Monday August 12, 2013
Contract Requirements between Long
Term Care Facilities and Hospice Service Providers
On June 27, 2013 CMS released the final ruling on contract
requirements between long term care providers and Hospice
Services. This regulation will be effective on August 26,
2013. Because there are similar services provided by
both long term care facilities and hospice providers it is possible
for residents to receive the same services or conflicting services
from both companies. The rationale behind the final ruling
from CMS is to help ensure safe and quality care for residents by
requiring a written agreement between the long term care facility
and the hospice provider outlining the services that will be
provided by both entities.
When hospice services are provided in long term care facilities
then each facility is responsible for ensuring that the hospice
services meet professional standards and principles that apply to
individuals providing services in the facility, and to the
timeliness of these services. The long term care facility
must meet the requirements of the contract between the hospice
provider and the long term care facility and this contract must be
signed by an authorized representative of the hospice service
provider and the long term care facility before hospice care can be
provided to residents at the facility. The written agreement must
address issues such as:
- The services hospice will provide
- The hospice's responsibilities for determining the appropriate
hospice plan of care
- The services the long term care facility will continue to
provide, based on each resident's plan of care
- A communication process including how the communication will be
documented between the long term care facility and the hospice
service, to ensure that the needs of the resident are addressed and
met 24 hours per day
- A provision that the long term care facility will immediately
notify the hospice service about the following: 1) a
significant change in the resident's physical, mental, social or
emotional status; 2) clinical complications that suggest a need to
alter the plan of care; 3) a need to transfer the resident from the
long term care facility for any condition; and 4) the resident's
death
- A provision stating that the hospice service assumes
responsibility for determining the appropriate course of hospice
care, including the determination to change the level of services
provided
- An agreement that it is the long term care facility's
responsibility to furnish 24 hour room and board care, meet the
resident's personal care and nursing needs in coordination with the
hospice representative, and ensure that the level of care provided
is appropriately based on the individual resident's needs
- A delineation of the hospice's responsibilities, including but
not limited to, providing medical direction and management of the
patient; nursing; counseling; social work; providing medical
supplies, durable medical equipment, and drugs; and all other
services that are necessary for the care of the resident's terminal
illness and related conditions
- A provision that when the long term care facility personnel are
responsible for the administration of prescribed therapies,
including those therapies determined appropriate by the hospice and
delineated in the hospice plan of care, the long term care
personnel may administer the therapies whether permitted by State
law
- A provision stating that the long term care facility must
report all alleged violations involving mistreatment, neglect, or
verbal, mental, sexual, and physician abuse, including injuries of
unknown source, and misappropriation of patient property by hospice
personnel, to the hospice administrator immediately when the
facility becomes aware of the alleged violation
- A delineation of the responsibilities of the hospice and the
facility to provide bereavement services to the long term facility
staff
The final ruling also states that the long term care facility
must designate a member of the facility's interdisciplinary team to
be responsible for working with hospice representatives. This team
member must have a clinical background.
In addition to the CMS requirements in the agreement between the
long term care facility and the hospice provider that are outlined
above, from a risk management perspective, you should also consider
adding the following additional provisions to the contract between
your facility and the hospice provider:
- Independent Contractor provision - this agreement clarifies
that the contractor is not a facility employee and therefore not
subject to the facility's worker's compensation benefits or
professional liability insurance coverage
- Hold Harmless provision - this agreement clarifies that one or
both parties agree to not hold the other responsible for
damages. This agreement indemnifies one or both parties by
agreeing to not hold the other responsible for any legal liability
or losses as a result of a specified incident or action
- Insurance coverage by both parties - this clause states that
each entity will carry their own general/professional liability
insurance. This provision without a hold
harmless/indemnification clause is only helpful if both the
facility and third party contractor are co-defendants.
In other words, if the third party contractor is not a party to a
claim against the facility, the third party contractor's liability
insurance will not hold harmless or indemnify the facility
The facility may want to consult with its Corporate Counsel
before finalizing the language in the contract between the facility
and the hospice provider, or with any other third party.
To read the complete final rule, the Federal Register is
attached.
