Raleigh  - On June 5, the Centers for Medicare & Medicaid Services (“CMS”) published the Hospice Conditions of Participation Final Rule, and changed the way hospice providers are expected to approach patient care. The new federal rule covers all hospice agencies that provide services to Medicare and Medicaid patients and receive federal payment for the services provided.  Poyner & Spruill attorneys Ken Burgess and Mike Hale recently presented a comprehensive training session to more than 50 North Carolina hospice providers in conjunction with the North Carolina Association for Home and Hospice Care, and co-authored a paper for the Association explaining the impact of the new rule on the state's hospice providers.

The rule reveals several significant changes in the way hospices will manage the quality of patient care. One of the most noteworthy changes is a shift in quality assessment from a problem-oriented approach to a patient-centered, outcome-oriented approach.  Under the old rule, quality of patient care, or the lack thereof, was primarily identified through surveys completed after the patient received care, and was reactive, by nature.  The new rule requires the hospice to identify patient and quality of care outcomes that it would like to achieve, and constantly monitor its success in meeting its defined goals.  This quality assessment performance improvement, or QAPI, approach is designed to lead to continued improvement of the hospice services offered, patient safety, and quality of care.

Another significant change in the new rule are new patient rights, including the right to receive effective pain management and symptom control for conditions related to the terminal illness.  While symptom control has long been a focus of hospice care, it is now recognized as a patient right.  The hospice patient also has the right to be involved in the development of his or her plan of care and the right to refuse care or treatment.

The new rule also places an increased emphasis on the hospice patient’s family and caregivers by requiring that the assessment of the need for bereavement services begin shortly after the patient’s admission to the hospice, and that the hospice include the primary caregiver, as well as the patient, in the development of the hospice plan of care if they wish to participate.

Since hospice care is primarily provided in the patient’s home, and patients may live in a nursing facility, the rule also addresses the coordination of services between hospices and nursing facilities, including new and specific contractual requirements between these two providers.  There are also some new requirements for hospice personnel qualifications, including a requirement that an experienced social worker with a Master’s degree in social work either directly provide, or supervise the provision of, social services.  Moreover, the hospice must obtain criminal background checks on all hospice employees who have direct patient contact or access to patient records.

Burgess, a healthcare attorney who represents long term care facilities, hospitals, and hospice providers, said "What we really want the public to know is that numerous hospice providers already utilize many of the patient-centered approaches and philosophies embodied in the new rule, but this rule requires that all providers do so, and do so in a systematic, consistent and demonstrable way."

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