-19 of the Administrative Code.

Effective: 12/26/2013
R.C. 119.032 review dates: 12/01/2018
Promulgated Under: 119.03
Statutory Authority: 3712.031
Rule Amplifies: 3712.031 , 3712.041 , 3712.051 , 3712.061 , 3712.09 , 3712.99

3701-19-39 Medical director.

(A) The medical director of a pediatric respite care program shall be a physician and have overall responsibility for the medical component of the program.

(B) The duties of the medical director shall include:

(1) Reviewing patient medical eligibility for pediatric respite care services;

(2) Participating as a member of the interdisciplinary team or teams in the development of individual plans of care or assuring that one or more other qualified physicians participate on the team or teams;

(3) Consulting with attending physicians, when appropriate, regarding pain and symptom management;

(4) Assuring overall continuity of the pediatric respite care program's medical services, including availability of physician services for routine and emergency situations;

(5) Acting as liaison between patients' attending physicians and the interdisciplinary team or teams;

(6) Establishing health policies for employees of the pediatric respite care program; and

(7) Serving as liaison with community physicians, medical schools, and hospitals.

Effective: 12/26/2013
R.C. 119.032 review dates: 12/01/2018
Promulgated Under: 119.03
Statutory Authority: 3712.031
Rule Amplifies: 3712.031 , 3712.041 , 3712.051 , 3712.061 , 3712.09 , 3712.99

3701-19-40 Interdisciplinary team and interdisciplinary plan of care.

(A) Each pediatric respite care program shall have an interdisciplinary team or teams that provides or supervises the provision of pediatric respite care and services. The governing body of the pediatric respite care program shall designate a registered nurse that is a member of an interdisciplinary team to coordinate the overall functioning of that interdisciplinary team to ensure all of the following:

(1) There is ongoing assessment of the pediatric respite patient's and family's needs;

(2) That all components of the plan of care are addressed by the interdisciplinary team; and

(3) The plan of care is implemented in accordance with its terms.

(B) The interdisciplinary team or teams shall perform the following functions:

(1) Establish policies and procedures governing the provision of care. If the pediatric respite care program has more than one interdisciplinary team, it designate which team is to be responsible for establishing the policies and procedures or it shall specify particular areas for which each team is to establish policies and procedures.

(2) Establish an interdisciplinary plan of care for each pediatric respite care patient and family;

(a) The interdisciplinary plan of care should include a statement indicating the expected frequency of admission to the pediatric respite care program's facility; and

(b) The interdisciplinary plan of care shall be reviewed and revised if necessary, upon each subsequent admission.

(3) Review the interdisciplinary plan of care on a periodic basis while the pediatric respite care patient is at the respite facility, no less frequently than every seven days;

(4) Encourage and foster active involvement of the patient and family in the development and implementation of the interdisciplinary plan of care; and

(5) Evaluate the pediatric respite care and services provided and monitor the continuity of care across all settings for the pediatric respite care program's patients and their families.

(C) A pediatric respite care program shall ensure that each patient's attending physician, if any, or the pediatric respite care program medical director, periodically reviews the patient's plan of care.

Effective: 12/26/2013
R.C. 119.032 review dates: 12/01/2018
Promulgated Under: 119.03
Statutory Authority: 3712.031
Rule Amplifies: 3712.031 , 3712.041 , 3712.051 , 3712.061 , 3712.09 , 3712.99

3701-19-41 Contracted services.

(A) A provider of a pediatric respite care program may arrange for another person or public agency to furnish a component or components of the pediatric respite care program pursuant to a written contract.

(B) When a provider of a pediatric respite care program arranges for home health agency or hospice care program to furnish a component or components of the pediatric respite care program to its patient, the care shall be provided by a licensed, certified, or accredited hospital, home providing nursing care, home health agency, or hospice care program pursuant to a written contract under which:

(1) The provider of pediatric respite care program furnishes to the contractor a copy of the pediatric respite care patient's interdisciplinary plan of care that is established under division (C) of section 3712.06 of the Revised Code and rule 3701-19-40 of the Administrative Code and specifies the care that is to be furnished by the contractor;

(2) The regimen described in the established plan of care is continued while the pediatric respite care patient receives care from the contractor, subject to the patient's needs, and with approval of the coordinator of the interdisciplinary team designated pursuant to division (C)(1) of section 3712.06 of the Revised Code and paragraph (A) of rule 3701-19-40 of the Administrative Code;

(3) All care, treatment, and services furnished by the contractor are entered into the pediatric respite patient's medical record;

(4) The designated coordinator of the interdisciplinary team ensures conformance with the established plan of care;

(5) A copy of the medical record and discharge summary maintained by the contractor is retained as part of the pediatric respite patient's medical record; and

(6) The contractor complies with the requirements of Chapter 3712. of the Revised Code, and this chapter as applicable to the contracted service.

(C) Any contract executed pursuant to this rule shall be legally binding on both parties and shall do all of the following:

(1) Identify the services that may be provided;

(2) Stipulate that services may be provided only with the express authorization of the pediatric respite care program;

(3) Describe the manner in which the contracted services are coordinated, supervised, and evaluated by the pediatric respite care program;

(4) Delineate the role or roles of the pediatric respite care program and the contractor in the admission process, patient and family assessment, and the interdisciplinary team reviews;

(5) Stipulate the requirements for documenting that services are furnished in accordance with the contract and the requirements of Chapter 3712. of the Revised Code, Chapter 3701-13 and this chapter of the Administrative Code;

(6) Set forth the qualifications of the personnel providing the services; and

(7) Stipulate that the pediatric respite care program shall provide pediatric respite care orientation and training, in accordance with paragraph (E) of rule 3701-19-38 of the Administrative Code, to the contractor's personnel who provide the care under the contract.

(D) The pediatric respite care program shall assure the continuity of patient and family care.

(E) The pediatric respite care program shall retain professional management responsibility for contracted services and shall ensure that those services are furnished in a safe and effective manner, by persons meeting the qualifications prescribed by Chapter 3701-13 and this chapter of the Administrative Code, and in accordance with the patient's plan of care and the other requirements of this chapter.

Effective: 12/26/2013
R.C. 119.032 review dates: 12/01/2018
Promulgated Under: 119.03
Statutory Authority: 3712.031
Rule Amplifies: 3712.031 , 3712.041 , 3712.051 , 3712.061 , 3712.09 , 3712.99

3701-19-42 Volunteers.

(A) Each pediatric respite care program may use volunteers to assist with the provision of administrative or direct patient care services and may have trained volunteers available to pediatric respite patients and pediatric respite patients' families as needed. Volunteers shall provide services under the supervision of a designated qualified and experienced pediatric respite care program staff member.

(B) Each pediatric respite care program that uses volunteers shall provide orientation and ongoing training to the volunteers it uses that is consistent with acceptable standards of pediatric respite care practice.

(1) The pediatric respite care program's goals and services;

(2) Confidentiality and protection of patient and family rights;

(3) Procedures for responding to medical emergencies or death;

(4) The physiological and psychological aspects of the life-threatening diseases or conditions for which the pediatric respite care progam provides services;

(5) Family dynamics, coping mechanisms, and psychological issues surrounding life-threatening disease or condition, death and bereavement;

(6) Safety policies and procedures; and

(7) General communication skills.

Effective: 12/26/2013
R.C. 119.032 review dates: 12/01/2018
Promulgated Under: 119.03
Statutory Authority: 3712.031
Rule Amplifies: 371.031, 3712.041 , 3712.051 , 3712.061 , 3712.09 , 3712.99

3701-19-43 Nursing services.

(A) Each pediatric respite care program shall provide nursing care and services by or under the supervision of a registered nurse. The program shall direct and staff nursing services to meet the nursing needs of all of the pediatric respite care program's patients. The program shall specify the patient care responsibilities of nursing personnel.

(B) A registered nurse shall be responsible for the supervision and oversight of all nursing services. It is recommended that the nursing services supervisor have education or experience or both in the nursing care needs of pediatric respite patients and the needs of pediatric respite patients' families.

(C) As used in this rule, "supervision" means monitoring and directing the provision of nursing care and services by record review, written or verbal instructions, review of interdisciplinary care plans, or direct observation.

(D) The pediatric respite care program shall ensure that nursing care is available twenty-four hours a day and seven days a week.

(E) The pediatric respite care program shall ensure that all of its policies and procedures are available and accessible to all nursing personnel.

Effective: 12/26/2013
R.C. 119.032 review dates: 12/01/2018
Promulgated Under: 119.03
Statutory Authority: 3712.031
Rule Amplifies: 3712.031 , 3712.041 , 3712.051 , 3712.061 , 3712.09 , 3712.99

3701-19-44 Medical social services.

(A) Each pediatric respite care program shall make medical social services available to each patient and his or her family as needed. Medical social services shall be provided by a social worker under the direction of a physician.

(B) The medical social service needs of each pediatric respite patient and his or her family shall be considered in conjunction with other services when the interdisciplinary team reviews the patient's and family's status.

(C) Medical social services shall be provided in a timely manner in accordance with pediatric respite care program's policy.

Effective: 12/26/2013
R.C. 119.032 review dates: 12/01/2018
Promulgated Under: 119.03
Statutory Authority: 3712.031
Rule Amplifies: 3712.031 , 3712.041 , 3712.051 , 3712.061 , 3712.09 , 3712.99

3701-19-45 Medical services.

(A) A pediatric respite care patient may identify his or her own attending physician or may designate the pediatric respite care program medical director to be their attending physician.

(B) Each pediatric respite care program shall provide or coordinate:

(1) Effective palliation and management of life-threatening disease or condition and related conditions; and

(2) Medical services which meet the medical needs of the patient that are not otherwise met by the patient's:.

(a) Attending physician;

(b) A physician assistant under the supervision, control, or direction of a physician; or

(c) An advanced practice nurse, who is acting within his or her scope of practice and who is working in collaboration with a physician.

(C) All medical orders for treatment, procedures, tests, and medications shall be signed by:

(1) A physician;

(2) A physician assistant under the supervision, control, or direction of a physician; or

(3) An advanced practice nurse, who is acting within his or her scope of practice and who is working in collaboration with a physician.

Effective: 12/26/2013
R.C. 119.032 review dates: 12/01/2018
Promulgated Under: 119.03
Statutory Authority: 3712.031
Rule Amplifies: 3712.031 , 3712.041 , 3712.051 , 3712.061 , 3712.09 , 3712.99

3701-19-46 Counseling and bereavement service.

(A) Each pediatric respite care program shall make available counseling services to the pediatric respite patient and the pediatric respite patient's family upon request. Counseling services shall include dietary, spiritual, bereavement and any other necessary counseling services while the patient is a resident in the pediatric respite care program. Counseling services shall be provided by a qualified interdisciplinary team member or one or more other qualified individuals, as determined by the pediatric respite care program.

(1) Counseling services shall be organized to meet the needs of the pediatric respite patients and their families;

(2) The program shall assess the needs of patients and families for spiritual counseling, in accordance with their religious preferences or self-determined goals; and

(3) The pediatric respite care program shall provide dietary counseling. Dietary counseling shall include use of food and mealtime to promote quality of life for pediatric respite care patients and to meet their needs for symptom control. Dietary counseling shall be planned and provided by or under the supervision of a dietitian or, if the program is unable to obtain the services of a dietitian, by a nurse.

(B) The pediatric respite care program shall make reasonable efforts to arrange for visits of clergy and other members of religious organizations in the community to patients who request visits and shall apprise patients of this opportunity.

(C) Each pediatric respite care program shall provide bereavement services, if requested, for pediatric respite patients' families. Bereavement services shall be provided under the supervision of a designated qualified professional with education or experience in providing those services.

(1) The plan of care for bereavement services shall reflect family needs and shall specify the frequency services are to be delivered and the persons furnishing the services; and

(2) Bereavement services shall be based on an assessment of the family's needs and its ability to cope with grief.

Effective: 12/26/2013
R.C. 119.032 review dates: 12/01/2018
Promulgated Under: 119.03
Statutory Authority: 3712.031
Rule Amplifies: 3712.031 , 3712.041 , 3712.051 , 3712.061 , 3712.09 , 3712.99

3701-19-47 Admission of patients to pediatric respite care.

(A) A pediatric respite care program shall not admit any individual who does not meet the definition of a pediatric respite patient.

(B) A pediatric respite care program shall admit patients, provide care and services, and discharge or transfer patients without discrimination on the basis of sex, age, race, creed, national origin, or handicap.

(C) A pediatric respite care program shall require that the patient, or the patient's authorized representative, sign an informed consent form. This form shall include an acknowledgement by signature of the patient or patient's representative, that they have been given a full explanation of the respite care program as it relates to the patient's life-threatening disease or condition and have been informed that the patient may withdraw consent at any time.

(D) A pediatric respite care program shall permit a pediatric respite patient to withdraw consent for pediatric respite care at any time.

(E) A pediatric respite care program shall provide a patient or the patient's representative with information regarding the scope of services provided by the pediatric respite care program, including any limitations of the pediatric respite care program and charges for the services.

(F) Prior to or upon admission of each patient, a pediatric respite care program shall obtain an oral statement from the patient's attending physician, if any, and the medical director of the pediatric respite care program or the physician member of the interdisciplinary team certifying that the patient has a life-threatening disease or condition.

(1) The program shall obtain written confirmation of the oral statement after admission within acceptable written standards of practice;

(2) The written certification statement shall be signed by the patient's attending physician, if any, and the medical director of the pediatric respite care program or the physician member of the interdisciplinary team; and

(3) The program should obtain from each patient's attending physician, if any, designation of an alternate physician to contact for emergency care of the patient or review of the patient's plan of care when the attending physician is not available.

Effective: 12/26/2013
R.C. 119.032 review dates: 12/01/2018
Promulgated Under: 119.03
Statutory Authority: 3712.021
Rule Amplifies: 3712.031 , 3712.041 , 3712.051 , 3712.061 , 3712.09 , 3712.99

3701-19-48 Standards for pediatric respite care program facilities.

(A) Each new pediatric respite care program facility shall be inspected by the director to determine compliance with provisions of this rule. The new pediatric respite care program facility shall not admit patients until the director has determined that the facility is in compliance with the requirements of this chapter of the Administrative Code.

(B) The pediatric respite care program facility shall meet all applicable provisions of the Ohio fire code adopted pursuant to section 3737.82 of the Revised Code.

(C) The building or buildings in which a pediatric respite care program facility is located shall comply with the applicable provisions of the Ohio building code adopted by the board of building standards pursuant to Chapters 3781., 3783., and 3791. of the Revised Code, and have a certificate of occupancy issued by the appropriate building authority.

(D) Each new pediatric respite care program facility not using a public sewage disposal system shall have its facility sewage disposal system inspected and approved by the local health department in accordance with Chapter 3701-29 of the Administrative Code.

(E) Each new pediatric respite care program facility shall:

(1) Design and maintain appropriate space providing optimal comfort and privacy for patients and family members.

(2) Maintain appropriate patient rooms designed and equipped for adequate nursing care, comfort and privacy of patients that must:

(a) Be equipped with or conveniently located near toilet and bathing facilities;

(b) Be at or above grade level;

(c) Contain an appropriate bed and other appropriate furniture;

(d) Have closet space providing security and privacy for clothing and personal belongings;

(e) Measure at least one hundred square feet for a single patient room or eighty square feet for each patient for a multipatient room; and

(f) Be equipped for calling the staff member on duty.

(3) Maintain appropriate bathroom facilities and plumbing. The facility must provide:

(a) An adequate supply of hot water at all times for patient use; and

(b) Plumbing fixtures with control valves that automatically regulate the temperature of the hot water used by patients.

(4) Provide appropriate linens. The pediatric respite care program facility must provide at all times:

(a) A quantity of linen for proper care and comfort of patients; and

(b) Linens must be handled, stored, processed and transported in a manner that prevents the spread of infection.

(5) Have provisions for isolating patients with infectious diseases.

(6) Provide meal service;

(a) The pediatric respite care program facility providing its own meal service must:

(i) Obtain an appropriate food service license, unless exempt in accordance with section 3717.42 of the Revised Code, or contracting with another licensed food service provider;

(ii) Serve at least three meals or their equivalent each day at regular times, with not more than fourteen hours between a substantial evening meal and breakfast;

(iii) Procure, store, prepare, distribute and serve all food under sanitary conditions;

(iv) Have a staff member trained or experienced in food management or nutrition who is responsible for:

(a) Planning menus that meet the nutritional needs of each patient, following the orders of the patient's physician and, to the extent medically possible, the dietary allowances recommended by the national academy of sciences;

(b) Supervising the meal preparation and service to ensure that the menu plan is followed;

(v) If the pediatric respite care program has patients who require medically prescribed or ordered special diets, have the menus for those patients planned by a dietician who supervises the preparation and serving of meals to ensure that the patient accepts the special diet.

Effective: 12/26/2013
R.C. 119.032 review dates: 12/01/2018
Promulgated Under: 119.03
Statutory Authority: 3712.031
Rule Amplifies: 3712.031 , 3712.041 , 3712.051 , 3712.061 , 3712.09 , 3712.99

3701-19-49 Twenty-four hour nursing services in pediatric respite care program facilities.

(A) A pediatric respite care program shall ensure that nursing services are available twenty-four hours per day and seven days a week in each facility used to provide care to its patients.

(1) These services shall be sufficient to meet the nursing needs of the pediatric respite care patients residing in the facility; and

(2) Each shift shall be staffed by a nurse who provides direct patient care. If staffed by a licensed practical nurse, a registered nurse shall be on call and available.

(B) The number and type of personnel shall be sufficient to meet the needs of the pediatric respite care patients.

(C) A pediatric respite care program facility shall provide each patient's treatments, medications, and diets as prescribed or ordered.

(D) The facility shall keep each patient comfortable, clean, well-groomed, and protected from accident, injury, and infection.

(1) Patient's shall be protected from accident and injury through the use of appropriate safety measures;

(2) Routine, special care, and emergency needs of all patients shall be met at all times; and

(3) Patient calls shall be responded to promptly.

Effective: 12/26/2013
R.C. 119.032 review dates: 12/01/2018
Promulgated Under: 119.03
Statutory Authority: 3712.031
Rule Amplifies: 3712.031 , 3712.041 , 3712.051 , 3712.061 , 3712.09 , 3712.99

3701-19-50 Clinical record.

(A) Each pediatric respite care program shall establish and maintain a clinical record for each pediatric respite care patient receiving care and services from the program and his or her family. The record shall be established and maintained in a central location in accordance with accepted standards of practice and at a minimum:

(1) The pediatric respite care program shall maintain the records and reports for seven years following the date of the pediatric respite care patient's discharge, except if the resident is a minor, the records shall be maintained for three years past the age of majority but not less than seven years.

(2) Upon closure of the pediatric respite care program facility, the operator shall provide and arrange for the retention of records and reports in a secured manner for not less than seven years. The pediatric respite care program shall notify the director of the location where the records will be stored.

(B) The clinical record shall be a comprehensive compilation of information that is documented promptly for all services provided. The record shall be organized in a manner that systematically facilitates retrieval of information. Entries to the clinical record shall be made, dated, and signed by the person providing the service within acceptable written standards of practice guidelines. All services furnished by employees, persons under contract, or volunteers, shall be documented in the clinical record.

(C) Each clinical record shall contain at least the following information:

(1) Identification data;

(2) Pertinent medical history, including the physician's diagnosis of a life-threatening disease or condition;

(3) Consent and authorization forms;

(4) Initial and subsequent assessments that include evaluations of the psychological, psychosocial, and spritiual needs, if any, of the patient as well as the need for bereavement or volunteer services;

(5) The interdisciplinary plan of care;

(6) Documentation of all services and events, such as evaluations, treatments, and progress notes; and

(7) Transfer and discharge summaries.

(D) The pediatric respite care program shall provide for storage of the clinical records to protect them against loss, destruction, and unauthorized use. The program also shall have policies and procedures to ensure the confidentiality of records.

(E) A pediatric respite care program which maintains a patient's clinical record electronically shall use an electronic signature system that meets the requirements specified under division (B) of section 3701.75 of the Revised Code. Electronic patient clinical records shall be accessible to the director during inspections.

Effective: 12/26/2013
R.C. 119.032 review dates: 12/01/2018
Promulgated Under: 119.03
Statutory Authority: 3712.031
Rule Amplifies: 3712.031 , 3712.041 , 3712.051 , 3712.061 , 3712.09 , 3712.99

3701-19-51 Medical supplies, drugs, biologicals, and medical appliances.

(A) Each pediatric respite care program shall arrange for provision of medical supplies, appliances, drugs, and biologicals to pediatric respite patients as needed for the palliation and management of the patient's life-threatening disease or condition and related conditions. The program shall ensure that drugs and biologicals are available at all times.

(B) The pediatric respite care patient or pediatric respite care patient's family may provide the pediatric respite care program with the patient's current medical supplies, drugs, biologicals, and medical appliances for administration and use while the patient is enrolled in the pediatric respite care program.

(C) Each pediatric respite care program shall ensure that drugs and biologicals are administered only by the following individuals:

(1) A physician, registered nurse, or a licensed practical nurse;

(2) A patient or a family member if approved by the attending physician; or

(3) Any other individual authorized by the Revised Code to perform this task.

(D) The individuals authorized to administer drugs or biologicals under paragraphs (B)(2) and (B)(3) of this rule and the drugs or biologicals they are authorized to administer shall be specified in the patient's plan of care.

(E) Each pediatric respite care program shall have a written policy for disposing of controlled drugs maintained by the facility for the pediatric respite care patient while the patient is enrolled in the pediatric respite care program when those drugs no longer are needed by the patient.

(F) Each pediatric respite care program shall ensure that the patient, patient's representative, and the patient's family receive a copy of the pediatric respite care program's written policies and procedures along with education on the management and disposal of controlled drugs when a controlled substance is ordered, and document such actions in the patient's clinical record.

Effective: 12/26/2013
R.C. 119.032 review dates: 12/01/2018
Promulgated Under: 119.03
Statutory Authority: 3712.031
Rule Amplifies: 3712.031 , 3712.041 , 3712.051 , 3712.061 , 3712.09 , 3712.99

3701-19-52 Variances; waivers.

(A) The director may grant a variance or waiver from any requirement established in rules 3701-19-30 to 3701-19-52 of the Administrative Code, unless the requirement is mandated by statute.

(B) A pediatric respite care program seeking a variance or waiver must submit a written request to the director. Such written request must include the following information:

(1) The rule requirement for which the variance or waiver is requested, with a reference to the relevant Administrative Code provision;

(2) The specific nature of the request, and the rationale for the request;

(3) The time period for which the variance or waiver is requested;

(4) If the request is for a variance, a statement of how the pediatric respite care program will meet the intent of the requirement in an alternative manner; and

(5) If the request is for a waiver, a statement regarding why application of the requirement will cause undue hardship to the pediatric respite care program and why granting the waiver will not jeopardize the health and safety of any patient.

(C) The decision regarding a variance or waiver is a discretionary act by the director and an informal procedure not subject to Chapter 119. of the Revised Code. Upon written request by a pediatric respite care program, the director may grant:

(1) A variance if the director determines that the requirement has been met in an alternative manner; or

(2) A waiver if the director determines that the strict application of the license requirement would cause an undue hardship to the pediatric respite care program and that granting the waiver would not jeopardize the health and safety of any patient.

(D) The director may stipulate a time period for which a variance or a waiver is to be effective and may establish conditions that the pediatric respite care program must meet for the variance or waiver to be operative. Such time period may be different than the time period sought by the pediatric respite care program in the written variance or waiver request.

(E) The director may establish conditions that the pediatric respite care program must meet for the variance or waiver to be operative. The director may, in his discretion, rescind the waiver or variance at any time upon determining that the pediatric respite care program is not meeting such conditions.

(F) The granting of a variance or waiver by the director shall not be construed as constituting precedence for the granting of any other variance or waiver. All variance and waiver requests shall be considered on a case-by-case basis.

(G) The provider whose request for a waiver or variance under this rule is denied may request reconsideration of the decision by the director. A request for reconsideration must:

(1) Be received in writing by the director within thirty days of receipt of the director's denial of a waiver or variance request;

(2) Present significant, relevant information not previously submitted to the director by the provider because it was not available to the provider at the time the waiver or variance request was filed; or

(3) Demonstrate that there have been significant changes in factors or circumstances relied upon by the director in reaching the initial decision.

(H) A decision on an appropriately filed request for reconsideration shall be issued within forty-five days of the director's receipt of the request for reconsideration and all information determined necessary by the director to make a decision.

(I) The reconsideration process is an informal procedure not subject to Chapter 119. of the Revised Code. The director's decision on reconsideration is final.

Effective: 12/26/2013
R.C. 119.032 review dates: 12/01/2018
Promulgated Under: 119.03
Statutory Authority: 3712.03
Rule Amplifies: 3712.031 , 3712.041 , 3712.051 , 3712.061 , 3712.09 , 3712.99