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10.07.21.00.htm 10.07.21.00. Title 10 DEPARTMENT OF HEALTH AND MENTAL HYGIENE Subtitle 07 HOSPITALS Chapter 21 Hospice Care Programs Authority: Health-General Article, §19-903 and 19-907, Annotated Code of Maryland
10.07.21.01.htm 10.07.21.01. 01 Scope and Purpose.. This chapter applies to any general or limited hospice care program as defined in Health-General Article, §19-901, Annotated Code of Maryland.
10.07.21.02.htm 10.07.21.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Attending physician" means the physician having the most significant role in the determination and delivery of the hospice patient's medical care.2) Bereavement Services.. a) "Bereavement services" means counseling services provided to the patient's family after the patient's death.b) "Bereavement services" includes:.
10.07.21.03.htm 10.07.21.03. 03 License Required.. A. A person may not operate or represent itself as operating a hospice care program in this State, without first obtaining a license from the Secretary.B. Section A of this regulation applies to a home health agency, hospital, related institution, or other licensed facility that operates a hospice care program that is distinct from the other services that it is authorized to provide.
10.07.21.04.htm 10.07.21.04. 04 Application Procedure.. A. Before a person may apply for a license to operate a general hospice care program, the person shall obtain a certificate of need from the Maryland Health Resources Planning Commission under Health-General Article, Title 19, Annotated Code of Maryland.B. The applicant shall submit an application for an initial license or renewal of a license on a written or electronic form provided by the Secretary.
10.07.21.05.htm 10.07.21.05. 05 Inspection by the Department.. A. A licensee, or a program seeking licensure under this chapter, shall be open at all times to inspection by the Department, and any agency designated by the Secretary, to conduct an inspection.B. The Department may:. 1) Periodically inspect a hospice care program for compliance with this chapter; and. 2) Conduct complaint investigations involving alleged licensure violations.. C. Noncompliance.. 1) If the Secretary determines that a hospice care
10.07.21.06.htm 10.07.21.06. 06 Administration.. A. Responsibility of Licensee. A licensee shall ensure that the operation of the hospice care program complies with Health-General Article, Title 19, Subtitle 9, Annotated Code of Maryland, and this chapter.B. Governing Body.. 1) A licensee shall have a governing body for the hospice care program. The governing body shall:. a) Determine the hospice care program's mission and purpose;. b) Conduct a periodic community needs assessment;. c) Provide outreach progr
10.07.21.07.htm 10.07.21.07. 07 Policies and Procedures.. The hospice care program shall adopt and implement written policies and procedures for:. A. The use of advance directives;. B. Identifying, reviewing, and discussing ethical dilemmas which arise in the care of patients and family;C. The use of specific treatment modalities in different hospice care settings, that is, palliative chemotherapy or radiation;D. The administration of medications, including who is qualified to administer medications;.
10.07.21.08.htm 10.07.21.08. 08 Personnel.. A. The hospice care program shall maintain sufficient health care professionals and volunteers to meet patient care needs.B. The hospice care program shall identify an interdisciplinary care team with responsibility for ensuring continuous assessment of the patient's and family's needs and implementation of an integrated plan of care. The hospice care program shall ensure that:1) A qualified health care professional coordinates the activities of the i
10.07.21.09.htm 10.07.21.09. 09 Quality Assurance.. A. The governing body shall ensure that the hospice care program conducts ongoing quality assurance and utilization review.B. Quality Assurance Program. The governing body shall assure that the hospice care program develops and implements a quality assurance and improvement program to assess and improve the quality of services being provided by the program.C. The quality assurance and improvement program shall:. 1) Focus on:.
10.07.21.10.htm 10.07.21.10. 10 The Interdisciplinary Plan of Care.. A. The interdisciplinary team shall develop a written plan of care for each patient and family. The plan of care shall reflect current standards of practice. The hospice care program shall document the attending physician's participation in the development, revision, and overall approval of the plan of care.B. The interdisciplinary plan of care shall reflect continuing communication between the attending physician and other member
10.07.21.11.htm 10.07.21.11. 11 Continuity of Care.. A. The hospice care program shall coordinate care to ensure continuity of care for the patient and family.B. Any changes in service delivery are to be based on an assessment of the patient's and family's needs and desires for hospice services and a hospice care program's transfer and discharge criteria.C. The hospice care program shall:. 1) Provide case management for the patient and family;. 2) Maintain an accurate, complete, and documented
10.07.21.12.htm 10.07.21.12. 12 Transfer or Discharge.. A. If the hospice care program does not provide inpatient hospice services directly, the hospice care program shall have a written transfer agreement with a hospice care program which provides those services.B. The hospice care program shall provide adequate and appropriate information about the patient and family at the time of transfer or discharge.C. When a patient and family transfers from one hospice care program to another or from home-based s
10.07.21.13.htm 10.07.21.13. 13 Physician Services.. A. Medical Director. The hospice care program shall have a medical director who shall be:. 1) A physician licensed to practice medicine in this State; and. 2) Knowledgeable about the psychosocial and medical aspects of hospice care.. B. Medical Director Duties. The medical director is responsible for:. 1) Reviewing, coordinating, and managing the clinical and medical care for all patients in the hospice care program;
10.07.21.14.htm 10.07.21.14. 14 Nursing Services.. A. Nursing services shall be provided by licensed or certified personnel, trained or experienced in hospice care and supervised by a registered nurse with training or experience in hospice nursing. All nursing services shall be provided in accordance with the requirements of Health Occupations Article, Title 8, Annotated Code of Maryland.B. The hospice care program shall provide nurse staffing levels based on:.
10.07.21.15.htm 10.07.21.15. 15 Ancillary Services.. A. The hospice care program shall have a written plan for the provision of pharmacy, laboratory, radiology, chemotherapy, and other ancillary services. When the service is provided by an organization other than the hospice care program, the hospice care program shall enter into a written agreement with the provider of ancillary services which specifies the services being provided and the procedures for accessing those services.B. The hospice care progr
10.07.21.16.htm 10.07.21.16. 16 Counseling Services.. A. Counseling Services. The hospice care program shall provide counseling services which address the needs of patients and families. The hospice care program shall provide counseling services as set forth in B-E of this regulation.B. Social Work Services. Social work services are to be based on an initial and continuing assessment of patient and family psychosocial needs. Each assessment shall be conducted by a social worker. Services shall be provided
10.07.21.17.htm 10.07.21.17. 17 Emergency Services.. A. The hospice care program shall ensure that emergency services are available 24 hours per day, 7 days a week.B. Emergency services are to include, at a minimum:. 1) Registered nurse and physician services;. 2) Palliative medications; and. 3) Other services, equipment, and supplies necessary to meet the patient's immediate needs as directed by the patient's plan of care.
10.07.21.18.htm 10.07.21.18. 18 Volunteer Services.. A. The hospice care program's volunteer services shall play a vital role in enhancing the quality of care delivered to the patient and family by encouraging community participation in the overall hospice care program.B. Volunteers may assist with patient care and administrative services consistent with the hospice care program's policies and in accordance with the requirements of this reguC. Volunteers shall document their activities in the clinical record..
10.07.21.19.htm 10.07.21.19. 19 Medical Records.. A. The hospice care program shall establish and maintain a clinical record for each patient in accordance with accepted principles of practice for maintaining medical records. The record is to be complete, accurately documented, readily accessible, and systematically organized to facilitate retrieval of information.B. The hospice care program shall:. 1) Document clinical and progress notes in a patient's medical record within 14 days of a visit or p
10.07.21.20.htm 10.07.21.20. 20 Patient's Representative.. A. A hospice care program shall recognize the authority of:. 1) A guardian of the person under Estates and Trusts Article, §13-705, Annotated Code of Maryland;. 2) A guardian of the property under Estates and Trusts Article, §13-201, Annotated Code of Maryland;. 3) An advance directive established in compliance with Health-General Article, §5-602, Annotated Code of Maryland;4) A surrogate decision maker with authority under Health-General Article,
10.07.21.21.htm 10.07.21.21. 21 Patient's Rights.. A. The hospice care program shall provide the patient or representative with a written notice of the patient's rights in advance of furnishing care. Documentation verifying receipt of and understanding of this information shall be included as part of the patient's record.B. The patient has the right to:. 1) Be treated with consideration and respect for individual dignity;. 2) Confidentiality in all aspects of service or treatment;. 3) Privacy;.
10.07.21.22.htm 10.07.21.22. 22 Complaint Procedure.. A. A hospice care program shall establish a procedure under which a patient or family member may make a complaint to a representative of the hospice care program.B. The hospice care program shall investigate and seek to resolve the complaint.. C. The hospice care program shall maintain documentation which reflects findings of the investigation and efforts to resolve the complaint.D. The hospice care program shall inform each patient and family of:.
10.07.21.23.htm 10.07.21.23. 23 Infection Control.. A. The hospice care program shall have an infection control program in all care settings.. B. There is to be a written plan for identifying, preventing, and controlling the spread of infection, which includes:1) Identifying an individual responsible for implementing and monitoring the infection control program;2) Establishing a system for periodic review and update of infection control policies and procedures governing at a minimum:a) Personal hygiene,.
10.07.21.24.htm 10.07.21.24. 24 Safety and Emergency Preparedness.. A. The hospice care program shall have a safety and emergency preparedness program that includes, at a minimum:1) A plan for reporting, monitoring, and following up on all accidents, injuries, and safety hazards;2) Education for patient and family caregivers, employees, and volunteers in the safe use of medical equipment;3) Evidence that equipment maintenance and safety requirements have been met; and. 4) A safe and sanitary sy
10.07.21.25.htm 10.07.21.25. 25 Home-Based Hospice Care Provided in a Licensed Health Care Facility.. A. Professional Management.. 1) When a hospice care program delivers hospice care to a resident of a licensed health care facility, the hospice care program shall assume full responsibility for professional management of the patient's hospice care in accordance with the requirements of this chapter.2) When a hospice care program delivers hospice care to a resident of a licensed health care facilit
10.07.21.26.htm 10.07.21.26. 26 Inpatient Hospice Care.. A. In addition to the other requirements of this chapter, when a hospice care program delivers inpatient care, the hospice care program shall provide nursing services 24 hours a day in a manner sufficient to meet the total nursing needs identified in the patient's plan of care. A registered nurse shall be on duty during each shift.B. The hospice care program shall design and equip all areas for the comfort and privacy of patients and family members. Spec
10.07.21.27.htm 10.07.21.27. 27 Penalties.. A. Administrative Penalty.. 1) The Secretary may, for noncompliance with any regulation under this chapter, impose an administrative penalty of up to:a) $500 for a first violation; and. b) $1,000 for a subsequent repeated violation.. 2) When considering whether to impose an administrative penalty and the amount of the penalty, the Secretary shall consider the following factors:a) The number, nature, and seriousness of the violations;. b) The extent to which th
10.07.21.28.htm 10.07.21.28. 28 Hearings.. A. A request for a hearing shall be filed with the Office of Administrative Hearings, with a copy to the Licensing and Certification Administration of the Department, not later than 30 days after receipt of notice of the Secretary's action. The request shall include a copy of the Secretary's action.B. A hearing requested under this chapter shall be conducted in accordance with State Government Article, §10-210 et seq. Annotated Code of Maryland,
10.07.21.9999.htm 10.07.21.9999. Administrative History Effective date: October 2, 1989 (16:19 Md. R. 2104). Regulations .01―16 repealed and new Regulations .01―28 adopted effective August 10, 1998 (25:16 Md. R. 1274)Regulation .04B amended effective August 29, 2016 (43:17 Md. R. 953) March 13, 2017 (44:5 Md. R. 292)
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