Chapter 3701-19 Hospice Care Programs

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) “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.

(G) “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.

(H) “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.

(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) “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.

(N) “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.

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

(P) “Nurse” means a registered nurse or licensed practical nurse.

(Q) “Palliative care” means treatment directed at controlling pain, relieving other symptoms, and focusing on the special needs of a hospice patient and the hospice patient’s family as they experience the stress of the dying process rather than treatment aimed at investigation and intervention for the purpose of cure or prolongation of life.

(R) “Person” means an individual, corporation, business trust, estate, trust, partnership, 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) “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.

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

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

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

HISTORY: 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 to 3712.09, 4723.41

R.C. 119.032 review dates: 07/26/2004 and 07/15/2009

(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 (N) 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.

HISTORY: Eff 12-31-90; 1-1-05

Rule promulgated under: RC 119.03

Rule authorized by: RC 3712.03

Rule amplifies: RC 3712.01, 3712.03 to 3712.06

R.C. 119.032 review dates: 09/27/2004 and 07/15/2009

(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 three 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.

(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 more than one location 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 more than one location 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) Except as provided in paragraph (H) of this rule, 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.

(H) An out-of-state hospice care program providing services to patients in Ohio on the effective date of this rule shall establish an Ohio administrative office and demonstrate compliance with the rules of this Chapter by December 31, 2006. An out-of-state hospice care program exempted from complying with paragraph (G) of this rule that ceases to provide services to patients in Ohio cannot recommence services in Ohio until the program complies with the requirements of paragraph (G) of this rule.

HISTORY: 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: 09/27/2004 and 07/15/2009

(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 the director he or she determines necessary to assess whether the criteria in paragraph (G)(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 transferrable:

(a) The director shall perform a reconsideration of the determination if requested by the hospice care program within thirty days of the mailing of the notice of the determination. The request shall be in writing and shall include any written documentation or other information not previously submitted to the director that the hospice care program wishes to refute the determination. The director’s final determination is not appealable under Chapter 119. of the Revised Code.

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

HISTORY: 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: 09/27/2004 and 07/15/2009

(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) 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.

(D) 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.

(E) 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.

HISTORY: 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: 09/27/2004 and 07/15/2009

(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. 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, 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 standards under which the program is certified or accredited.

(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.

HISTORY: 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: 09/27/2004 and 07/15/2009

(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: 09/21/2004 and 07/15/2009

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

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 establishing qualifications of employees and independent contractors;

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

Interpretive guideline: The physician appointed to serve 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; and

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

(C) Arrange for 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; and

(4) Implement the hospice care program’s quality assurance program under rule 3701-19-22 of the Administrative Code.

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

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, 3712.04, 3712.05, 3712.06

Prior Effective Dates: 12/31/1990, 9/05/97, 10/17/99

(A) Each hospice care program shall utilize personnel to provide services 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 or teams;

(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 car 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 employ personnel without discrimination on the basis of sex, age, race, creed, national origin, or handicap.

(D) 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.

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

(F) 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.

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, 3712.04, 3712.05, 3712.06, 3712.09

Prior Effective Dates: 12/31/1990, 9/05/97, 10/17/99

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

Interpretive guideline: The medical director may be either a physician who is 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, as requested, 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.

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, 3712.04, 3712.05, 3712.06

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

(A) Each hospice care program shall have an interdisciplinary team or teams that provides or supervises the provision of hospice care and services.

INTERPRETIVE GUIDELINE: it is recommended that the governing body of a hospice care program employ a registered nurse to coordinate the overall functioning of the interdisciplinary team or teams by taking such actions as ensuring that meetings are held at proper intervals, all patient and family needs are addressed, and appropriate personnel serve on the team or teams.

(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) Coordinate and provide or supervise the provision of all components of each interdisciplinary plan of care. One individual shall be designated to ensure all of the following:

(a) There is ongoing assessment of the hospice patient’s and family’s needs;

(b) All components of the plan of care are addressed by the interdisciplinary team; and

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

INTERPRETIVE GUIDELINE: it is recommended that the individual designated to coordinate the plan of care be the registered nurse member of the interdisciplinary team;

(4) Review the interdisciplinary plan of care on a periodic basis.

INTERPRETIVE GUIDELINE:

(a) It is recommended that the interdisciplinary team conduct meetings to review plans of care.

(b) The interdisciplinary team shall review the plan of care no less frequently than once every two weeks.

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

(6) 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.

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

(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.

(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 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 (D) 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 to 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 (B) (3) 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 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.

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

Promulgated Under: 119.03

Statutory Authority: 3712.03, 3712.09

Rule Amplifies: 3712.01 to 3712.06, 3712.09

Prior Effective Dates: 12/31/1990, 9/5/97

(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: 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

(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

(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: 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

(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.

(B) Home care services shall be provided by home health 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 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 or appropriate therapist shall prepare for each home health aide written instructions for patient care which are consistent with the interdisciplinary plan of care.

(E) A registered nurse shall make and document a supervisory visit to the patient’s residence at least every two weeks when home health aide services are being provided to assess the provision of the home health 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, 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.

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

(A) Each hospice care program shall provide physician services which, in addition to palliation and management of terminal illness and related conditions, meet the general medical needs of the patients to the extent that those needs are not met by the patient’s attending physician.

(B) Interpretive guidelines:

(1) The attending physician is identified by the patient as the physician who is primarily responsible for the patient’s medical care. The hospice patient may designate the hospice care program medical director to be the attending physician.

(2) Oversight of the provision of physician 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.

(3) All medical orders for treatment, procedures, tests, and medications shall be signed by a physician.

HISTORY: Eff 12-31-90; 10-17-99

Rule promulgated under: RC Chapter 119.

Rule authorized by: RC 3712.03

Rule amplifies: RC 3712.01, 3712.04, 3712.05, 3712.06

R.C. 119.032 Review Date: 10/1/04; 9/1/99

(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, 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 prefrences.

(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.

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

(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.

HISTORY: 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: 07/26/2004 and 07/15/2009

(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 obtain informed consent from the patient. The program shall require that the patient, or the patient’s authorized representative, sign an informed consent form.

Interpretive guideline: this form shall include acknowledgment by the patient or the representative that he or she has been given a full explanation of the palliative rather than curative nature of hospice care as it relates the patient’s terminal illness and that the patient voluntarily consents to the provision of hospice care. In addition, the hospice patient and the hospice patient’s family shall be advised of the scope and variety of services provided by the hospice care program. It is recommended that the form also specify the charges for the services provided by the program and state that consent for hospice care may be withdrawn at any time.

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

(E) 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) Prior to or within forty-eight hours after admission of a patient, the program should obtain from the patient’s attending physician, if any, oral information about current medical findings, any dietary restrictions, and any medication orders, medical treatment orders, and other pertinent orders. This information should be confirmed, in writing, within twenty-one days after the oral communication or within other acceptable written standards of practice guidelines;

(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.

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, 3712.04, 3701.05, 3712.06

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

(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.

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, 4723.41

Prior Effective Dates: 12/31/1990

(A) Each hospice care program 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 assurance 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 assurance program to correct identified problems and to revise hospice care program policies if necessary.

HISTORY: Eff 12-31-90; 1-1-05

Rule promulgated under: RC 119.03

Rule authorized by: RC 3712.03

Rule amplifies: RC 3712.01 to 3712.06

R.C. 119.032 review dates: 07/26/2004 and 07/15/2009

(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 principles 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.

Interpretive guideline: the program shall ensure that the storage area for the records affords protection from fire, water, vermin, and like hazards. The program also shall have policies and procedures to ensure the confidentiality of the 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.

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

Promulgated Under: 119.03

Statutory Authority: 3712.03

Rule Amplifies: 312.01, 3712.04, 3712.05, 3712.06

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

(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 the “Joint Commission on Accreditation of Healthcare Organizations”, or the “American Osteopathic Association.”

(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, a nursing home or residential care facility licensed under Chapter 3721. of the Revised Code, or an adult care facility licensed under Chapter 3722. of the Revised Code; and

(2) Only on an occasional basis and not for more than seven consecutive days.

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, 3712.04, 3712.05, 3712.06

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

(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: 09/21/2004 and 07/15/2009

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

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: 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

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, pursuant to section 3737.82 of the Revised Code.

(C) 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.

(D) 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 100 square feet for a single patient room or 80 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 14 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.

HISTORY: Eff 1-1-05

Rule promulgated under: RC 119.03

Rule authorized by: RC 3712.03

Rule amplifies: RC 3712.01, 3712.03, 3712.06

R.C. 119.032 review dates: 07/15/2009