Hospice and Palliative Care Association of NYS

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Marlene Andrews
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1 Hospice and Palliative Care Association of NYS October 14, 2016 October 17, 2016

2 Department of Health Updates October 17, 2016

3 Rebecca Fuller Gray, Director Division of Home & Community Based Services October 17, 2016

4 October 17, Hospice State Regulations Revised State regulations revised and effective August 31, 2016 Revised: 10 NYCRR Parts 700.2, 717, 793, 794 Makes the State operational rules for hospices consistent with federal regulations (CoPs) Dear Administrator Letter DHCBS provides summary of changes

5 October 17, Public Health Law Changes Public Health Law (PHL) 4002 (5): Terminally ill means an individual has a medical prognosis that the individual s life expectancy is approximately one year or less if the illness runs its normal course. PHL expanded the definition of terminal illness from six months to 12 months life expectancy. This change from 6 months to 12 months incorporates the Medicaid Redesign Initiative (MRT #209) to expand the Medicaid hospice benefit. This will allow individuals to access hospice care earlier in their terminal illness to manage symptoms on an ongoing basis and reduce the need for more costly emergency room visits and hospital stays.

6 October 17, Summary of Regulatory Changes Expands the definition of terminal illness from 6 months to 12 months life expectancy and addresses the difference in terminal illness for different payer sources Increases hospice residence capacity from 8 to 16 beds Adds definition of palliative care consistent with PHL 4012b: palliative care which means the active interdisciplinary care of patients with advanced, life limiting illness, focusing on relief of distressing physical and psychosocial symptoms and meeting the spiritual needs. Its goal is achievement of the best quality of life for patients and families.

7 October 17, Section Definition Changes 700.2(c)(55) defines a hospice patient as a person who is certified as being terminally ill, with a life expectancy of 12 months or less, who, alone or in conjunction with designated family member(s), has voluntarily requested admission into hospice and has been accepted into hospice for which the Department has issued a certificate of approval; provided, however, that nothing herein shall be construed to require provision of services to a patient that are not covered by the patient s payment source.

8 October 17, Section Definitions Changes 700.2(c)(58) clarifies that palliative and supportive care is provided to a hospice patient for the reduction and abatement of pain and other symptoms and stresses associated with terminal illness and dying (c)(60) is added to include the definition of palliative care, as defined in PHL, provided to a person with advanced, life limiting illness (a)(27) increases the maximum bed capacity of a hospice residence from 8 to 16 beds.

9 October 17, Part 717 Summary of Changes is amended to increase the maximum bed capacity for a free standing hospice residence from 8 to 16 beds is amended to reduce maximum room capacity from 4 to 2 patients as required by federal rules for inpatient facilities and units is amended to allow a hospice to operate a maximum of 25% of total residence beds as dually certified beds at any given time.

10 October 17, Revisions to 793 and and 794 have been reordered to make them more consistent with the Federal Conditions of Participation rules. Sections and requirements have been added to make consistent with Federal CoPs and also to update the State specific requirements

11 October 17, Governing Authority This section is predominately unchanged. It includes State specific requirements for: a patient complaint procedure an emergency response plan Health Commerce System account

12 October 17, Personnel This section includes: Health status & immunization requirements Maintenance and content of personnel records Job description required for each position In-service education for all staff and volunteers Hospice aides - minimum 12 hours in-service annually (NEW) Time and payment records are maintained for all personnel An annual assessment of performance and effectiveness

13 October 17, Hospice Residence Service This is a new section separated from Inpatient Service section. Addresses requirements for hospice residences, including: Residential in character Food service requirements Staffing as appropriate to meet needs of patients Routine and emergency drugs It increases the maximum bed capacity from 8 to 16 beds.

14 October 17, Hospice Surveillance Impact Act of CMS frequency for hospice recertification survey is changing to every 3 years (NYS standard was every 4 years). All hospices must be on the 3 year survey cycle by April Surveillance process in NOT changing as a result of revised State regulations.

15 October 17, Hospice Complaints 45 Hospices currently operating in NY State 28 hospice complaint intakes past 12 months 11 of these complaints were investigated onsite - 6 complaints were substantiated - 5 complaints were unsubstantiated

16 October 17, Hospice Surveillance Top Cited Deficient Findings: Tag # Standard Regulation Rank 0545 CONTENT OF PLAN OF CARE (c) REVIEW OF THE PLAN OF CARE (d) UPDATE OF COMPREHENSIVE ASSESSMENT (d) PLAN OF CARE (b) IDG, CARE PLANNING, COORDINATION OF SERVICES

17 October 17, #1 Most frequent citation Tag (c) Standard: Content of the plan of care The hospice must develop an individualized written plan of care for each patient. The plan of care must reflect patient and family goals and interventions based on the problems identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must include all services necessary for the palliation and management of the terminal illness and related conditions, including the following:

18 October 17, #2 Most frequent citation Tag (d) Standard: Review of the plan of care The hospice interdisciplinary group (in collaboration with the individual s attending physician, if any) must review, revise and document the individualized plan as frequently as the patient s condition requires, but no less frequently than every 15 calendar days.

19 October 17, #3 Most frequent citation Tag (d) Standard: Update of the comprehensive assessment The update of the comprehensive assessment must be accomplished by the hospice interdisciplinary group (in collaboration with the individual s attending physician, if any) and must consider changes that have taken place since the initial assessment. It must include information on the patient's progress toward desired outcomes, as well as a reassessment of the patient s response to care. The assessment update must be accomplished as frequently as the condition of the patient requires, but no less frequently than every 15 days.

20 October 17, #4 Most frequent citation Tag (b) Standard: Plan of care All hospice care and services furnished to patients and their families must follow an individualized written plan of care established by the hospice interdisciplinary group in collaboration with the attending physician (if any), the patient or representative, and the primary caregiver in accordance with the patient s needs if any of them so desire.

21 October 17, #5 Most frequent citation Tag Condition of participation: Interdisciplinary group, care planning, and coordination of services The plan of care must specify the hospice care and services necessary to meet the patient and family-specific needs identified in the comprehensive assessment as such needs relate to the terminal illness and related conditions.

22 October 17, Emergency Preparedness Updates Providers must have an Emergency Preparedness plan that includes: Specific procedures to assure the health care needs of patients continue to be met in emergencies that interfere with the delivery of services; Orientation of all employees to their responsibilities in carrying out the plan; and Plan should address the different settings where hospice care may be provided such as in a hospice residence or inpatient unit.

23 October 17, Emergency Preparedness Requirements Health Commerce System DOH s primary communication system Hospice s information must be accurate on HCS Roles must be assigned, updated, and accurate Hospices must access HCS minimally every 24 hours and more frequently during an emergent event.

24 October 17, Emergency Preparedness Requirements Emergency Response Drills Purpose to familiarize providers with the survey, forms used, information needed and allow hospice to develop systems for quick access of this information Conducted by the Department on HCS Health Emergency Response Data System (HERDS) Hospice participation is REQUIRED

25 October 17, April 2016 Drill Compliance COMPLIANCE EMERGENCY DRILL Agencies were considered compliant if they submitted all forms for all days of the Emergency Drill Activity. Many agencies participated on some days of the drill, but not all days (partially participated). Fully Participated Partially Participated Did not Participate Compliant Non Compliant Total Number Numb Number Number Number Number % er % Number LHCSAs % % 1,224 ALPS* % % 81 CHHAs/LTHHCPs** % % 166 Hospices % % 45 *81 Agencies identified themselves as ALP LHCSAs. Once identified, they were not required to participate in the Emergency Drill. ** 33 of the compliant CHHAs reported combined information for themselves and an associated LTHHCP.

26 October 17, Emergency Response Surveys: Issued on Health Commerce System (HERDS Survey) Hospices REQUIRED to respond DOH s means to collect information during an emergency including: Patient census Patient classification (levels 1,2,3) # of patients that are electricity and ventilator dependent # of patients in hospice residence & free standing inpatient units Hospice s ability to serve current caseload Hospice s surge capacity Patient counts/classification in impacted areas (by county) TALs if ordered evacuation Evacuation and repatriation status if applicable

27 October 17, Emergency Preparedness CMS Emergency Preparedness Rule effective November 16, 2016 Implementation by November 16, 2017

28 October 17, Hospice Statistical Reports Dear Administrator Letter will be issued soon to communicate activation of report and due date Report will be due in December (providers will have at least 6 weeks to complete once report is activated on Health Commerce System) All providers must submit Failure to submit may result in an enforcement action under Section 12 of the Public Health Law - Adversely affects character and competence

29 October 17, Statistical Reports 2014 Compliance with Reporting Number submitted % Compliant Number not submitted % Not Compliant TOTAL # PROVIDERS LHCSA % % 1,220 ALP LHCSA % % 115 CHHA/LTHHCP % % 199 HOSPICE % % 45

30 October 17, Home Care Worker Registry Criminal History Record Check Public Health Law 3613 will be amended to include hospice programs for purposes of the Home Care Worker Registry (HCR) requirements Aides employed by hospice must be entered on the HCR HCR provides an aide s training and employment status Public Health Law 2899 will be amended to include requirements for CHRC for hospice aides

31 October 17, Advanced Home Health Aide Legislation will allow the Advanced Home Health Aide (AHHA) to perform advanced tasks with appropriate training and upon assignment by registered nurses and under supervision by registered nurses. Advanced tasks could be performed pursuant to an authorized health practitioner s ordered care and under the direct supervision of registered nurse employed by a home care agency or hospice provider. Legislation has NOT been signed into Law yet

32 October 17, Advanced Home Health Aide Will require regulations to developed and issued by State Education Department in collaboration with Department of Health Regulations will specify: The types of advanced tasks allowed Qualifications, training and competency requirements Training Program requirements

33 October 17, Questions Phone: Mail: Division of Home and Community Based Services 875 Central Avenue Albany, NY 12206

December 1, DAL: DHCBS Subject: Emergency Preparedness Requirements for Home Care and Hospice Providers. Dear Administrator:

December 1, DAL: DHCBS Subject: Emergency Preparedness Requirements for Home Care and Hospice Providers. Dear Administrator: December 1, 2016 DAL: DHCBS 16-11 Subject: Emergency Preparedness Requirements for Home Care and Hospice Providers Dear Administrator: The purpose of this letter is to provide guidance to Certified Home