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Article 7
Hospice Agencies

Section

310. Applicability and purpose of 7 AAC 12.310 - 7 AAC 12.349.

312. Licensure.

314. Inspections.

316. Scope of service: full-service hospice agency.

317. Scope of service: volunteer hospice agency.

318. Admission criteria.

319. Plan of care.

320. Advance health care directives; client rights.

321. Abuse, neglect, and mistreatment.

323. Quality improvement plan.

325. Governing body.

326. Professional advisory committee.

327. Interdisciplinary team.

329. Administration.

331. Professional management.

333. Hospice home health aide services.

334. Physical therapy services.

335. Social work services.

336. Volunteer services.

337. Counseling services.

338. Hiring, orientation, and training.

339. Clinical and administrative records.

340. Employee health.

341. Infection control.

342. Central supply; medical supplies and appliances.

343. Pharmaceutical hospice services.

344. Contracts.

349. Definitions.

7 AAC 12.310. Applicability and purpose of 7 AAC 12.310 - 7 AAC 12.349

(a) Except as provided in (b) of this section, and unless the department waives applicability under (e) of this section, the provisions of 7 AAC 12.310 - 7 AAC 12.349 apply to a public or private entity conducting, maintaining, or operating a hospice program that provides hospice care

(1) where a client lives or stays;

(2) for the treatment of physical, emotional, and mental symptoms of terminal illness; and

(3) that is based on hospice philosophy.

(b) A volunteer hospice agency is subject to the provisions of

(1) this section;

(2) 7 AAC 12.312 (Licensure);

(3) 7 AAC 12.314 (Inspections);

(4) 7 AAC 12.317 (Scope of Service: Volunteer Hospice Agency);

(5) 7 AAC 12.318 (Admission Criteria);

(6) 7 AAC 12.320 (Advance Health Care Directives; Client Rights), except 7 AAC 12.320(b) (2)(I) and (L);

(7) 7 AAC 12.321 (Abuse, Neglect, and Mistreatment);

(8) 7 AAC 12.325 (Governing Body);

(9) 7 AAC 12.329(b) and (c) (Administration), dealing with program director requirements;

(10) 7 AAC 12.336 (Volunteer Services);

(11) 7 AAC 12.338(a) , (b), (c), and (k) (Hiring, Orientation, and Training);

(12) 7 AAC 12.339 (Clinical and Administrative Records);

(13) 7 AAC 12.340 (Employee Health);

(14) 7 AAC 12.341 (Infection Control);

(15) 7 AAC 12.344 (Contracts), except 7 AAC 12.344(4) ; and

(16) 7 AAC 12.349 (Definitions).

(c) In addition to the applicable provisions of 7 AAC 12.310 - 7 AAC 12.349, a hospice agency is subject to the applicable requirements described in 7 AAC 12.600(a) and (i).

(d) Nothing in 7 AAC 12.310 - 7 AAC 12.349 relieves a hospice agency from compliance with 42 C.F.R. Part 418 for certification of a hospice agency to participate in the Medicare program. Licensure under this chapter does not qualify a hospice agency for participation in the Medicare program.

(e) The department will waive the applicability of this chapter for a hospice agency that provides proof that it is participating in the rural demonstration project under P.L. 108-173, title IV, sec. 409 (Medicare Prescription Drug, Improvement, and Modernization Act of 2003), and that it is in compliance with all applicable federal requirements for that project. A waiver issued under this subsection is void if the hospice agency ceases to participate in the project or ceases to be in compliance with applicable federal requirements.

History: Eff. 5/24/2007, Register 182

Authority: AS 47.32.010

AS 47.32.020

AS 47.32.030

7 AAC 12.312. Licensure

(a) Unless the department issues a waiver under 7 AAC 12.310(e) , an individual or entity must obtain a license from the department under 7 AAC 12.610 and this section if the individual or entity seeks to

(1) conduct, maintain, or operate a hospice agency;

(2) participate in conducting, maintaining, or operating a hospice agency; or

(3) represent that the individual or entity will provide hospice services.

(b) A hospice agency may have more than one office that is either a branch office or a subunit of the parent agency. Each parent agency and each branch office or subunit must be assigned a distinctive name. For purposes of this section,

(1) a branch office is located in the same service area as the parent agency and shares administration, supervision, and service with the parent agency on a daily basis; a branch office is not required to be separately licensed under this chapter; and

(2) a subunit is located outside the service area where the parent agency is located, and does not share administration, supervision, and services with the parent agency on a daily basis; a subunit must be separately licensed under this chapter.

(c) The completed application submitted to the department must contain

(1) the applicant's name and address;

(2) the location of the hospice agency and each of its subunits and branch offices;

(3) identification of each person administratively responsible for the hospice program, including each person's name, address, telephone number, and affiliation, if any, with a licensed home health agency, hospital, or other health care facility;

(4) identification of the proposed service area;

(5) a list of hospice services directly provided by the hospice agency;

(6) a list of any hospice services to be provided through a contractual agreement, including each provider's name, address, and telephone number; and

(7) any additional information specified by the department as necessary to determine that the applicant is a hospice agency.

(d) The department will grant, deny, suspend, or revoke a license in accordance with AS 47.32 and this chapter.

History: Eff. 5/24/2007, Register 182

Authority: AS 47.32.010

AS 47.32.020

AS 47.32.030

7 AAC 12.314. Inspections

(a) The department will inspect each hospice agency, and may inspect each subunit or branch office of a hospice agency, after the initial application as specified in AS 47.32 and 7 AAC 12.610, and subsequently as specified in AS 47.32, 7 AAC 10.9600 - 7 AAC 10.9620, and 7 AAC 12.925.

(b) The department will announce in advance any visit conducted in the home of a hospice client. The department will conduct the visit only with the client's permission. The department will consider the client's health in determining whether to visit the client in the home. A client's refusal to permit a home visit by the department does not affect the hospice agency's licensure.

History: Eff. 5/24/2007, Register 182

Authority: AS 47.32.010

AS 47.32.020

AS 47.32.030

AS 47.32.050

AS 47.32.060

AS 47.32.090

AS 47.32.100

AS 47.32.110

7 AAC 12.316. Scope of service: full-service hospice agency

(a) A full-service hospice agency shall provide

(1) physician or advanced nurse practitioner services to provide directed medical care that meets the client's medical needs for palliative care and management of terminal illness;

(2) nursing care and services provided by or under the supervision of a registered nurse;

(3) social work services provided in accordance with 7 AAC 12.335;

(4) spiritual and emotional counseling services in accordance with 7 AAC 12.337 to the client, the client's family, and caregivers if these services are desired during the time the client is receiving hospice care;

(5) bereavement counseling services in accordance with 7 AAC 12.337 to the client's family and caregivers after the client's death;

(6) volunteer services in accordance with 7 AAC 12.336;

(7) dietary counseling services in accordance with 7 AAC 12.337;

(8) pharmaceutical hospice services in accordance with 7 AAC 12.343;

(9) services related to the referral and transfer of clients for laboratory services that are provided by an organization other than the hospice; the referral and transfer services must be provided in accordance with a written plan that delineates available services and the procedures for referring and transferring clients;

(10) services related to the transfer of specimens for laboratory services that are provided by an organization other than the hospice; the transfer services must be provided in accordance with a written plan that delineates available services and the procedures for transferring specimens; and

(11) short-term respite care to the client's family for the relief of the client's daily care.

(b) In addition to meeting the requirements of (a) of this section, the hospice agency shall evaluate each client's

(1) access to emergency medical services, including ambulance service;

(2) access to service, equipment, and supplies;

(3) safety and emergency preparedness within the client's place of residence.

(c) The hospice agency shall make nursing services, physician or advanced nurse practitioner services, and drugs and biologicals available on a 24-hour basis to the extent necessary to meet the client's needs for palliative care and management of terminal illness and related conditions.

(d) The hospice agency shall arrange for short-term inpatient care if home care is not feasible for pain control, symptom management, and respite purposes. The agency shall ensure that any short-term inpatient care is provided in a licensed facility that is most appropriate to meet the client's needs.

(e) The hospice agency shall offer hospice care in the least costly setting that can assure the quality of care and each type and amount of service that is necessary to meet the client's needs.

(f) The hospice agency shall have a risk management program that includes procedures to investigate, analyze, and respond to client grievances related to client care.

(g) The hospice agency shall develop and implement written policies and procedures consistent with this chapter that govern each service provided by the agency, including policies relating to confidentiality, training, and admissions. The policies and procedures must accurately describe the agency's goals, the methods by which the goals are achieved, and the mechanisms by which basic hospice care services are delivered. The agency shall review its policies and procedures at least annually. The program director shall document each review by dating and signing an attestation. The agency shall revise its policies and procedures if determined necessary by the agency or by the department to ensure that each policy and procedure is current and adequate for purposes of carrying out the agency's functions and maintaining consistency with this chapter.

History: Eff. 5/24/2007, Register 182

Authority: AS 47.32.010

AS 47.32.020

7 AAC 12.317. Scope of service: volunteer hospice agency

(a) Subject to (b) of this section, a volunteer hospice agency shall provide each of, and only, the following services:

(1) direct service volunteers;

(2) spiritual and emotional support services to the client, the client's family, and caregivers if these services are desired during the time the client is receiving hospice care;

(3) supervision, orientation, and training to direct service volunteers and other hospice staff;

(4) bereavement counseling services to assist the client's family and caregivers in coping with grief experienced after the client's death; and

(5) volunteer services in accordance with 7 AAC 12.336.

(b) A volunteer hospice agency may provide short-term respite care to the client's family for the relief of the client's daily care.

(c) A volunteer hospice agency shall investigate, analyze, and respond to client grievances related to client care.

(d) A volunteer hospice agency shall ensure that each client has a plan of care approved by the attending physician or advanced nurse practitioner, and by the program manager.

(e) A volunteer hospice agency shall develop and implement written policies and procedures consistent with this chapter that govern each service provided by the agency, including policies relating to confidentiality, training, and admissions. The policies and procedures must accurately describe the agency's goals, the methods by which the goals are achieved, and the mechanisms by which basic hospice care services are delivered. The agency must review its policies and procedures at least annually. The program director shall document each review by dating and signing an attestation. The agency shall revise its policies and procedures if determined necessary by the agency or by the department to ensure that each policy and procedure is current and adequate for purposes of carrying out the agency's functions and maintaining consistency with this chapter.

(f) Volunteer services in a volunteer hospice agency must be directed by a coordinator of volunteer services who shall

(1) implement a direct service volunteer program;

(2) coordinate the orientation, education, support, and supervision of direct service volunteers; and

(3) coordinate the use of direct service volunteers with other hospice staff and community resources.

History: Eff. 5/24/2007, Register 182

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