T A B L E O F C O N T E N T S. Medicare Hospice CoPs California Hospice Standards Title 22 Regulation Page No.(s) SAMPLE

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1 TABLE OF CONTENTS.. [ Subpart A ] Definitions Article 1 - Definitions Article 1 - Definitions Hospice Hospice Home Health Agency 1 Hospice Care No Equivalent No Equivalent 2 No Equivalent Administrator Administrator 2 No Equivalent No Equivalent Audiologist 2 Bereavement Counseling Bereavement Services No Equivalent 2 CAP Period No Equivalent No Equivalent 2 Comprehensive Assessment No Equivalent No Equivalent 3 Multiple Locations Multiple Locations Branch Office 4 No Equivalent Counselor No Equivalent 4 No Equivalent No Equivalent Dentist 4 No Equivalent Department Department 4 Dietary Counseling Dietary Counseling Dietitian 5 No Equivalent Director Director 5 No Equivalent Facility-based Service No Equivalent 5 No Equivalent Family No Equivalent 5 No Equivalent Residence No Equivalent 5 Hospice Aide Home Health Aide Home Health Aide 5 No Equivalent No Equivalent Home Health Services 6 No Equivalent Home Health Aide Services No Equivalent 6 No Equivalent Homemaker No Equivalent 6 No Equivalent Homemaker Services No Equivalent 6 No Equivalent Hospice Physician No Equivalent 6 Initial Assessment No Equivalent No Equivalent 6 No Equivalent Inpatient Care Arrangements No Equivalent 7 No Equivalent Interdisciplinary Care No Equivalent 7 No Equivalent Interdisciplinary Team No Equivalent 7 No Equivalent License License 7 No Equivalent Licensee Licensee 7 Licensed Professional No Equivalent No Equivalent 8 No Equivalent Licensed Vocational Nurse Licensed Vocational Nurse 8 No Equivalent Medical Direction No Equivalent 8 No Equivalent Medical Director No Equivalent 8 i-viii Table of Contents - i

2 Nurse Practitioner Nurse Practitioner No Equivalent 8 Occupational Therapist No Equivalent Occupational Therapist 9 Occupational Therapy Assistant No Equivalent Occupational Therapist 9 Assistant Palliative Care Palliative No Equivalent 9 No Equivalent Parent Agency Parent and Primary Home 9 Health Agency No Equivalent Patient Patient 10 No Equivalent No Equivalent Physical Therapist 10 No Equivalent No Equivalent Physical Therapist Assistant 10 Physician Physician Physician 10 Attending Physician Attending Physician No Equivalent 10 Physician Designee No Equivalent No Equivalent 11 No Equivalent Plan of Care No Equivalent 11 No Equivalent Preliminary Services No Equivalent 11 No Equivalent Primary Caregiver No Equivalent 11 No Equivalent No Equivalent Private Agency 11 No Equivalent Professional Management No Equivalent 12 No Equivalent No Equivalent Public Agency 12 No Equivalent No Equivalent Subdivision 12 No Equivalent No Equivalent Podiatrist 12 No Equivalent No Equivalent Public Health Nurse 12 No Equivalent Registered Nurse Registered Nurse 12 No Equivalent Residence No Equivalent 13 No Equivalent Respite Services No Equivalent 13 Representative No Equivalent No Equivalent 13 Restraint No Equivalent No Equivalent 13 Seclusion No Equivalent No Equivalent 14 No Equivalent Skilled Nursing Services Skilled Nursing Services 14 Criteria for Licensure of Home Health Agencies No Equivalent Social Services/Counseling Services No Equivalent 15 No Equivalent Social Worker Social Worker 15 No Equivalent Social Work Associate Social Work Assistant 15 No Equivalent No Equivalent Speech Pathologist 16 Table of Contents - ii

3 No Equivalent Spiritual Services No Equivalent 16 Terminally Ill Terminal Disease/Terminal Illness No Equivalent 16 Also Referred to as Employee Volunteer No Equivalent 16 No Equivalent Volunteer Services No Equivalent 16 Employee Also Referred to as Volunteer No Equivalent 17 [ Subpart B ] Eligibility, Election and Duration of Benefits Eligibility Requirements No Equivalent No Equivalent Duration of Hospice Care No Equivalent No Equivalent 18 Coverage Election Periods Certification of Terminal No Equivalent No Equivalent 18 Illness Election of Hospice Care No Equivalent No Equivalent Admission to Hospice Care No Equivalent No Equivalent Discharge from Hospice No Equivalent No Equivalent 25 Care Revoking the Election of No Equivalent No Equivalent 27 Hospice Care Change of the Designated Hospice No Equivalent No Equivalent 28 [ Subparts C, D and F ] Subpart C Conditions of Participation: Patient Care Subpart D - Core Services Subpart F - Other Services [Subpart C ] Patient Care Condition of Participation: Patient s rights Condition of Participation: Initial and comprehensive assessment of the patient Article 2, 3, 4, 5, and 6 Article 2 License Article 3 Services Article 4 Administration Article 5 Qualifications for Home Health Aide Certification 6.6 Patient/Family Rights and Responsibilities A. Rights and Responsibilities B. Retaliation or Discrimination 3.1 Assessments Requirements for 3.2 Content of the Plan Acceptance of Patients 3.4 Review of the plan Plan of Treatment; Plan of Patient Rights Table of Contents - iii

4 Condition of Participation: Interdisciplinary group, care planning, and coordination of service Condition of Participation: Quality assessment and performance improvement Data Submission requirements under the hospice quality reporting program Condition of Participation: Infection Control Condition of Participation: Licensed Professional Services Condition of Participation: Core Services 3.5 Coordination of the plan Care; Plan for Personal Care Services 4.1 Responsibilities Reference: Documentation Orders for Medication and 4.3 Patient/Family Participation Treatment 6.5 Quality Assessment and Performance Improvement Quality Management 38 No Equivalent No Equivalent Record-Keeping Requirement A. Employee Health Examinations and Health Records 6.4 Reporting Requirements A. Reporting of Outbreaks B. Unusual Occurrences Employee s Health Assessments and Health Records Reporting of Communicable Disease Reporting of Outbreaks Annual Reports 42 No Equivalent No Equivalent Services Provided 2.2 Physician A. Medical Director B. Attending Physician C. Hospice Physician 2.3 Nursing A. Skilled Nursing B. Licensed Vocational Nursing 5.4 Nursing 2.5 Social Work 2.6 Counseling 5.3 Director of Patient Care Services 2.6 Counseling 3. Bereavement Services Dietary Services 2. Spiritual Services 5.7 Spiritual Services Preventive, Treatment and Rehabilitative Services Skilled Nursing Services Nurse Supervisor Medical Social Services Director of Patient Care Services Diet Counseling Services 45 Table of Contents - iv

5 Condition of Participation: Nursing Services Waiver of requirement that substantially all nursing services be routinely provided directly by a hospice. Non-Core Services Condition of Participation: Furnishing of Non-Core Services Condition of Participation: Physical Therapy, Occupational Therapy, and Speech-Language Pathology Condition of Participation: Waiver of Requirement Physical Therapy, Occupational Therapy, Speech-Language Pathology, and Dietary Counseling Condition of Participation: Hospice Aide and Homemaker Services Condition of Participation: Volunteers No Equivalent No Equivalent 54 No Equivalent No Equivalent 55 No Equivalent Therapy Services 55 No Equivalent No Equivalent Home Health Aide/Homemaker Services 2.4 Home Health Aide/Homemaker A. Home Health Aide B. Homemaker 2.8 Volunteer Services 5.8 Volunteers A. Coordination B. Training C. Personnel Files Personal Care/Home Health 57 Aide Services Home Health Aide Certification Home Health Aide Training Issuance, Denial, Revocation or Suspension of Home Health Aide Certificate Home Health Aide/Personal Care Services Supervision No Equivalent 66 Table of Contents - v

6 [Subpart D ] Organizational Environment Condition of Participation: Organization and Administration of Services Condition of Participation: Medical Director Condition of Participation: Clinical Records Condition of Participation: Drugs and Biologicals, Medical Supplies, and Durable Medical Equipment See Addendum I Page A Condition of Participation: Short-Term Inpatient Care See Addendum I Page A Condition of Participation: Hospices That Provide Inpatient Care Directly See Addendum I Page A Condition of Participation: Hospices That Provide Hospice Reference: Hospice Definition 6.1 Governing Body 5.1 Administration 2.1 Services Provided 6.2 Policies A. Administrative Policies B. Contractual Services Reference: Volunteers B. Training Reference: Governing Body Administrator Reference: Written Administrative Policies Services Arranged By Agreement Parent and Primary Home Health Agency Branch Office Medical Director No Equivalent Record-Keeping Requirements B. Patients Medical Records 4. Maintenance of Records Patient Health Records Patients Health Records Availability No Equivalent No Equivalent 82 No Equivalent No Equivalent Facility-Based Services No Equivalent 82 No Equivalent No Equivalent Table of Contents - vi

7 Care To Residents of a SNF/NF or ICF/11D See Addendum I Page A Condition of Participation: Personnel Qualifications Condition of Participation: Compliance with Federal, State, and Local Laws and Regulations Related to the Health and Safety of Patients Physician Hospice Physician Attending Physician Social Worker License Licensee Physician Social Worker Speech Pathologist Occupational Therapist Occupational Therapist Assistant Physical Therapist Physical Therapist Assistant Plans of Correction License Required Application for License Special Conditions for License Operation of a Home Health Agency Across State Lines Disclosure Clause Report of Changes Fee Issuance, Denial, Expiration and Renewal Transferability Separate Licenses Availability of License Voluntary Suspension of License Voluntary Cancellation of License Revocation or Involuntary Suspension of License Pursuing Disciplinary Action to Completion Reinstatement of Revoked or Suspended License Table of Contents - vii

8 Program Flexibility [Subpart E ] Removed and Reserved Addendum I Medicare Hospice CoPs: Drug & Biological, Medical A-1 Supplies & DME Short-Term Inpatient Care A Hospices That Provide A-3 Inpatient Care Directly Hospices That Provide A-7 Hospice Care To Residents of a SNF/NF or ICF/MR [Subpart F] Covered Services No Equivalent No Equivalent A-9 [Subpart G] Payment for Hospice Care No Equivalent No Equivalent A-12 [Subpart H] Coinsurance No Equivalent No Equivalent A-20 Addendum II California Hospice Standards A2-1 Title 22 Regulations A2-4 California Hospice Facility License A2-24 Table of Contents - viii

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