Current through Register Vol. XLI, No. 45, November 8, 2024
Section 64-54-5 - Provision of care5.1. A hospice shall provide services seven days a week, twenty-four hours a day to meet the needs of the patient.5.2. A hospice shall provide the services described in subsections 5.6. and 5.7. of this rule to the extent necessary to meet the needs of patients that are reasonable and necessary for the palliation and management of the terminal illness.5.3. The hospice shall make services available at the patient's place of residence. 5.3.a. Services provided to patients residing at skilled nursing facilities, nursing facilities, intermediate care facilities for the mentally retarded or any other facilities, shall meet all the same requirements as any other patient of the hospice and the hospice shall have an agreement for services. 5.3.a.1. The hospice shall retain professional management of hospice care.5.3.a.2. The hospice shall ensure continuity of care.5.3.a.3. The hospice shall ensure care is provided in accordance with the plan of care.5.3.a.4. The hospice shall develop a way to monitor and supervise hospice services in these facilities.5.4. Services shall be provided in a manner consistent with accepted standards of practice.5.5. Services shall be provided under the supervision of a hospice Interdisciplinary Team.5.6. The hospice shall provide the following services at a minimum: 5.6.a. Physician services which shall meet the medical needs of the patients for the palliation and management of the terminal illness. The medical director and hospice physicians shall be licensed according to the West Virginia Board of Medicine or the West Virginia Board of Osteopathy and are subject to the rules of the Board. Nurse practitioner's, when serving as the patient's attending physician, shall be licensed according to the West Virginia Board of Examiners for Registered Professional Nurses and are subject to the rules of the Board;5.6.b. Nursing services which shall meet the nursing needs of all patients for the palliation and management of the terminal illness. Each patient shall be under the care of a Registered Nurse, who is licensed by the West Virginia Board of Examiners for Registered Professional Nurses. Licensed Practical Nurses shall be licensed by the West Virginia State Board of Examiners for Licensed Practical Nurses;5.6.c. Medical social services which shall meet the needs of the patients for the palliation and management of the terminal illness. The medical social worker shall have at least a Bachelor's degree from an accredited Social Work study and be licensed in accordance with the West Virginia Board of Social Work Examiners;5.6.d. Spiritual care which shall meet the spiritual needs of the patients. Spiritual care shall be provided under the direction of a person who has received education or training in providing spiritual care;5.6.e. Bereavement services which are provided up to one year after a patient has died. Bereavement services shall be provided under the direction of a person who has received education or training in bereavement counseling;5.6.f. Interdisciplinary team services which includes a Physician, Registered Nurse, Social Worker, Counselor and any other services required to meet the needs of the patient for the palliation and management of the terminal illness; and5.6.g. Nutritional counseling which shall meet the needs of the patients.5.7. The hospice shall provide additional services as needed for the support and care of hospice patients. 5.7.a. Therapy services shall be provided under the supervision of a Physical Therapist, Occupational Therapist or Speech Pathologist Therapist as needed for the palliation and management of the terminal illness. 5.7.a.1. The Physical Therapist or Physical Therapist Assistant shall be licensed and supervised in accordance with the West Virginia Board of Physical Therapy.5.7.a.2. The Occupational Therapist or Certified Occupational Therapy Assistant shall be licensed and supervised in accordance with the West Virginia Board of Occupational Therapy.5.7.a.3. The Speech - Language Pathologist shall be licensed in accordance with the West Virginia Board of Examiners Speech-Language Pathology and Audiology.5.7.b. The hospice shall provide Home Health Aides and homemaker services to meet the personal care needs of the patient. 5.7.b.1. The Home Health Aide shall be competency evaluated for all duties he or she performs.5.7.b.2. The Home Health Aide shall be under the supervision of a Registered Nurse. A Registered Nurse shall make an onsite visit to the patient's place of residence no less than every 14 (fourteen) days to assess the home health aide's services. The home health aide does not need to be present during this visit. A Registered Nurse shall make an onsite visit to the patient's place of residence in order to observe and assess each aide while he or she is performing care no less than every 28 (twenty eight) days.5.7.b.3. The Homemaker shall be under the supervision of the Registered Nurse and shall be supervised directly at the patient's residence by the Registered Nurse every 30 (thirty) days.5.7.c. The hospice shall provide nutritional services to meet the dietary needs of the patient. These services shall be under the direction of a person who is qualified by training or education.5.7.d. The hospice shall provide pharmaceutical services to meet the patients' needs for palliative care and symptom management. The Pharmacist shall be licensed in the state in which he or she practices.5.7.e. The hospice shall provide volunteer services to meet the patient's needs. The services shall be provided under the direction of a person qualified by training or education.5.7.f. The hospice shall provide Respite and Inpatient care for patient symptom management or caregiver relief. The care shall be provided in a facility acceptable to the Centers for Medicare and Medicaid Services for this purpose.5.7.g. The hospice shall provide continuous care nursing on a twenty-four hour basis for palliative care and symptom management at the patient's residence during periods of crisis.5.7.h. The hospice shall provide medical supplies including drugs and biologicals, as needed for the patient's palliation and symptom management.5.8. A hospice program shall provide or arrange a competency evaluation, employee training and continuing education program.5.8.a. The hospice shall ensure all licensed and unlicensed staff are competent to perform the duties assigned to them.5.8.b. The orientation and continuing education program for all patient care staff shall contain at a minimum:5.8.b.1. Orientation and training for new employees to acquaint them with the philosophy, organization, services, practices and goals of the hospice program;5.8.b.2. The psychological aspects of terminal disease and the hospice's goal in providing palliative care and supportive services;5.8.b.3. Family dynamics and psychosocial issues surrounding terminal disease, death and bereavement;5.8.b.4. Communication and documentation skills;5.8.b.5. Policies and services of the hospice;5.8.b.6. The role of the plan of care in determining the services to be provided;5.8.b.7. Ethics, confidentiality of patient information, patient and family rights and grievance procedures; and5.8.b.8. Additional initial and continued training needed specific to the duties, responsibilities and the competency of the employee.5.9. A hospice shall admit a patient only on the recommendation of the medical director or physician designee in consultation with the patient's attending physician. 5.10. The hospice shall not deny acceptance of a patient to the hospice service based on race, color, national origin, age, sex, religion or ethnicity.5.11. The hospice shall inform a patient or his or her legal representative in writing at the time of admission and again per hospice policy with any changes to the following:5.11.a The responsibilities of a hospice in regards to the care of the patient, including services to be provided by the hospice and the patient's and caregiver's role in the care; 5.11.b. The materials and equipment available to the patient and family;5.11.c. Any existing pre-payment, refund or sliding scale fee policy;5.11.d. A statement of the patient's and family's financial responsibility if any;5.11.e. The phone number of the Office of Health Facility Licensure and Certification with instructions on how to make a complaint; and5.11.f. The drugs and biologicals for which the patient and the hospice would be responsible.5.12. Once a patient has been accepted for care, care shall not be reduced due to the patient's inability to pay for the care unless the following requirements are met: 5.12.a. A list of services is provided to the patient or his or her legal representative detailing what the patient is responsible for with the dollar amount of those services; and5.12.b. A review of the patient's finances and referrals to outside agencies shall determine no further financial assistance is available and the patient or his or her legal representative refused continued services based on this assessment.5.13. A hospice may discharge a patient if: 5.13.a. The patient moves out of the hospice service area or transfers to another hospice;5.13.b. It determines the patient no longer meets the terminally ill diagnosis; or5.13.c. Its policy determines justifiable reason for the discharge.5.14. A hospice shall assist a patient in obtaining necessary follow up care before discharging or transferring the patient and shall give the patient at least a 48 hour notice of the pending discharge from hospice services. This notice may be less than 48 hours in the event of a patient discharge for staff safety reasons.5.15. A hospice shall complete a discharge summary to provide important clinical information to health care professionals assuming the care of the patient. 5.15.a. The hospice shall provide a discharge summary along with pertinent hospice documentation to the patient's attending physician.5.15.b. The hospice shall provide the discharge summary along with pertinent hospice documentation to the agency or facility assuming the patient's care.5.16. A hospice shall supply an itemized statement detailing services provided and charges assessed at no additional cost upon request from the patient or his or her legal representative.