471 Neb. Admin. Code, ch. 36, § 003

Current through September 17, 2024

Section 471-36-003 - PROVIDER REQUIREMENTS

003.01GENERAL PROVIDER REQUIREMENTS. Providers must comply with all applicable provider participation requirements codified in 471 Nebraska Administrative Code (NAC) 2 and 3. In the event that participation requirements in 471 NAC 2 or 3 conflict with requirements outlined in this chapter, the participation requirements in this chapter will govern.

003.02SERVICE SPECIFIC PROVIDER REQUIREMENTS. Hospice providers must participate in Medicare, and meet the licensure and certification requirements of the Nebraska Department of Health and Human Services Division of Public Health.

003.02(A)STANDARDS OF CARE. The hospice provider must deliver services in accordance with the following standards:

(i) A hospice provider must be primarily engaged in providing the scope of services outlined in this chapter, and must do so in a manner that is consistent with accepted standards of practice;

(ii) The hospice provider must designate a physician to serve as medical director. The medical director must be a doctor of medicine or osteopathy who is an employee, or is under contract with the hospice. When the medical director is not available, a physician designated by the hospice provider assumes the same responsibilities and obligations as the medical director;

(iii) The hospice provider must maintain clinical records containing past and current findings for each hospice client for the longer of six years, or the time period identified in 175 NAC 16. The clinical record must contain correct clinical information that is available to the client's attending physician and hospice staff. The clinical record may be maintained electronically;

(iv) Medical supplies and appliances, durable medical equipment, and drugs and biologicals related to the palliation and management of the terminal illness and related conditions, as identified in the hospice plan of care, must be provided by the hospice provider while the client is under hospice care;

(v) The needs, preferences, cultural diversity, values, and expectations of client and caregiver are reflected in all aspects of service delivery;

(vi) All service provision is done in a manner that is empowering to the client and caregiver;

(vii) The client and caregiver feels safe and confident that their right to privacy is protected;

(viii) The client and caregiver is treated with dignity and respect at all times;

(ix) The hospice provider must assume full responsibility for the professional management of the client's hospice care;

(x) The hospice provider must conduct and document, in writing or electronically, a client-specific comprehensive assessment that identifies the client's need for hospice care and services, and the client's need for physical, psychosocial, emotional, and spiritual care. This assessment includes all areas of hospice care related to the palliation and management of the terminal illness and related conditions as outlined in this chapter;

(xi) The hospice provider must maintain a certification that the client is terminally ill based on the clinical judgment of the hospice medical director or the physician member of the hospice interdisciplinary group (IDG), or the client's attending physician if the client has an attending physician;

(xii) Maintain the signed election statement in its files;

(xiii) The hospice provider must designate a hospice interdisciplinary group (IDG) or groups as defined in this chapter which, in consultation with the client's attending physician, must prepare a written plan of care for each client. The plan of care must specify the hospice care and services necessary to meet the client and family-specific needs identified in the comprehensive assessment as such needs relate to the terminal illness and related conditions;

(xiv) Provide on-call services 24 hours a day, seven days a week;

(xv) Allow the Department staff to review agency policies regarding hiring and reporting to ensure that appropriate procedures regarding abuse, neglect, and law violations are in place;

(xvi) Agree and assure that any suspected abuse or neglect must be reported to law enforcement and appropriate Department staff;

(xvii) A hospice provider must routinely provide all core services directly by hospice provider employees. Any hospice employee or volunteer who is or will be ordering, referring, or prescribing items or services to clients, must be enrolled as a Medicaid provider in accordance with the provisions of 471 NAC 2;

(xviii) All professionals who furnish services directly, under an individual contract, or under arrangements with a hospice provider, must be legally authorized, licensed, certified, or registered, in accordance with applicable federal, state, and local laws, and must act only within the scope of his or her state license, or state certification, or registration. All personnel qualifications must be kept current at all times;

(xix) The hospice provider must organize, manage, and administer its resources to provide the hospice care and services which are reasonable and necessary for the palliation and management of the terminal illness and related conditions;

(xx) The hospice provider must have a signed, written, non-resident-specific contract with each certified nursing facility (NF), intermediate care facility for individuals with developmental disabilities (ICF/DD), institution for mental diseases (IMD), assisted living facility (ALF), or center for the developmental disabilities (CDD); and

(xxi) The hospice provider must maintain and document an effective infection control program that protects clients, families, visitors, and hospice personnel by preventing and controlling infections and communicable diseases.

003.02(B)PROVIDER AGREEMENT AND ENROLLMENT. The hospice provider must complete and submit Form MC-19, Service Provider Agreement. When enrollment by hospice is done to provide inpatient services in a facility, a copy of the hospice provider's contract with the facility must be attached.

003.02(C)QUALITY ASSURANCE. The Department may refuse to execute or may cancel a contract or provider agreement with a hospice provider when the hospice provider:

(i) Does not meet the hospice requirements in this chapter;

(ii) Consistently admits clients who do not meet the eligibility requirements for terminal illness or consistently exceed the six-month prognosis;

(iii) Consistently refuses to provide, or is unable to provide, services identified in the assessment and on the hospice plan of care;

(iv) Consistently bills the majority of claims at the continuous home care (CHC); or

(v) Consistently discharges clients in conflict within this chapter.

003.02(D)HOSPICE AIDE AND HOMEMAKER COMPETENCY AND QUALIFICATIONS. All hospice aide and homemaker services must be provided by individuals who meet the personnel requirements specified in 42 Code of Federal Regulations (CFR) § 418.76. The hospice must maintain documentation that demonstrates the following requirements of this standard are being met:

(i) A hospice aide provides services that are:

(1) Ordered by the hospice interdisciplinary group (IDG);

(2) Included in the plan of care;

(3) Permitted to be performed under state law by such hospice aide; and

(4) Consistent with the hospice aide training;

(ii) The duties of a hospice aide include the following:

(1) The provision of hands-on personal care;

(2) The performance of simple procedures as an extension of therapy or nursing services;

(3) Assistance in ambulation or exercises; and

(4) Assistance in administering medications that are ordinarily self-administered;

(iii) Hospice aides must report changes in the client's medical, nursing, rehabilitative, and social needs to a registered nurse (RN), as the changes relate to the plan of care and quality assessment and improvement activities. Hospice aides must also complete appropriate records in compliance with the hospice's policies and procedures;

(iv) Supervision of hospice aides must meet the following requirements:

(1) A registered nurse (RN) must act as the supervising nurse for hospice aides;

(2) The supervising nurse must make an on-site visit to the client's home no less frequently than every 14 days to assess the quality of care and services provided by the hospice aide and to ensure that services ordered by the hospice interdisciplinary group (IDG) meet the client's needs;

(3) The hospice aide does not have to be present during this visit:

(a) If an area of concern is noted by the supervising nurse, then the hospice must make an on-site visit to the location where the client is receiving care in order to observe and assess the aide while he or she is performing care; and

(b) If an area of concern is verified by the hospice during the on-site visit, then the hospice must conduct, and the hospice aide must complete, a competency evaluation in accordance with hospice federal regulations;

(4) The supervising nurse must make an annual on-site visit to the location where a client is receiving care in order to observe and assess each aide while he or she is performing care; and

(5) The supervising nurse must assess an aide's ability to demonstrate initial and continued satisfactory performance in meeting outcome criteria that include, but is not limited to:

(a) Following the client's plan of care for completion of tasks assigned to the hospice aide by the registered nurse (RN);

(b) Creating successful interpersonal relationships with the client and family;

(c) Demonstrating competency with assigned tasks;

(d) Complying with infection control policies and procedures as outlined in 175 NAC 16; and

(e) Reporting changes in the client's condition.

003.02(E)ATTENDING PHYSICIAN REQUIREMENTS. Services of an attending physician who is not an employee of the hospice are covered, billed, and reimbursed in accordance with 471 NAC 18. An attending physician who is not an employee of the hospice must be enrolled as a Medicaid provider in accordance with the provisions of 471 NAC 2 and 18.

471 Neb. Admin. Code, ch. 36, § 003

Amended effective 6/2/2024