in this issue August 2008 TheJournal · 2020. 3. 18. · pice criteria and are hospice appropriate,...

They come in all shapes, forms and sizes - young and old, male andfemale. They hail from far and near, ruraland urban. They share their expertise, lead

the team, and care for dying patients. Why somehave even been known to “leap tall buildings with a single bound” or “boldly gowhere no man has gone before”! Who are these incredible people? OurHospice Medical Directors of course!

The role of a Hospice Medical Director is not one to be taken lightly.There is much responsibility that he/she assumes in this position. TheInterdisciplinary Group (IDG) can’t function without him/her. The Hospice

Medical Director provides leadership and guidance,is a consultant to many, is an expert on pain andsymptom management, is often a liaison with other

members of the local medical community, has to make sure patients meet hos-pice criteria and are hospice appropriate, has to certify the terminal illness ofhospice patients, and has to stay abreast of the changes in guidelines (state andfederal) – just to mention a few highlights of the job.

This issue of The Journal focuses on Hospice MedicalDirectors. Included in this issue you will find a crosswalk of theLA State Minimum Standards, the Condition of Participation (CoPs), and theMS State Minimum Standards - all with regards to Hospice Medical Directors.

Hospice Medical Directors are special people with a heart of compassionand a philosophy of care that is to be commended. Makesure to let your Medical Director know how much youappreciate him/her.

The Crosswalk is designed to help equip hospice providers with neces-sary information to compare their State Minimum Standards with the FederalConditions of Participation. Highlights pertaining to Medical Directors weretaken from each state as well as the newly revised Federal Conditions ofParticipation. The columns are color coded for each of the three entities.

The Crosswalk is not all inclusive of all standards and providers are urgedto make sure they have a current copy of the CoPs as well as the state minimumstandards. The new CoPs are effective December 2, 2008.

Hospice providers are responsible to be compliant with the current regula-tions and its requirements until December 2, 2008.

Remember, hospice providers are held to the most stringent guidelines,whether it is state or federal.

next month:717 Kerlerec, N.O., LA 70116 Toll Free 1-888-546-1500(504) 945-2414 Fax (504) 948-3908 www.LMHPCO.org

Not yet a Member?Get more information about LMHPCO at www.LMHPCO.org

TheJournalTheJournalAugust 2008

in this issueThe Role of HospiceMedical Directors of the Louisiana-Mississippi Hospice & Palliative Care Organization

Role of the Hospice Nurse

MercifulEmpatheticDevotedIndispensableCaringApproachableLeader

DoctorIndividualReady to serveEducatorConsultantTeacherOverseerRegulatory Expert

Do You Know These VIPs?

leadership

liason

guidance

compassion

Louisiana-Mississippi Hospice & Palliative Care Organization

The Journal

The Leslie Lancon Memorial Education Nursing Scholarship was estab-lished in 2005 by LMHPCO. The annual scholarship will beawarded to support hospice nursing excellence and educationthroughout Lousisiana and Mississippi. The awards will focus notonly on excellence for those seeking academic degrees in hospicenursing, but also those seeking advanced certification in hospiceand palliative care nursing.

2

The Louisiana-Mississippi Hospice and Palliative CareOrganization is a 501(c)3 non-profit organization governed by aboard of directors representing all member hospice programs. Itis funded by membership dues, grants, tax-deductible donations

and revenues generated by educational activities. LMHPCOexists to ensure the continued development of hospice and pal-liative care services in Louisiana and Mississippi. LMHPCOprovides public awareness, education, research, and technical

assistance regarding end-of-life care, as well as advocacy for ter-minally ill and bereaved persons, striving to continually improve

the quality of end-of-life care in Louisiana and Mississippi.

EXECUTIVE BOARDPresident, Sandra Bishop, Memorial Hospice at Gulfport

13305 Roxbury Place • Gulfport, MS 39503Phone: 228-831-1228 • Cell: 228-424-3345

E-mail: [email protected]

President-Elect, Stephanie SchedlerMemorial Hospice & Palliative Care

1045 Florida Avenue • Slidell, LA 70458Phone: 985-847-0174 888-643-2041

Fax: 985-649-0671 • E-mail: [email protected]

Treasurer, Kathleen GuidryLouisiana Hospice & Pallaitive Care

522 North Main Street • Jennings, LA 70546Phone: 337-616-3482 • Fax: 337-616-9399


Secretary, Laurie Grady, Hospice of Light2012 Hwy 90, Suite 29 • Gautier, MS 39553

Phone: 228-497-2400 • 888-497-2404Fax: 228-497-9035 • E-mail: [email protected]

LOUISIANA AT LARGE MEMBERSOpal Carriere, Serenity Hospice

3712 MacArthur Boulevard, Suite 204New Orleans, LA 70114

Phone: 504-366-3996 • 866-366-3996Fax: 504-366-7268


Martha McDurmond, Hospice of Shreveport/Bossier3829 Gilbert (Madison Park)Shreveport, LA 71104-5005


Glen Mire, Hospice of AcadianaUMC, Family Medicine

2390 West Congress Street • Lafayette, LA 70506Phone: (337) 261-6690 • Fax: 337-261-6662


MISSISSIPPI AT LARGE MEMBERSLinda Gholston, The Sanctuary Hospice House5159 West Main Street • Tupelo, MS 38801Phone: 662-844-2111 • Fax: 662-844-2354E-mail: [email protected]

Belinda Patterson, Hospice Ministries450 Town Center Boulevard • Ridgeland, MS 39157

Phone: 601-898-1053 • 800-273-7724Fax: 601-898-1805


Ann Walker, Magnolia Regional Health Center &Hospice, 2034 East Shiloh Road • Corinth, MS 38834


Executive DirectorJamey Boudreaux

717 Kerlerec • New Orleans, LA 70116Phone: 504-945-2414 • Toll-Free: 888-546-1500

Fax: 504-948-3908E-mail: [email protected]

Education Director, Nancy DunnP.O. Box 1999 • Batesville, MS 38606

Phone: 662-934-0860 • Fax: 504-948-3908E-mail: [email protected]

F F FThe Journal is produced monthly by Noya Design, Inc.

Newsworthy submissions are encouraged. Please contact GlennNoya with questions, comments and submissions at

ph: 504-455-2585 • Em: [email protected]

Calendarwww.LMHPCO.org

NHPCO September Audio Web SeminarUpdate

Leadership Topic, September 23, 2008Enhancing Access for Eligible Patients:Successful StrategiesAdvanced Registration Ends September 18th.Register today!

All seminars take place from 2p - 3:30p ET.For presenter information, detailed seminardescriptions and a full listing of all 2008seminar topics visitwww.nhpco.org/aws2008.

Provided by the Meniscus Educational Institute

Management Strategies for Opioid-InducedSide Effects – Available for CNE Credit

Registration InformationThere is no fee for participating in theseactivities.

WEBINAR SCHEDULE

Monday, September 15, 2008: 8:00–9:00 PM EDT

Tuesday, September 30, 2008: 8:00–9:00 PM EDT Thursday, October 2, 2008: 9:30–10:30 AM EDT Thursday, October 2, 2008: 2:30–3:30 PM EDT Wednesday, October 8, 2008: 11:00 AM-12:00 PMEDT

GENERAL INFORMATIONPhone: 610-834-1810

REGISTRATION DEADLINEPlease register 1 to 2 days prior to the live webi-nar to download log-in and conference callinstructions, and important program materials.

REGISTRATION OPTIONSPhone 1-888-622-9927

INTERNETwww.meniscus.com/register/nursing-sideef-fects08

Supported by an educational grant fromWyeth Pharmaceuticals

Area Code 601 Quarterly LuncheonTuesday September 30, 2008 (11:30AM -1:30PM)To reserve your seat you must contact BelindaPatterson [email protected] or byphone at (800) 273-7724.

September 23-26, 200817th International Congress on Palliative CarePalais des Congrès in Montréal, CanadaFor more information go to: www.pal2008.com

September 23, 2008Palmetto-GBA Coalition MeetingColumbia, SC

October 23-25, 2008NHPCO’s 9th Clinical Team ConferenceHyatt Regency, Dallas, TXFor more information go to:http://www.nhpco.org/i4a/pages/index.cfm?pageid=3259

March 25-28, 2009AAHPM & HPNA Annual AssemblyAustin, TXFor more information go to:http://www.hpna.org/DisplayPage.aspx?Title=Annual%20Conferences

April 23-25, 2009NHPCO’s 24th Management & LeadershipConferenceOmni-Shoreham Hotel, Washington, DCFor more information go to:http://www.nhpco.org/i4a/pages/index.cfm?pageid=3259

April 29, 200916th Annual National HFA Living with GriefTeleconference (12:30-3:00PM)Diversity & End-of-Life CareFor more information, go to: www.hospicefounda-tion.org


August 2008 3

Subchapter A. General Provisions§8201. DefinitionsHospice Physician— a person who is adoctor of medicine or osteopathy, andis currently and legally authorized topractice medicine in the State ofLouisiana, designated by the hospice toprovide medical care to hospicepatients in lieu of their primary physi-cian.

Interdisciplinary Group (IDG)— aninterdisciplinary group or groups desig-nated by the hospice, composed of rep-resentatives from all the core services.The IDG must include at least a doctorof medicine or osteopathy, a registerednurse, a social worker, and a pastoral orother counselor. The interdisciplinarygroup is responsible for participation inthe establishment of the plan of care;provision or supervision of hospice careand services; periodic review andupdating of the plan of care for eachindividual receiving hospice care, andestablishment of policies governing theday-to-day provision of hospice careand services. If a hospice has more thanone interdisciplinary group, it must des-ignate in advance the group it choosesto execute the establishment of policiesgoverning the day-to-day provision ofhospice care and services.

MEDICAL D IRECTOR/PHYSICAN

LA State MinimumStandards

Current as of December, 1999Proposed Changes in Red

§ 418.3 Definitions.Attending physician means a physicianwho--(a) Is a doctor of medicine or osteopa-thy; and (b) Is identified by the individ-ual, at the time he or she elects toreceive hospice care, as having themost significant role in the determina-tion and delivery of the individual'smedical care.

Physician designee means a doctor ofmedicine or osteopathy designated bythe hospice who assumes the sameresponsibilities and obligations as themedical director when the medicaldirector is not available.

(1) The hospice must designate aninterdisciplinary group or groups com-posed of individuals who work togetherto meet the physical, medical, psy-chosocial, emotional, and spiritualneeds of the hospice patients and fami-lies facing terminal illness and bereave-ment. Interdisciplinary group membersmust provide the care and servicesoffered by the hospice, and the group,in its entirety, must supervise the careand services. The hospice must desig-nate a registered nurse that is a memberof the interdisciplinary group to providecoordination of care and to ensure con-tinuous assessment of each patient’sand family’s needs and implementationof the interdisciplinary plan of care.The interdisciplinary group mustinclude, but is not limited to, individu-als who are qualified and competent topractice in the following professionalroles:(i) A doctor of medicine or osteopathy(who is an employee or under contract

101 DEFINITIONS101.31 Hospice Physician – A doctorof medicine or osteopathy who is cur-rently and legally authorized to practicemedicine in the State of Mississippi andis designated by the hospice to providemedical care to hospice patients, incoordination with the patient’s primaryphysician.

101.35 Interdisciplinary Team (IDT)– An interdisciplinary team or group(s)designated by the hospice, composed ofrepresentatives from all the core servic-es. The Interdisciplinary Team mustinclude at least a doctor of medicine orosteopathy, a registered nurse, a socialworker, and a pastoral or other coun-selor. The interdisciplinary team isresponsible for participation in theestablishment of the plan of care; provi-sion or supervision of hospice care andservices; periodic review and updatingof the plan of care for each individualreceiving hospice care, and establish-ment of policies governing the day-to-day provision of hospice care and serv-ices. If a hospice has more than oneinterdisciplinary team; it must desig-nate, in advance, the team it chooses toexecute the establishment of policiesgoverning the day to-day provision ofhospice care and services.

MS State Minimum Standards

Current as of February 22, 2008

c r o s s w a l kMedicare Conditionsof Participation (CoPs)

Revised June 5, 2008 withEffective Date of Revisions

December 2, 2008


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Subchapter B. Organization andStaffing§8217. PersonnelQualifications/ResponsibilitiesI. Medical Director/PhysicianDesignee. A physician, currently andlegally authorized to practice medicinein the State, and knowledgeable aboutthe medical and psychosocial aspects ofhospice care. The Medical Directorreviews, coordinates, and is responsiblefor the management of clinical andmedical care for all patients.NOTE: The Medical Director orPhysician Designee may be an employ-ee or a volunteer of the hospice agency.The hospice agency may also contractfor the services of the Medical Directoror Physician Designee.Proposed Changes:The Medical Director shall complete 2hours of Continuous Medical Education(CME) annually related to end of lifecare. Documentation of this CME shallbe maintained in the Medical Director’spersonnel record. 1. Qualifications. A Doctor of Medicineor Osteopathy licensed to practice inthe state of Louisiana.2. Responsibilities. The MedicalDirector or Physician designee assumesoverall responsibility for the medicalcomponent of the hospice’s patient careprogram and shall include, but not belimited to:a. serve as a consultant with the attend-ing physician regarding pain and symp-tom control as needed;b. serve as the attending physician ifdesignated by the patient/family unit;

with the hospice).(ii) A registered nurse.(iii) A social worker.(iv) A pastoral or other counselor.(2) If the hospice has more than oneinterdisciplinary group, it must identifya specifically designated interdiscipli-nary group to establish policies govern-ing the day-to-day provision of hospicecare and services.

§ 418.102 Condition of participation:Medical director.The hospice must designate a physicianto serve as medical director. The med-ical director must be a doctor of medi-cine or osteopathy who is an employee,or is under contract with the hospice.When the medical director is not avail-able, a physician designated by the hos-pice assumes the same responsibilitiesand obligations as the medical director.(a) Standard: Medical director con-tract.(1) A hospice may contract with eitherof the following—(i) A self-employed physician; or(ii) A physician employed by a profes-sional entity or physicians group.When contracting for medical directorservices, the contract must specify thephysician who assumes the medicaldirectorresponsibilities and obligations.(b) Standard: Initial certification ofterminal illness. The medical directororphysician designee reviews the clinicalinformation for each hospice patientandprovides written certification that it isanticipated that the patient’s lifeexpectancy is 6 months or less if the ill-ness runs its normal course. The physi-cian must consider the following whenmaking this determination:(1) The primary terminal condition;(2) Related diagnosis(es), if any;(3) Current subjective and objectivemedical findings;(4) Current medication and treatment

PART IV ADMINISTRATION109 ADMINISTRATION109.02 Medical Director1. Each hospice shall have a MedicalDirector, who, on the basis of training,experience and interest, shall be knowl-edgeable about the psychosocial andmedical aspects of hospice care.2. The Medical Director shall beappointed by the governing body or itsdesignee.3. The Medical Director is expected toplay an integral role in providing med-ical supervision to the hospice interdis-ciplinary group and in providing overallcoordination of the patient’s plan ofcare. The Medical Director’s expertisein managing pain and symptoms asso-ciated with the patient’s terminal dis-ease is necessary, regardless of the set-ting in which the patient is receivingservices to assure that the hospicepatient has access quality hospice care.The duties of the Medical Director shallinclude, but not be limited to:a. Determination of patient medical eli-gibility for hospice services in accor-dance with hospice program policy;b. Collaboration with the individual’sattending physician to assure all aspectsof medical care are taken into consider-ation in devising a palliative plan ofcare;c. Review, revise and document theplan at intervals specified in the plan,but no less than every 14 calendar days;d. Acting as a medical resource to thehospice care team and as a medical liai-son with physicians in the community;and



Medicare Conditionsof Participation (CoPs)


August 2008 5

c. review patient eligibility for hospiceservices;d. serve as a medical resource for thehospice interdisciplinary group;Proposed Changes: d. serve as a medical resource for thehospice Interdisciplinary Team;e. act as a liaison to physicians in thecommunity;f. develop and coordinate proceduresfor the provision of emergency care;Proposed Changes:f. develop and coordinate policies andprocedures for the provision of patientcare;g. provide a system to assure continu-ing education for hospice medical staffas needed;h. participate in the development of thePOC prior to providing care, unless thePOC has been established by an attend-ing physician who is not also theMedical Director or PhysicianDesignee; and i. participate in the review and updateof the POC, unless the plan of care hasbeen reviewed/updated by the attendingphysician who is not also the MedicalDirector or Physician Designee. Thesereviews must be documented.Proposed Changes:j. attend IDT meetingsk. document evidence of active partici-pation in the hospice program (i.e. per-formance of above responsibilities andtime spent upon performance of thoseresponsibilities)

orders; and(5) Information about the medical man-agement of any of the patient’s condi-tions unrelated to the terminal illness.(c) Standard: Recertification of theterminal illness. Before the recertifica-tion period for each patient, asdescribed in §418.21(a), the medicaldirector or physician designee mustreview the patient’s clinical informa-tion.(d) Standard: Medical director respon-sibility. The medical director or physi-cian designee has responsibility for themedical component of the hospice’spatient care program.

e. Coordination of efforts with eachattending physician to provide care inthe event that the attending physician isunable to retain responsibility forpatient care.

113 ORGANIZATION ANDSTAFFING PERSONNEL QUALI-FICATIONS/RESPONSIBILITIES113.09 Medical Director/PhysicianDesigneeA physician, currently and legallyauthorized to practice medicine in theState, and knowledgeable about themedical and psychosocial aspects ofhospice care. The Medical Directorreviews, coordinates, and is responsiblefor the management of clinical andmedical care for all patients.NOTE: The Medical Director orPhysician Designee may be an employ-ee or a volunteer of the hospice agency.The hospice agency may also contractfor the services of the Medical Directoror Physician Designee.1. Qualifications – A Doctor ofMedicine or Osteopathy licensed topractice in the State of Mississippi.2. Responsibilities – The MedicalDirector or Physician designee assumesoverall responsibility for the medicalcomponent of the hospice’s patient careprogram and shall include, but not belimited to:a. Serve as a consultant with the attend-ing physician regarding pain and symp-tom control as needed;b. Serve as the attending physician ifdesignated by the patient/family unit;c. Review patient eligibility for hospiceservices;d. Participate in the review and updateof the POC for each patient at a mini-mum of every 14 calendar days, unlessthe plan of care has beenreviewed/updated by the attendingphysician who is not also the MedicalDirector or Physician Designee. Thesereviews must be documented.e. Document the patient’s progresstoward the outcomes specified in the





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Subchapter C. Patient Care Services§8219. Patient Care StandardB. Admission criteria.2. certification of terminal illnesssigned by the attending physician andthe medical director of the agency;C. Admission procedure. Patients are tobe admitted only upon the order of thepatient's attending physician.f. for an individual who is terminallyill, certificationof terminal illness signed by the med-ical director or the physician memberof the IDG and the individual's attend-ing physician.

§ 418.25 Admission to hospice care.(a) The hospice admits a patient onlyon the recommendation of the medicaldirector in consultation with, or withinput from, the patient’s attendingphysician (if any).(b) In reaching a decision to certify thatthe patient is terminally ill, the hospicemedical director must consider at leastthe following information:(1) Diagnosis of the terminal conditionof the patient.(2) Other health conditions, whetherrelated or unrelated to the terminal con-dition.(3) Current clinically relevant informa-tion supporting all diagnoses

§ 418.26 Discharge from hospicecare.(b) Discharge order. Prior to discharg-ing a patient for any reason listed inparagraph(a) of this section, the hospice mustobtain a written physician’s dischargeorder from the hospice medical direc-tor. If a patient has an attending physi-cian involved in his or her care, thisphysician should be consulted beforedischarge and his or her review anddecision included in the discharge note.

Sec. 418.22 Certification of terminalillness.(b) Content of certification.Certification will be based on thephysician’s or medical director’s clini-cal judgment regarding the normalcourse of the individual’s illness. Thecertification must conform to the fol-lowing requirements:

plan of care.f. Serve as a medical resource for thehospice interdisciplinary group and as aliaison to physicians in the community;g. Develop and coordinate proceduresfor the provision of emergency care;h. Provide a system to assure continu-ing education for hospice medical staffas needed;

114 PATIENT CARE SERVICES114.01 Patient Care Standard2. Admission criteriab. Certification of terminal illnesssigned by the attending physician andthe medical director of the agency uponadmission and recertification;3. Admission Procedure – Patients areto be admitted only upon the order ofthe patient’s attending physician.b. Documentation at admission will beretained in the clinical record and shallinclude:e. Certification of terminal illnesssigned by the medical director andattending physician.





August 2008 7

§8221. Plan of Care (POC)A. Prior to providing care, a writtenplan of care is developed for eachpatient/family by the attending physi-cian, the Medical Director or physiciandesignee and the IDG. The care provid-ed to an individual must be in accor-dance with the POC.B. Review and Update of the Plan ofCare. The plan of care is reviewed andupdated at intervals specified in thePOC, when the patient's conditionchanges, and a minimum of every 14days for home care and every 7 daysfor general inpatient care, collabora-tively with the IDG and the attendingphysician. 1. Agency shall have policy and proce-dures for the following:

(1) The certification must specify thatthe individual’s prognosis is for a lifeexpectancy of 6 months or less if theterminal illness runs its normal course.(2) Clinical information and other doc-umentation that support the medicalprognosis must accompany the certifi-cation and must be filed in the medicalrecord with the written certification asset forth in paragraph (d)(2) of this sec-tion. Initially, the clinical informationmay be provided verbally, and must bedocumented in the medical record andincluded as part of the hospice’s eligi-bility assessment.(c) Sources of certification.(1) For the initial 90-day period, thehospice must obtain written certifica-tion statements (and oral certificationstatements if required under paragraph(a)(3) of this section) from--(i) The medical director of the hospiceor the physician member of the hospiceinterdisciplinary group; and(ii) The individual's attending physicianif the individual has an attending physi-cian.(2) For subsequent periods, the onlyrequirement is certification by one ofthe physicians listed in paragraph(c)(1)(i) of this section.

§ 418.54 Condition of participation:Initial and comprehensive assessmentof the patient.(b) Standard: Timeframe for comple-tion of the comprehensive assessment.The hospice interdisciplinary group, inconsultation with the individual’sattending physician (if any), must com-plete the comprehensive assessment nolater than 5 calendar days after the elec-tion of hospice care in accordance with§ 418.24.(d) Standard: Update of the compre-hensive assessment.The update of the comprehensiveassessment must be accomplished bythe hospice interdisciplinary group (incollaboration with the individual’sattending physician, if any) and must

114.02 Plan of Care (POC)1. Within 48 hours of the admission, awritten plan of care must be developedfor each patient/family by a minimumof two IDT members and approved bythe full IDT and the Medical Directorat the next meeting. The care providedto an individual must be in accordancewith the POC.

114.03 Review and Update of thePlan of CareThe plan of care is reviewed and updat-ed at intervals specified in the POC,when the patient’s condition changesand a minimum of every 14 days forhome care and every 7 days for generalinpatient care, collaboratively with theIDT and the attending physician.




b. physician orders must be signed anddated in a timely manner, not to exceed14 days, unless the hospice has docu-mentation that verifies attempts to getorders signed; in this situation up to 30days will be allowed. 2. The agency shall have documenta-tion that the patient’s condition andPOC is reviewed and the POC updated,even when the patient’s condition doesnot change. C. Coordination and Continuity ofCare. The hospice shall adhere to thefollowing additional principles andresponsibilities:2. nursing services, physician services,and drugs and biologicals are routinelyavailable to hospice patients on a 24-hour basis, seven days a week;

§8201Core Services— nursing services,physician services,medical social services, and counselingservices, includingbereavement counseling, dietary coun-seling, spiritualcounseling, and any other counselingservices provided to meet the needs ofthe individual and family. These servic-es must be provided by employees ofthe hospice, except that physician serv-ices and counseling services may beprovided through contract.

§8233. Clinical RecordsH. The clinical record shall contain acomprehensive compilation of informa-tion including, but not limited to, thefollowing:

consider changes that have taken placesince the initial assessment. It mustinclude information on the patient’sprogress toward desired outcomes, aswell as a reassessment of the patient’sresponse to care. The assessmentupdate must be accomplished as fre-quently as the condition of the patientrequires, but no less frequently thanevery 15 days.

Core Services§ 418.64 Condition of participation:Core services. (a) Standard: Physicianservices. The hospice medical director,physician employees, and contractedphysician(s) of the hospice, in conjunc-tion with the patient’s attending physi-cian, are responsible for the palliationand management of the terminal illnessand conditions related to the terminalillness.(1) All physician employees and thoseunder contract, must function under thesupervision of the hospice medicaldirector.(2) All physician employees and thoseunder contract shall meet this require-ment by either providing the servicesdirectly or through coordinating patientcare with the attending physician.(3) If the attending physician isunavailable, the medical director, con-tracted physician, and/or hospice physi-cian employee is responsible for meet-ing the medical needs of the patient.

§ 418.104 Condition of participation:Clinical records.(a) Standard: Content. Each patient’srecord must include the following: (5) Physician certification and recertifi-

1. Agency shall have policy and proce-dures for the following:a. The attending physician’s participa-tion in the development, revision, andapproval of the POC isdocumented. This is evidenced bychange in patient orders and document-ed communication between HospiceStaff and the attending physician;b. Physician orders must be signed anddated in a timely manner, but must bereceived before billing is submitted foreach patient.2. The agency shall have documenta-tion that the patient’scondition and POC is reviewed and thePOC updated, even when the patient’scondition does not change.

PART VI BASIC HOSPICE CARE116 CORE SERVICES116.01 Hospice care shall be providedby a hospice care team. Medical, nurs-ing and counseling services are basic tohospice care and shall be provideddirectly (Medical Director only may becontract).Hospice care will be available twenty-four (24) hours a day, seven (7) days aweek.1. Medical services shall be under thedirection of the Medical Director.

114.10 Clinical Records8. The clinical record shall contain acomprehensive compilation of informa-tion including, but not limited to, thefollowing:





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2. certifications of terminal illness;3. written physician's orders for admis-sion and changes to the POC;

§8223. Pharmaceutical Services3. Drugs and treatments are adminis-tered by agency staff only as orderedby the physician.

Subchapter D. Administration§8235. Agency OperationsB. Hours of Operation2. Hospice provides on-call medicaland nursing services to assess and meetchanging patient/family needs, provideinstruction and support, and conductadditional on-site assessment or treat-ment, 24 hours a day, seven days perweek.

cation of terminal illness as required in§ 418.22 and § 418.25 and described in§ 418.102(b) and § 418.102(c) respec-tively, if appropriate. (7) Physician orders.

§ 418.106 Condition of participation:Drugs and biologicals, medical sup-plies, and durable medical equip-ment.(b) Standard: Ordering of drugs.(1) Only a physician as defined by sec-tion 1861(r)(1) of the Act, or a nursepractitioner in accordance with the planof care and State law, may order drugsfor the patient.(2) If the drug order is verbal or givenby or through electronic transmission—(i) It must be given only to a licensednurse, nurse practitioner (where appro-priate), pharmacist, or physician; and(ii) The individual receiving the ordermust record and sign it immediatelyand have the prescribing person sign itin accordance with State and Federalregulations.

§ 418.100 Condition of Participation:Organization and administration ofservices.(2) Nursing services, physician servic-es, and drugs and biologicals (as speci-fied in § 418.106) must be made rou-tinely available on a 24-hour basis7 days a week. Other covered servicesmust be available on a 24-hour basiswhen reasonable and necessary to meetthe needs of the patient and family.

b. Certifications of terminal illness;c. Written physician’s orders for admis-sion and changes to the POC;

114.05 Pharmaceutical Services4. Drugs and treatments are adminis-tered by agency staff as ordered by thephysician.

115 ADMINISTRATION115.02 Hours of Operation2. Hospice provides on-call medicaland nursing services to assess and meetchanging patient/family needs, provideinstruction and support, and conductadditional on-site assessment or treat-ment, 24 hours a day, seven days perweek.

115.05 Quality Assurance5. The Hospice’s written plan for con-tinually assessing and improving allaspects of operations must include:b. A system to ensure systematic, objec-tive quarterly reports. Documentationmust be maintained to reflect that suchreports were reviewed with the IDT, theMedical Director, the Governing Bodyand distributed to appropriate areas;





9August 2008


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Subchapter E. Hospice InpatientFacility§8251. Medical DirectorThe hospice inpatient facility shall havea Medical Director who is a doctor ofmedicine or osteopathy and is currentlylicensed to practice medicine inLouisiana. The Medical Director mustensure and assume the overall responsi-bility for the medical component of thehospice’s in-patient care program.

§ 418.114 Condition of participation:Personnel qualifications.(a) General qualification require-ments. Except as specified in paragraph(c)of this section, all professionals whofurnish services directly, under an indi-vidual contract, or under arrangementswith a hospice, must be legallyauthorized (licensed, certified or regis-tered) in accordance with applicableFederal, State and local laws, and mustact only within the scope of his orher State license, or State certification,or registration. All personnel qualifica-tions must be kept current at all times.(b) Personnel qualifiations for certaindisciplines.The following qualifications must bemet:(1) Physician. Physicians must meetthe qualifications and conditions asdefined in section 1861(r) of the Actand implemented at §410.20 of thischapter.

§ 418.110 Condition of participation:Hospices that provide inpatient caredirectly.A hospice that provides inpatient caredirectly in its own facility must demon-strate compliance with all of the fol-lowing standards:(m) Standard: Restraint or seclusion.(4) The use of restraint or seclusionmust be in accordance with the order ofa physician authorized to order restraintor seclusion by hospice policy in accor-dance with State law.(5) Orders for the use of restraint orseclusion must never be written as astanding order or on an as needed basis(PRN).(6) The medical director or physiciandesignee must be consulted as soon aspossible if the attending physician didnot order the restraint or seclusion.(7) Unless superseded by State law thatis more restrictive—(i) Each order for restraint or seclusionused for the management of violent or

PART VIII INPATIENT FACILITY130 INPATIENT FACILITY130.02 Medical Director-InpatientServices-The hospice inpatient facilityshall have a Medical Director who is adoctor of medicine or osteopathy and iscurrently licensed to practice medicinein Mississippi. The Medical Directormust ensure and assume the overallresponsibility for the medical compo-nent of the hospice’s inpatient careservices.





11August 2008

self-destructive behavior that jeopardiz-es the immediate physical safety of thepatient, a staff member, or others mayonly be renewed in accordance with thefollowing limits for up to a total of 24hours:(A) 4 hours for adults 18 years of ageor older;(B) 2 hours for children and adoles-cents 9 to 17 years of age; or(C) 1 hour for children under 9 years ofage; andAfter 24 hours, before writing a neworder for the use of restraint or seclu-sion for the management of violent orself-destructive behavior, a physicianauthorized to order restraint or seclu-sion by hospice policy in accordancewith State law must see and assess thepatient.(5) The condition of the patient who isrestrained or secluded must be moni-tored by a physician or trained staff thathave completed the training criteriaspecified in paragraph (n) of this sec-tion at an interval determined by hos-pice policy.(6) Physician, including attendingphysician, training requirements mustbe specified in hospice policy. At aminimum, physicians and attendingphysicians authorized to order restraintor seclusion by hospice policy in accor-dance with State law must have a work-ing knowledge of hospicepolicy regarding the use of restraint orseclusion.(7) When restraint or seclusion is usedfor the management of violent or selfdestructive behavior that jeopardizesthe immediate physical safety of thepatient, a staff member, or others, thepatient must be seen face-to-face within1 hour after the initiation of the inter-vention—(i) By a—(A) Physician; or(B) Registered nurse who has beentrained in accordance with the require-ments specified in paragraph (n) of thissection.





The Journal12

§8257. Pharmaceutical Services ofInpatient HospiceE. Orders for medications. A physicianmust order all medication for thepatient.1. If the medication order is verbal, thephysician must give it only to alicensed nurse, pharmacist, or anotherphysician; and the individual receivingthe order must record and sign it imme-diately.2. All orders (to include telephoneand/or verbal) are to be signed by theprescribing physician in a timely man-ner, not to exceed 30 days.F. Administering Medications.2. Physicians' orders are checked atleast daily to assure that changes arenoted.

(ii) To evaluate—(A) The patient’s immediate situation;(B) The patient’s reaction to the inter-vention;(C) The patient’s medical and behav-ioral condition; and(D) The need to continue or terminatethe restraint or seclusion.(9) If the face-to-face evaluation speci-fied in § 418.110(m)(11) is conductedby a trained registered nurse, thetrained registered nurse must consultthe medical director or physiciandesignee as soon as possible after thecompletion of the 1-hour face-to-faceevaluation.

§ 418.106 Condition of participation:Drugs and biologicals, medical sup-plies, anddurable medical equipment.(d) Standard: Administration of drugsand biologicals.(2) Patients receiving care in a hospicethat provides inpatient care directly inits own facility may only be adminis-tered medications by the followingindividuals:(i) A licensed nurse, physician, or otherhealth care professional in accordancewith their scope of practice and Statelaw;(ii) An employee who has completed aState-approved training program inmedication administration; and(iii) The patient, upon approval by theinterdisciplinary group.

130.05 Pharmaceutical Services ofInpatient Hospice- The hospice shallprovide pharmaceutical services inaccordance with acceptable profession-al standards of nursing and pharmaceu-tical practice and State law. The hos-pice shall have policies and proceduresthataddress receipt, storage, dispensing,labeling, medication administration, allaspects of controlled substance storage,usage, and disposal of controlled sub-stances, the handling of medicationerrors and components for incorporat-ing pharmacy practices into the facili-ty’s overall quality improvement plan.




This year’s Heart of Hospicerecipients were SusanStephens (Willis-KnightonHospice of Louisiana,Shreveport, LA) and JuneStevens (Hospice Ministries,Ridgeland, MS). Both werehonored their many years ofservice at a luncheon held onthe final day of the LMHPCOannual LeadershipConference. Both Susan andJune were surrounded by fam-ily and friends, as well as the247 hospice professionals in attendance at this year’s Conference.


13August 2008

CMS Published the Final Rule on FY2009Hospice Wage Index on August 1, 2008 and

LMHPCO members can access the rates for yourregion at: http://www.lmhpco.org/login/wages/FY2009_Wage_Index.pdf Louisiana parishes arelocated on page 62-64; Mississippi counties on

pages 77-80.

NOTE

LA Medicaid follow up from Leadership Conferencesession: Information as requested by the LeadershipConference attendees during Lana Ryland’s session

can be found at:http://www.lmhpco.org/forums/Blah.cgi?b=52,m=1218142783 These attachments contain a list of serv-ices and supplies currently covered by the Medicaid

Nursing Home Room & Board reimbursement. Ifyou need further clarification regarding these

items, please contact Lana directly at 225-342-6116

NOTE

CMS has released more the following guidancewith regards to CR5567

https://questions.cms.hhs.gov/cgibin/cmshhs.cfg/php/enduser/std_adp.php?p_

faqid=9353&p_created=1215795853&p_sid=yMMBxj9j&p_accessibility=0&p_redirect=&p_lva=

9149&p_sp=cF9zcmNoPTEmcF9zb3J0X2J5PSZwX2dyaWRzb3J0PTQ6MiZwX3Jvd19jbnQ9MzYs

MzYmcF9wcm9kcz04LDU3LDEwMTAmcF9jYXRzPSZwX3B2PTMuMTAxMCZwX2N2PSZwX3NlYXJja

F90eXBlPWFuc3dlcnMuc2VhcmNoX25sJnBfcGFnZT0x

NOTE

INTERNET RESOURCESAmerican Academy of Hospice and

Palliative Medicinewww.aahpm.org

• • • • •The Center to Advance Palliative Care (CAPC)

www.capc.org• • • • •

End of Life/ Palliative EducationResource Center

www.eperc.mcw.edu• • • • •

Growth House, Inc.www.growthhouse.org

• • • • •Hospice Foundation of America

www.hospicefoundation.org• • • • •

Louisiana~Mississippi Hospice &Palliative Care Organization

www.LMHPCO.org• • • • •

The National Hospice &Palliative Care Organization

www.nhpco.org

Dr Jack McNulty,Director of thePalliative CareInstitute ofSoutheasternLouisiana led adinner time discus-sion with 30 hospi-tal based palliativecare professionals(representing 14hospitals in south-east Louisiana andthe MississippiGulf Coast)regarding the con-tinued development of palliative care services within their facil-ities. This is the third year the dinner meeting was organizedby LMHPCO, funded by the Palliative Care Institute and heldin conjunction with the annual Leadership Conference. Thisyear’s table conversation focused on the development of a sur-vey instrument that will benchmark the current level of pallia-tive care services offered within hospital facilities located inboth Mississippi and Louisiana.

briefs


The Journal14

This year’s annual conference proved to be a huge suc-cess. We had our biggest number of attendees ever. Theavailability of information on a local, state and nationallevel was outstanding. Sessions were packed, some to over-flowing. A plethora of information was made available tohelp assist providers as they continue to provide hospicecare within our two state region. The NHPCO Bookstorewas a big hit. Thanks to Dr. Larry Grubbs and TammyLeBouef for spear heading this event.

The electronic version of the handouts made availableto us by the presenters is being made available to our mem-bership on LMHPCO web-site. Check out those sessionsyou wish you could have attended.

There is excitement in the air as LMHPCO looks at theeducational needs and continues planning. Thanks to all ofyou who completed an annual LMHPCO Survey as thishelps us meet the needs of the organization as well as pre-pare for upcoming events. Be on the lookout for upcomingarea code educational opportunities in the near future.

Thanks to theEducation Committeemembers and all otherswho helped make thisyear’s conference a suc-cess. It is indeed a pleas-ure to work with such tal-ented people!

Proves to be a Huge Success

Nancy Dunn, RN, MS, CT, LMHPCO Education Director


August 2008 15

The 2008 Leadership Conference Handouts arenow available to members at:

http://www.lmhpco.org/login/leadership-conf/index.shtml

NOTE


(as of 7/15/2008):PROVIDER MEMBERS:A& E Hospice, Olive Branch, MSAgape Hospice Care of Shreveport, LAAgape Northeast Hospice, West Monroe, LAAgape Northwest Hospice, Minden, LABaptist Memorial Hospice-Golden Triangle,

Columbus, MSBayou Region Hospice, Houma, LABrighton Bridge Hospice, Oberlin, LACamellia Home Health & Hospice, Bogalusa,

LACamellia Home Health & Hospice, Columbia,

MSCamellia Home Health & Hospice, Hattiesburg,

MSCamellia Home Health & Hospice, Jackson, MSChristus Schumpert, Shreveport, LACircle of Life Hospice, Inc, Shreveport, LAComfort Care Hospice, Laurel, MSCommunity Hospice, LLC, New Orleans, LACommunity Hospice, Inc, Sherman, MSCommunity Hospices of America – McComb,

MSCommunity Hospices of America – Meridian,

MSCommunity Hospices of America – Minden,

LACommunity Hospices of America – Natchez,

MSCommunity Hospices of America – Shreveport,

LAContinue Care Hospice & Home Health,

Hollandale, MSDelta Regional Medical Center Hospice,

Greenville, MSDestiny Hospice, Palliative Care & Specialty

Services, Inc, Tutwiler, MSElayn Hunt Correctional Center Hospice,

St Gabriel, LAEternity Hospice, Inc, Gulfport, MSEternity Hospice, Inc, Indianola, MSEternity Hospice, Inc, Laurel, MSFaith Foundation, Alexandria, LAFirst Choice Hospice, Inc, Olla, LAForrest General Hospice, Hattiesburg, MSGenerations Hospice Service Corporation,

Denham Springs, LAGenesis Hospice Care, Inc. Cleveland, MSGilbert’s Hospice Care – Flowood, MSGilbert’s Hospice Care – Tupelo, MSGuardian Hospice Care, LLC, Alexandria, LAHarbor Hospice of Lake Charles LP, LAHeart to Heart Hospice, Inc – Amory, MSHeart to Heart Hospice, Inc – Belmont, MSHeart to Heart Hospice, Inc – Booneville, MSHelping Hands Hospice dba: Hospice in His

Hands-In-Patient, Kosciusko, MSHelping Hands Hospice dba: Hospice in His

Hands-In-Patient, Magee, MSHelping Hands Hospice dba: Hospice in His

Hands-In-Patient, Walnut Grove, MSHeritage Hospice, Amory, MSHeritage Hospice, Corinth, MSHospice Associates, Metairie, LAHospice Care of Louisiana, Alexandria, LAHospice Care of Avoyelles, Alexandria, LAHospice Care of Avoyelles, Marksville, LAHospice Care of Louisiana, Baton Rouge, LA

Hospice Care of Louisiana, Lafayette, LAHospice Care of Louisiana/Mississippi, Slidell,

LAHospice Care of Louisiana, Monroe, LAHospice Care of Louisiana, New Orleans, LAHospice Care of Mississippi, Waveland, LAHospice Ministries, Brookhaven, MSHospice Ministries, Forest, MSHospice Ministries, Natchez, MSHospice Ministries, McComb, MS Hospice Ministries, Ridgeland, MSHospice of Acadiana, Inc, Lafayette, LAHospice of Baton Rouge, Baton Rouge, LAHospice of Caring Hearts, LLC, Dubach, LAHospice of Leesville, Leesville, LAHospice of Light, Gautier, MSHospice of Light, Lucedale, MSHospice of Many, Many, LAHospice of Natchitoches, Natchitoches, LAHospice of St Tammany, Mandeville, LAHospice of Shreveport/Bossier, LAHospice of South Louisiana, Houma, LAHospice TLC, Winnsboro, LAInfinity Care Hospice of Louisiana, LLC, New

Orleans, LAJordan’s Crossing Hospice, LLC, Shreveport,

LAJourney Hospice, Alexandria, LAJourney Hospice, Baton Rouge, LALifePath Hospice Care Services, LLC,

Shreveport, LALife Source Services, Baton Rouge, LALivingston Hospice Associates, LLC, Walker,

LALouisiana Hospice of Mamou, Mamou, LALouisiana Hospice & Pallaitive Care, Jennings,

LALouisiana Hospice & Palliative Care,

Opelousas, LAMagnolia Regional Health Center HH &

Hospice, Corinth, MSMemorial Hospital Hospice at Gulfport,

Gulfport, MSMemorial Hospice & Pallaitive Care,

Ponchatoula, LAMemorial Hospice & Pallaitive Care, Slidell,

LAMid-Delta Hospice of Batesville, Batesville,

MSMy Hospice, Metairie, LANorth Mississippi Hospice of Oxford, Oxford,

MSNorth Mississippi Hospice of Oxford,

Southaven, MSNorth Mississippi Medical Center Hospice,

Tupelo, MSNorth Oaks Hospice, Hammond, LAOdyssey Healthcare, Gulfport, MSOdyssey Healthcare, Jackson, MSOdyssey Healthcare of Lake Charles, LAOdyssey Healthcare, Minden, LAOdyssey Healthcare of New Orleans, Metairie,

LAOdyssey Healthcare, Shreveport, LAOmega Hospice, Southaven, MSPatient Choice Hospice, Tallulah, LAPatient’s Choice Hospice, Vicksburg,Pax Hospice, Madison, MSPointe Coupee, New Roads, LA

Premier Hospice, Bastrop, LAProfessional Hospice & Healthcare Services,

Greenville, MSQuality Hospice Care, Inc, Philadelphia, MSRichland Hospice, LLC, Rayville, LARiver Region Hospice, LLC, River Ridge, LARiver Region Hospice House, River Ridge, LASt Catherine’s Hospice, LLC, LaPlace, LASt Joseph Hospice, Baton Rouge, LASt Joseph Hospice and Palliative Care, LLC,

New Orleans, LASt Joseph Hospice & Palliative Care

Northshore, Covington, LASt Johns Hospice & Palliative Care, Ruleville,

MSSt Joseph Hospice of Acadiana, Lafayette, LASt Joseph Hospice of CENLA, Alexandria, LASt Teresa’s Hospice & Palliative Care, Inc,

Lafayette, LASerenity Hospice Services, New Orleans, LASoutheast Louisiana Hospice, Bogalusa, LASouth Mississippi Homecare & Hospice, Inc (dab

Deaconess Hospice), Hattiesburg, MSTrinity Hospice, LLC, Hattiesburg, MSTrinity Hospice, LLC, Ocean Springs, MSUnity

Hospice, Olive Branch, MSVital Hospice, Inc, Metairie, LAWillis Knighton Hospice of Louisiana,

Shreveport, LAASSOCIATE MEMBERSAncillary Medical Services, Canton, MSAt Home Hospice Care, Fayette, MSDeyta, LLC, Louisville, KYDruzak Medical, Inc, Aliquippa, PAGranec Hospice Billing, Inc, Tuscaloosa, ALGuest Care Management, LLC, Shreveport, LAHealthCare ConsultLink, Fort Worth, TXHealthWyse, LLC, Wilmington, MAHospice Pharmacia, Philadelphia, PAThe Hospice Pharmacy Group, Grapevine, TXJBHM Architects, Jackson, MSMUMMS Software, New Orleans, LAMutual of America, Metairie, LAPatio Drugs, Metairie, LAProCare Hospice Care, Steubenville, OHSouthern Patient Care, Inc, Tupelo, MSINDIVIDUAL MEMBERSPatty Andrews, New Orleans, LAMichael C. Couch, Shreveport, LASusan Drongowski, New Orleans, LADelaine Gendusa, LCSW, Springfield, LASusan Nelson, MD, Baton Rouge, LAPat Snead, Hattiesburg, MSNealy Zimmermann, New Haven, CTORGANIZATIONAL MEMBERSALS Association Louisiana Chapter, Baton

Rouge, LAOur Lady of the Lake RMC, Baton Rouge, LAPalliative Care Institute of Southeast Louisiana,

Covington, LASouthern Eye Bank, Metairie, LAPROFESSIONAL MEMBERSMatt Freeland, CPA, Ridgeland, MSJ. Courtney Horton, III, Terry, MSLaura L McClintock, DO, Shreveport, LAJoAnn D Moore, Chalmette, LAAnn Roseberry, Benton, LA

Members make the work of LMHPCO possible!

The Journal16

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