6 Colo. Code Regs. § 1011-1-21-4

Current through Register Vol. 47, No. 11, June 10, 2024

Section 6 CCR 1011-1-21-4 - ADMINISTRATION

4.1 The hospice shall organize, manage, and administer its resources to provide hospice care and services to patients, caregivers and families necessary for the palliation and management of the terminal illness.

4.2 The hospice shall have an administrator who has training and experience in business or health service administration and at least two years of supervisory or administrative experience in hospice care or closely related health care services.

4.3 The administrator shall be responsible for the management of the hospice staff and operations and shall be accountable for and report to the Governing Body regarding the discharge of all delegated duties and functions. If the administrator delegates specific duties, the person responsible shall be clearly identified.

4.4 The duties of the administrator shall include but not be limited to:

(A) Directing the hospice and ensuring implementation of policies and procedures regarding all activities and patient/family care services provided in the hospice, whether provided through staff employed directly by the hospice, by volunteers or through contract arrangement;

(B) Designating an alternate to act in his or her absence;

(C) Implementing administrative policies and procedures; and

(D) Implementing financial policies and procedures, approved by the governing body, according to sound business practice.

4.5 The hospice shall develop, implement, and maintain an effective, ongoing, hospice-wide data-driven quality assessment and performance improvement program that complies with 6 CCR 1011-1, Chapter 2, Part 4. In addition, the hospice's governing body shall ensure that the program:

(A) Reflects the complexity of its organization and services;

(B) Involves all hospice services (including those services furnished under contract or arrangement);

(C) Focuses on indicators related to improved palliative outcomes, and

(D) Takes actions to demonstrate improvement in hospice performance.

4.6 The hospice shall maintain documented evidence that its quality assessment and performance improvement program has been implemented and is functioning effectively.

6 CCR 1011-1-21-4