Ohio Administrative Code|Rule 3701-19-22.1 | Admission of non-hospice palliative care patients to hospice inpatient facilities.

                                                
(A) A hospice care program that operates
		  an inpatient hospice facility or unit may admit non-hospice palliative care
		  patients to the inpatient hospice facility or unit for medically necessary care
		  on a short-term basis in accordance with section 3712.10 of the Revised
		  Code.
(B) A hospice care program that operates
		  an inpatient hospice facility or unit that admits non-hospice palliative care
		  patients shall admit patients, provide care and services, and discharge or
		  transfer patients without discrimination on the basis of sex, age, race, creed,
		  national origin, or handicap.
(C)  A hospice care program that operates
		  an inpatient hospice facility or unit that admits non-hospice palliative care
		  patients shall require that the non-hospice palliative care patient, or the
		  patient's authorized representative, sign an informed consent form. This
		  form shall include an acknowledgment by signature of the patient or
		  patient's representative, that they have been given a full explanation of
		  the palliative nature of the care they will receive while admitted to the
		  facility or unit and have been informed that the patient may withdraw consent
		  at any time.
(D)  A hospice care program that operates
		  an inpatient hospice facility or unit that admits non-hospice palliative care
		  patients shall permit a patient to withdraw consent for inpatient care at any
		  time.
(E) A hospice care program that operates
		  an inpatient hospice facility or unit that admits non-hospice palliative care
		  patients shall provide a patient or the patient's representative with
		  information regarding the scope of services provided by the hospice inpatient
		  facility or unit, including any limitations of services and charges for the
		  services.
(F) Each hospice care program that
		  operates an inpatient hospice facility or unit that has admitted non-hospice
		  palliative care patients under section 3712.10 of the Revised Code or intends
		  to admit non-hospice palliative care patients under this Chapter, shall provide
		  a written attestation in accordance with paragraph (C)(8)(b) of rule 3701-19-03
		  of the Administrative Code by April 1, 2020.
(G) Each hospice care program that
		  operates an inpatient hospice facility or unit that admits non-hospice
		  palliative care patients in accordance with section 3712.10 of the Revised Code
		  and this chapter, shall ensure:
(1) The director has
			 access to all facilities, services, and records for non-hospice palliative care
			 patients for the purpose of inspections conducted pursuant to rule 3701-19-05
			 of the Administrative Code; and
(2) All non-hospice
			 palliative care patients and their families or caregivers are included in the
			 quality assurance and performance improvement requirements set forth in
			 paragraphs (D), (E), and (F) of rule 3701-19-06 of the Administrative
			 Code.
(a) The records associated with the quality assurance and
				performance improvement program for non-hospice palliative care patients and
				their families or caregivers may be maintained and reviewed separate from the
				hospice care program quality assessment and performance improvement program;
				and
(b) Beginning January 30, 2021, a report of the findings of
				the quality assessment and performance improvement program review required by
				this paragraph and the actions taken by the hospice care program to correct
				identified problems, shall be submitted to the department of health in a manner
				prescribed by the director.
(H) In addition to the notification
		  requirements set forth in paragraph (D) of rule 3701-19-07 of the
		  Administrative Code, a hospice care program that operates a hospice inpatient
		  facility or unit that admits non-hospice palliative care patients shall notify
		  the director, in writing, of any intent to cease the admission of non-hospice
		  palliative care patients within thirty days of the discontinuation of the
		  service.
(I) In addition to the orientation and training
		  requirements set forth in rules 3701-19-09 and 3701-19-13 of the Administrative
		  Code, all hospice care program personnel and volunteers that provide care to
		  non-hospice palliative care patients in a hospice care program inpatient
		  facility or unit shall be provided additional training in:
(1) The philosophy of
			 palliative care;
(2) The goals of
			 palliative care; and
(3) Physiological and
			 psychosocial issues associated with palliative care.
(J) In addition to the duties prescribed to the medical
		  director of a hospice care program in rule 3701-19-10 of the Administrative
		  Code, the hospice care program medical director, or the medical director's
		  designee, for a hospice care program that admits non-hospice palliative care
		  patients to the hospice's inpatient facility or unit shall:
(1) Review all referrals
			 for admission of a non-hospice palliative care patient;
(2) Ensure that an
			 assessment of the medical and psychosocial needs of the non-hospice palliative
			 care patient is conducted to determine whether the patient's needs can be
			 met by the hospice inpatient facility or unit. This assessment may include, but
			 is not limited to, a review of the patient's medical records from the
			 referring provider, a physical exam, assessment tools designed to determine the
			 patient's psychosocial needs, or other tools the medical director deems
			 appropriate; and
(3) Document the
			 determination as follows:
(a) If a determination is made to admit the non-hospice
				palliative care patient and the patient accepts, written documentation of the
				decision and the assessments conducted shall be included in the patient's
				clinical record for a period of no less than six years;
(b) If a determination is made to not admit the non-hospice
				palliative care patient, the following information shall be maintained in a
				manner that can be made available to the director upon request, for a period of
				no less than six years:
(i) Date of
				  referral;
(ii) Diagnosis and reason
				  for the referral;
(iii) The assessments
				  conducted, if any; and
(iv) The reason the non-hospice palliative care patient was
				  not admitted.
(K) Non-hospice palliative care patients admitted to a
		  hospice care program inpatient facility or unit, shall have an
		  interdisciplinary team or teams that provide or supervise the provision of care
		  and services to non-hospice palliative care patients.
(1) The hospice care
			 program shall designate an interdisciplinary team to be responsible for
			 establishing the policies and procedures related to caring for non-hospice
			 palliative care patients admitted to the hospice care program inpatient
			 facility or unit. The team shall ensure that all policies and procedures are
			 available and accessible to all hospice care program inpatient facility or unit
			 personnel.
(2) A registered nurse
			 shall be designated to coordinate each interdisciplinary team and ensure the
			 following:
(a) A clinical record is created and maintained in
				accordance with rule 3701-19-23 of the Administrative Code for each non-hospice
				palliative care patient admitted to a hospice care program inpatient facility
				or unit;
(b) There is ongoing assessment of the non-hospice
				palliative care patient's and and patient's family's
				needs;
(c) That all components of the plan of care are addressed
				by the interdisciplinary team; and
(d) The plan of care is implemented in accordance with its
				terms.
(3) Each
			 interdisciplinary team shall perform the following functions:
(a) Establish an interdisciplinary plan of care for each
				non-hospice palliative care patient and their family that is coordinated by one
				individual who shall ensure:
(i) All components of the
				  plan are addressed and implemented; and
(ii) The non-hospice
				  palliative care patient and their family are encouraged to be actively involved
				  in the development of the plan of care.
(b) Review the interdisciplinary plan of care on a periodic
				basis, but no less frequently than every three days; and
(c) Provide an ongoing evaluation of the palliative care
				and services provided to the non-hospice palliative care patient and their
				family.
(4) As part of each
			 non-hospice palliative care patient's interdisciplinary plan of care, the
			 hospice care program inpatient facility or unit shall ensure:
(a) That the medical components of care are provided under
				the direction of a physician or a physician's designee prior to providing
				care and services to the non-hospice palliative care patient;
(b) A list of services that will be provided by or arranged
				for by the hospice care program is provided to the non-hospice palliative care
				patient;
(c) Nursing care is available to the non-hospice palliative
				care patient twenty-four hours a day seven days a week in accordance with rule
				3701-19-14 of the Administrative Code;
(d) The non-hospice palliative care patient's plan of
				care is reviewed by the patient's attending physician and by the
				interdisciplinary team; and
(e) That each non-hospice palliative care patient's
				attending physician, if any, is sent a copy of the patient's plan of care.
				The date that the copy of the plan of care was sent to the attending physician
				shall be documented in the patient's clinical record.
(L) All medical social services provided to non-hospice
		  palliative care patients in a hospice care program inpatient facility or unit
		  shall be provided in accordance with rule 3701-19-15 of the Administrative
		  Code.
(M) All medical services provided to non-hospice palliative
		  care patients in a hospice care program inpatient facility or unit shall be
		  provided in accordance with rule 3701-19-17 of the Administrative
		  Code.
(N) All counseling services provided to non-hospice
		  palliative care patients in a hospice care program inpatient facility or unit
		  shall be provided in accordance with paragraphs (A), (B) and (C) of rule
		  3701-19-18 of the Administrative Code. If indicated, the hospice care program
		  may provide bereavement counseling for the non-hospice palliative care patient
		  and the patient's family
(O) All necessary physical therapy, occupational therapy,
		  and speech therapy services provided to non-hospice palliative care patients in
		  a hospice care program inpatient facility or unit shall be provided in
		  accordance with rule 3701-19-19 of the Administrative Code.
(P) Each hospice care program shall arrange for provision
		  of medical supplies, appliances, drugs, and biologicals to all non-hospice
		  palliative care patients as needed for the palliation and management of the
		  patient's illness and related conditions. The program shall ensure that
		  drugs and biologicals are available at all times. Each hospice care program
		  shall ensure that drugs and biologicals are administered only by a registered
		  nurse, a licensed practical nurse, a physician assistant, an advanced practice
		  registered nurse, or a physician.