• CMS Finalizes Contract Requirements Between Long Term Care Facility and Hospice Service

    Monday August 12, 2013

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    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.  

      Federal Register - Long Term Care Hospice Contracts


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