216 R.I. Code R. 216-RICR-40-10-11.5 - Organization and Management

11.5.1 Governing Body

A. There shall be an organized governing body or equivalent legal authority ultimately responsible for:

1. The management, fiscal affairs, and operation of the hospice program;

2. The assurance of quality care and services; and

3. The compliance with all federal, state and local laws and regulations pertaining to a hospice program and the rules and regulations of this Part.

B. The governing body or other legal authority shall furthermore be responsible to:

1. Make services available on a twenty-four (24) hour basis to meet the needs of patients/family as required under the provisions of §§11.5.5(F)(2) and 11.5.5(G)(1) of this Part;

2. Provide a sufficient number of appropriate personnel, physical resources and equipment to facilitate the delivery of prescribed services;

3. Ensure conformity of the facility with all Federal, State, and local Rules and Regulations Pertaining to Fire, Safety, Sanitation, Communicable and Reportable Diseases, other relevant health and safety requirements, and all Rules and Regulations of this Part; and

4. Implement a policy of non-discrimination in the provision of services to patients and the employment of persons without regard to race, color, creed, national origin, gender, religion, sexual orientation, age, gender identity or expression, handicapping condition or degree of handicap, in accordance with Title VI of the Civil Rights Act of 1964, U.S. Executive Order #11246 entitled "Equal Employment Opportunity," U.S. Department of Labor Regulations, Title V of the Rehabilitation Act of 1973, the Rhode Island Fair Employment Practices Act, R.I. Gen. Laws Chapter 28-5, the Americans with Disabilities Act, and any other applicable Federal or State laws relating to discriminatory practices.

C. The governing body or other legal authority shall designate:

1. An administrator who shall be responsible for the management and operation of the hospice program; and

2. A medical director who assumes overall responsibility for the medical component of patient care and to ensure achievement and maintenance of quality standards of professional practice.

D. The governing body or equivalent legal authority shall adopt and maintain bylaws or acceptable equivalent which defines responsibilities for the operation and performance of the organization, identifies purposes and means of fulfilling such. In addition, the governing body or equivalent legal authority shall establish administrative policies pertaining to no less than the following:

1. Responsibilities of the administrator and the medical director;

2. Conflict of interest on the part of the governing body, professional staff, and employees;

3. The services to be provided;

4. Criteria for the selection, admission and transfer of terminally ill patient/families;

5. Patient/family consent and involvement in the development of patient care plan;

6. Developing support network when relatives are not available and patient needs and wants that support;

7. Linkages and referrals with community and other health care facilities or agencies that shall include a mechanism for recording, transmitting, and receiving information essential to the continuity of patient/family care. Such information must contain no less than:

a. Patient identification data such as name, address, age, gender, name of next of kin, health insurance coverage,

b. Diagnosis and prognosis, medical status of patient, brief description of current illness, medical and nursing plans of care including such information as medications, treatments, dietary needs, baseline laboratory data,

c. Functional status,

d. Special services such as physical therapy, occupational therapy, speech therapy and similar services,

e. Psychosocial needs,

f. Such other information pertinent to ensure continuity of patient care,

g. Any additional information as cited in the "continuity of care" form available on the department's website: www.health.ri.gov. Designated licensed personnel shall complete the "continuity of care" form approved by the department for each patient who is discharged to another health care facility, such as a hospital, or who is discharged home with follow-up home care required. Said form shall be provided to the receiving facility or agency prior to or upon transfer of the patient,

8. Professional management responsibilities for contracted services,

9. Reports of patient's condition and transmission thereof to the patient's physician, and

10. Such other matters as may be relevant to the organization and operation of hospice care.

11.5.2 Organization of Services

A. The governing body or other legal authority shall organize hospice program services to provide an integrated continuum of care for terminally ill patients/families and to ensure that such care is rendered under the professional management responsibility of the hospice program.

1. An organizational chart with written description of the organization, authorities, responsibilities, accountabilities, and relationships shall be maintained, that shall include but not be limited to:

a. A description of each level of care and services;

b. Policies and procedures pertaining to hospice care and services that are consistent with professionally recognized standards of practice;

c. A description of the system for the maintenance of patient records; and

d. Such other related provisions as deemed appropriate.

11.5.3 Quality Improvement

A. Each hospice program shall establish a written quality improvement plan that shall be reviewed by the Department during the facility's annual survey and that includes:

1. Program objectives;

2. Oversight responsibility (e.g., reports to the governing body);

3. Hospice-wide scope;

4. Involvement of all patient care disciplines/services;

5. Provides criteria to monitor nursing care, including medication administration;

6. Prevention and treatment of decubitus ulcers;

7. Accidents and injuries, resulting in unexpected death;

8. Any other data necessary to monitor quality of care; and

9. Methods to identify, evaluate, and correct problems.

B. All patient care services, including services rendered by a contractor, shall be evaluated.

C. Each licensed hospice program administrator shall designate a qualified individual to coordinate and manage the hospice program's quality improvement program.

D. A quality improvement committee for a hospice program shall be established and shall annually review and approve the quality improvement plan for the hospice program. Said plan shall be available to the public upon request.

E. The hospice program's quality improvement committee shall include at least the following members:

1. The hospice program administrator;

2. The director of nursing;

3. The medical director; and

4. A social worker.

F. The quality improvement committee shall meet at least quarterly; shall maintain records of all quality improvement activities; and shall keep records of committee meetings that shall be available to the Department during any on-site visit.

G. The Director may not require the quality improvement committee to disclose the records and the reports prepared by the committee except as necessary to assure compliance with the requirements of this Part.

H. Good faith attempts by the quality improvement committee to identify and correct quality deficiencies will not be used as a basis for hospice licensure sanctions.

I. If the Department determines that a hospice program is not implementing its quality improvement program effectively and that quality improvement activities are inadequate, the Department may impose sanctions on the hospice program to improve quality of patient care.

J. The program shall take and document appropriate remedial action to address problems identified through the quality improvement program. The outcome(s) of the remedial action shall be documented and submitted to the governing body for their consideration.

11.5.4 Written Agreements

A. There shall be written agreements for the provision of those services required in §11.5.5(B) of this Part, not provided directly by the hospice program. The agreements shall clearly delineate the responsibilities of the parties involved and shall include no less than the following provisions:

1. A stipulation that services may be provided only with the express authorization of the hospice program;

2. The responsibility of the licensed hospice program for the admission of patients/families to the hospice service;

3. Identification of services to be provided that must be within the scope and limitations set forth in the plan of care and that must not be altered in type, amount, frequency or duration (except in case of adverse reaction) by the individual, agency, or institution;

4. The manner in which the services are coordinated, supervised and evaluated by the hospice program;

5. Assurance of compliance with the patient care policies of the licensed hospice program;

6. Establishment of procedures for, and frequency of, patient/family care assessment;

7. Furnishing the hospice plan of care to other health care facilities upon transfer of patient;

8. Assurance that personnel and services meet the requirements specified herein pertaining to personnel and services, including licensure, personnel qualifications, functions, supervision, hospice training and orientation, in-service training, and attendance at case conferences;

9. Reimbursement mechanism, charges, and terms for the renewal or termination of the agreement;

10. Such other provisions as may be mutually agreed upon or as may be relevant and deemed necessary;

11. Assurance that the inpatient provider has established policies consistent with those of the hospice program and that the inpatient care facility agrees to abide by the patient care plan and protocol established by the hospice program;

12. Assurance the medical record shall include a record of all inpatient services and events, and a copy of the discharge summary and, if requested, a copy of the medical record to be provided to the hospice program; and

13. The party responsible for the implementation of the provisions of the agreement.

B. The hospice program shall retain professional management responsibility for contracted services to ensure that they are furnished in a safe and effective manner by persons meeting the qualifications stated herein, in accordance with the patient's plan of care.

11.5.5 Minimum Services Required/Availability and Accessibility of Services

A. Any service available through a hospice program shall be provided to patients/families, with the consent of the terminally ill patient and family.

B. Services that are to be provided directly through staff personnel of a hospice program shall include the following core services:

1. Physician services (may include attending physicians' or certified nurse practitioners' services in accordance with §11.5.8(A) of this Part);

2. Nursing services;

3. Social services;

4. Counseling services, including spiritual counseling, when required;

5. Pain assessment; and

6. Availability of drugs and biologicals on a twenty-four (24) hour basis.

C. A hospice program may use contracted staff if necessary to supplement hospice staff personnel in order to meet the needs of patients during periods of peak patient loads or under extraordinary circumstances. If contracting is used, the hospice shall maintain professional management responsibility for the services and shall assure that the qualifications of staff and services provided meet the requirements herein.

D. In addition to the minimum services listed in §11.5.5(B) of this Part, a hospice program shall ensure that the following services are provided, as applicable, to patients/families directly by hospice staff personnel or under written arrangement as specified in §11.5.4 of this Part.

1. Home health aide and homemaker services;

2. Short-term respite care, and general inpatient care;

3. Physical therapy, occupational therapy, and speech-language pathology services;

4. Medical supplies and appliances; and

5. Nutritional counseling.

E. Pain Assessment

1. All health care providers licensed by this state to provide health care services and all health care facilities licensed under R.I. Gen. Laws, shall assess patient pain in accordance with the requirements of the Rules and Regulations Pertaining to Pain Assessment promulgated by the Department.

F. Availability of Services

1. A hospice program shall make:

a. Nursing services, physician services, drugs and biologicals routinely available on a twenty-four (24) hour basis, seven (7) days a week, as may be required in accordance with the plan of care;

b. All other services available on a twenty-four (24) hour basis to the extent necessary to meet the needs of individuals for care that is reasonable and necessary for the palliation and management of terminal illness and related conditions in accordance with the plan of care; and

c. Patient visiting and assessment capability available on a twenty-four (24) hour basis, seven (7) days a week to respond to acute and urgent patient/family needs.

2. Additional health services or related services may be provided as may be deemed appropriate to meet patient/family needs and such services must be rendered in a manner consistent with acceptable standards of practice.

G. Accessibility to Hospice Care

1. Each hospice program shall establish a mechanism to enable patients/families to make telephone contact with responsible staff personnel on a twenty-four (24) hour basis, seven (7) days a week. Mechanical answering devices shall not be acceptable.

H. Accessibility to Pharmacy Services

1. Each hospice program shall provide on a twenty-four (24) hour basis, seven (7) days a week, accessibility to pharmacy services to enable patient/family to obtain prescription drugs and biologicals, for the palliative care and management of the terminally ill patient.

I. Continuity of Care. The hospice program shall assure the continuity of patient/family care in the home and inpatient settings through written policies, procedures, and criteria pertaining to no less than the following:

1. Admission criteria and initial assessment of the patient/family need and decision for care;

2. Signed informed consent;

3. Ongoing assessment of patient/family needs;

4. Development and review of the plan of care by the interdisciplinary team;

5. Transfer of patients to inpatient care facilities for inpatient respite care and general inpatient care;

6. The provision of appropriate patient/family information at the point of transfer between levels of care settings;

7. Community or other resources to insure continuity of care and meet patient/family needs;

8. Management of symptom control through palliative care and utilization of therapeutic services (see §11.5.5(E)(1) of this Part);

9. Provision of continuing care for patients transferred to inpatient care facilities;

10. Constraints imposed by limitations of services, family conditions; and

11. Such other criteria as may be deemed appropriate.

11.5.6 Plan of Care

A. After an initial assessment of patient/family needs, a written plan of care shall be established by the medical director or physician designee, the attending physician and the interdisciplinary team for each patient/family admitted to the hospice program. Such plan of care shall be developed with the participation of the patient and family, and shall include only those services that are acceptable to the patient and family. Furthermore, the family shall be involved whenever possible in the implementation and continuous assessment of the plan of care. The hospice program shall ensure that each patient and family/primary caregiver(s) receive education and training provided by the hospice appropriate to the care and services identified in the plan of care.

B. The plan of care shall include, but not be limited to, provisions pertaining to:

1. Pertinent diagnosis and prognosis;

2. Interventions to facilitate the management of pain and symptoms;

3. Measurable targeted outcomes anticipated from implementing and coordinating the plan of care;

4. A detailed statement of the patient/family needs addressing the physical, psychological, social, and spiritual needs of the patient/family; the scope of services required; the frequency of visits; the need for inpatient care (respite and/or general inpatients); nutritional needs; medications; management of discomfort and symptom control; management of grief;

5. Drugs and treatments necessary to meet the needs of the patient;

6. Medical supplies and appliances necessary to meet the needs of the patient;

7. The interdisciplinary group's documentation of patient and family understanding, involvement, and agreement with the plan of care, in accordance with the hospice's own policies, in the clinical record;

8. Consent of patient/patient's designated agent/family; and

9. Such other relevant modalities of care and services as may be appropriate to meet patient/family care needs.

C. The plan of care shall be reviewed and updated at periodic intervals by the interdisciplinary team.

D. A revised plan of care shall include information from the patient's updated comprehensive assessment and the patient's progress toward outcomes specified in the plan of care.

11.5.7 Levels of Care

A. Home Care: Home care services shall be provided to hospice patients/families either as routine home care or continuous home care during periods of crisis, in order to maintain the terminally ill patient at home.

B. General Inpatient Care: Short-term general inpatient care for the control of pain or management of acute and severe clinical conditions that cannot be managed in the current setting shall be provided only in licensed hospitals, licensed nursing facilities, or hospice inpatient facilities that meet the requirements of §§11.6.1 through 11.7.15(A) of this Part. Hospice care provided in a nursing facility or hospital shall have a binding written agreement with a hospice program that includes the provisions of §11.5.4 of this Part.

C. Inpatient Respite Care: Inpatient respite care may be provided for short periods of time to relieve family members or others caring for the terminally ill patient in the home. Such care shall be provided only in a licensed hospital, nursing facility or hospice inpatient facility that meets the requirements of §§11.6.1 through 11.7.15(A) of this Part, and with whom the hospice program has entered into a binding agreement as provided in §11.5.4 of this Part.

11.5.8 Hospice Services

A. Attending Practitioner Services: Attending practitioner services shall be provided by a physician, as defined in R.I. Gen. Laws Chapter 5-37, or a certified nurse practitioner, as defined in R.I. Gen. Laws Chapter 5-34, to meet the general medical needs of patients for the management of the terminal illness and related conditions, through palliative and supportive care and in accordance with hospice policies. Attending practitioner services may also be provided by a physician assistant, as long as the physician assistant's role is providing medical and surgical services in collaboration with physicians, as set forth in the provisions of R.I. Gen. Laws Chapter 5-54.

1. Such policies shall include provisions governing the relationship of the attending physician or the certified nurse practitioner, or physician assistant, to the medical director, and the interdisciplinary team.

2. In addition to palliation and management of terminal illness and related conditions, staff physician(s) and/or certified nurse practitioner(s) of the hospice program, including the physician member(s), certified nurse practitioner member(s), and/or physician assistant member(s) of the interdisciplinary group shall also meet the general medical needs of the patients to the extent that these needs are not met by the attending physician, certified nurse practitioner, and/or physician assistant.

B. Nursing Services: Nursing services shall be provided under the direction of a licensed professional (registered) nurse to meet the nursing care needs of patients/families as prescribed in the plan of care and in accordance with acceptable standards of practice and hospice policies.

C. Social Services: Social services shall be offered by a person licensed under R.I. Gen. Laws Chapter 5-39.1 and the Rules and Regulations Pertaining to Licensing Clinical Social Workers and Independent Clinical Social Workers. Such services shall be provided as prescribed in the plan of care and in accordance with acceptable standards of practice and hospice care policies.

D. Bereavement Counseling Services: Bereavement counseling services shall be offered to meet the needs of the members of families both before and after the death of the patient. Such services shall be provided by a professional person qualified by training and experience for the development, implementation, and assessment of a plan of care to meet the needs of the bereaved.

E. Spiritual Counseling Services: Spiritual counseling services shall be available. Patients/families shall be notified of the availability of such services.

F. Nutritional Counseling: Dietary counseling services for the patient/family shall be available as may be required, while the individual is in hospice care.

G. Home-Health Aide/Nursing Assistant Services: Each hospice program shall provide home-health aide/nursing assistant services pursuant to §11.5.5(E)(1) of this Part and as prescribed by the patient/family plan of care and consistent with policies of the hospice program.

1. The home-health aide/nursing assistant shall provide personal care and other related support services under the supervision of a registered nurse from the licensed hospice program and/or a therapist when the aide carries out simple procedures as an extension of physical, speech, or occupational therapy or social services. Duties of home-health aides/nursing assistants shall include, but not be limited to:

a. Performance of simple procedures as an extension of therapy services;

b. Personal care;

c. Ambulation and exercise;

d. Assistance with medications that are ordinarily self-administered, in accordance with state and federal laws and regulations;

e. Preparing meals and assisting patients with eating;

f. Household services that are essential to the patient's health care at home;

g. Reporting changes in patient's condition and needs; and

h. Completing appropriate records.

H. Volunteer Services: The development and utilization of trained lay and professional volunteers shall be required of a hospice program. Direct patient care rendered by volunteers shall be provided under the supervision of a qualified and experienced staff member of the hospice program and shall be consistent with the established patient/family plan of care. Furthermore, direct patient care volunteers shall:

1. Have the necessary qualifications and skills to provide the prescribed service;

2. Have participated in an appropriate orientation and training program of hospice care; and

3. Be responsible to record patient care services rendered.

I. Medical Supplies: Medical supplies and appliances, including drugs and biologicals, as may be needed, shall be provided (either directly or by arrangement) for the palliation and management of the terminal illness and related conditions in accordance with §11.5.5(E)(1) of this Part.

J. Administration of Drugs and Biologicals. Drugs and biologicals as prescribed by the physician or other practitioner working within the scope of his/her practice in the plan of care may be administered by the following individuals:

1. A licensed nurse, certified nurse practitioner, physician, and/or physician assistant;

2. Selected non-licensed personnel with demonstrated competence who have satisfactorily completed a State-Approved Program on Drug Administration may administer oral or topical drugs in accordance with the Rules and Regulations Pertaining to Rhode Island Certificates of Registration for Nursing Assistants, Medication Aides, and the Approval of Nursing Assistant and Medication Aide Training Programs if adequate medical and nursing supervision is provided in accordance with R.I. Gen. Laws Chapter 5-34, agency policies, and applicable federal laws and regulations.

3. The patient may self-administer drugs, or a member of the family/caregiver may also administer drugs to the patient in accordance with the plan of care, upon written approval of the attending physician, certified nurse practitioner, or, as appropriate, physician assistant.

K. Pharmacy Services: Hospice programs shall have policies pertaining to the disposal of controlled substances and legend drugs that are consistent with the Rules and Regulations Pertaining to the Disposal of Legend Drugs.

L. Other Services: such as physical, occupational, speech, and hearing therapy services must be available and when provided, such services must be rendered in accordance with the plan of care and in a manner consistent with accepted standards of practice.

M. Clinical Records.

1. A clinical record shall be established for every patient receiving care and services. The record shall be completed promptly and accurately documented, readily accessible and systematically organized to facilitate retrieval.

2. Each clinical record shall include a comprehensive compilation of information.

Entries shall be made for all services provided, signed by the staff providing the services. The record shall include entries on all services rendered whether furnished directly or under arrangements with the hospice. Each patient's record shall contain no less than:

a. the initial and subsequent assessment;

b. the plan of care;

c. identification data;

d. consent form;

e. any advance directives;

f. pertinent medical history; and

g. complete documentation of all services and events (including evaluations, treatment, progress notes).

3. Records shall be maintained by the agency for a period of at least five (5) years following the date of discharge and shall be safeguarded against loss or unauthorized use.

4. Each program shall establish policies and procedures to govern the use and removal of records and determine the conditions for release of information in accordance with statutory provisions pertaining to confidentiality.

11.5.9 Personnel

A. A registered nurse with training and experience in hospice care shall be designated to coordinate the overall plan of care for each patient/family.

B. Each hospice program shall designate a sufficient number of staff personnel (including volunteers) with training and experience in hospice care and whose qualifications are commensurate with their duties and responsibilities to provide care services to patients/families.

1. Staff personnel shall provide evidence of current registration, certification or licensure as may be required by law. For every person employed by the hospice program who is licensed, certified, or registered by the Department, a mechanism shall be in place to electronically verify such licensure via the Department's electronic licensure database.

C. A job description for each classification of position shall be established clearly delineating qualifications, duties, authority, and responsibilities inherent in each position.

D. An ongoing program for the training of all personnel shall be conducted by the hospice program, that shall include:

1. An orientation program for new staff personnel (including volunteers); and

2. A continuing program for the development and improvement of skills of staff to ensure the delivery of quality hospice care services.

E. Administrator

1. The governing body or other legal authority shall appoint an individual who possesses appropriate education and experience to serve as administrator of the hospice program, and who shall be responsible for:

a. The management and operation of the program;

b. The enforcement of policies, rules and regulations, and statutory provisions pertaining to the program;

c. Serving as liaison between the governing body and staff; and

d. The planning, organizing, and directing of such other activities as may be delegated by the governing body.

2. A hospice inpatient facility shall have a full-time administrator. Any change in administrators shall be reported in writing to the Department within fifteen (15) days. The administrator shall designate in writing the person to act in his/her absence in order to provide the hospice inpatient facility with administrative direction at all times.

F. Medical Director

1. The overall responsibility for the medical component of patient care shall be under the direction of a physician, qualified by training and experience in hospice care, who shall also be responsible for no less than the following:

a. Coordination of medical care provided by the hospice program;

b. Ensuring and maintaining quality standards of professional practice;

c. Implementation of patient care policies;

d. The achievement and maintenance of quality assurance of professional practices through a mechanism for the assessment of patient/family care outcomes;

e. Ensuring completion of health care worker screening and immunization requirements as contained in the Rules and Regulations Pertaining to Immunization, Testing, and Health Screening for Health Care Workers (Part 20-15-7 of this Title);

f. The certification of terminally ill patients admitted to the hospice program;

g. Participation as a member of the interdisciplinary team, in the development, implementation, and assessment of patient/family plan of care; and

h. Consulting with attending physicians and/or certified nurse practitioners regarding patient care plans.

2. Upon appointment, the name of the medical director shall be submitted to the Department. Each time a new medical director is appointed, the name of said physician shall be reported promptly to the Department. The medical director's Rhode Island medical license number, medical office address, telephone number, emergency telephone number, hospital affiliation and other credentialing information shall be maintained on file by the hospice program and updated as needed.

G. Criminal Records Check

1. Criminal records checks shall be in accordance wit h R.I. Gen. Laws § 23-17-34.

2. If an applicant has undergone a national criminal records check within eighteen (18) months of an application for employment, then an employer may request from the bureau a letter indicating if any disqualifying information was discovered. The bureau will respond without disclosing the nature of the disqualifying information. This letter must be maintained on file to satisfy the requirements of R.I. Gen. Laws § 23-17-34.

H. Photo Identification

1. A hospice program shall require all persons, including students, who examine, observe, or treat a patient to wear a photo identification badge which states, in a reasonably legible manner, the first name, licensure/registration status, if any, and staff position of such person.

I. Hospice Inpatient Facilities

1. In additional to the personnel requirements contained above, each hospice inpatient facility shall have a registered nurse on the premises twenty-four (24) hours a day. In addition, the necessary nursing service personnel (licensed and non-licensed) shall be in sufficient numbers on a twenty-four (24) hour basis, to assess patients' needs, to develop and implement patient care plans, to provide direct patient care services, and to perform other related activities to maintain the health, safety, and welfare of patients.

J. In-Service Education

1. An in-service educational program shall be conducted on an ongoing basis, that shall include an orientation program for new personnel and a program for the development and improvement of skills of all personnel. The in-service program shall be geared to the needs of the population and shall include annual programs on prevention and control of infection, food services and sanitation (as appropriate), fire prevention and safety, confidentiality of patient information, patient rights and any other areas related to hospice care.

a. Provisions shall be made for written documentation of in-service educational programs, including attendance.

K. Health Screening

1. Upon hire and prior to delivering services, a pre-employment health screening shall be required for each individual who has or may have direct contact with a patient in the hospice. Such health screening shall be conducted in accordance with the Rules and Regulations Pertaining to Immunization, Testing, and Health Screening for Health Care Workers (Part 20-15-7 of this Title) promulgated by the Department.

L. Latex

1. Any hospice program that utilizes latex gloves shall do so in accordance with the provisions of the Rules and Regulations Pertaining to the Use of Latex Gloves by Health Care Workers, in Licensed Health Care Facilities, and by Other Persons, Firms, or Corporations Licensed or Registered by the Department (Part 20-15-3 of this Title) promulgated by the Department.

11.5.10 Interdisciplinary Team

A. The governing body or other legal authority shall designate an interdisciplinary team composed of staff personnel that includes:

1. Attending practitioner;

2. Professional (registered) nurse;

3. Social worker;

4. Spiritual counselors; and

5. Such other staff and non-staff personnel as may be deemed appropriate.

B. The interdisciplinary team shall be responsible to develop, implement and assess patient/family plans of care, and in addition:

1. The supervision of care, personnel and services provided;

2. The provision of direct patient care as may be required and appropriate;

3. The development of a patient/family plan of care, and the revision of such plan of care as may be required;

4. The development of policies and procedures governing patient/family care and services; and

5. Such other duties as may be deemed appropriate by the governing body.

11.5.11 Rights of Patients

A. Each hospice program shall adopt applicable "rights of patients" pursuant to the provisions of R.I. Gen. Laws § 23-17-19.1 and shall make such available to patients/patient's designated agent/families.

B. In addition to the rights stated in R.I. Gen. Laws § 23-17-19.1, the patient shall be offered treatment without discrimination as to creed, gender, sexual orientation, age, gender identity or expression, handicapping condition or degree of handicap.

C. No charge shall be made for furnishing a health record or part of a health record to a patient, his or her attorney or authorized representative if the record or part of the record is necessary for the purpose of supporting an appeal under any provision of the Social Security Act, 42 U.S.C. § 301 et seq., and the request is accompanied by documentation of the appeal or a claim under the provisions of the Workers' Compensation Act, R.I. Gen. Laws Chapters 28-29 through 28-38. Additionally, charges shall not be made if the record is requested for immunization records required for school admission or by the applicant or beneficiary or individual representing an applicant or beneficiary for the purposes of supporting a claim or appeal under the provision of the Social Security Act or any federal or state needs-based benefit program such as Medical Assistance, RIte Care, Temporary Disability Insurance, or unemployment compensation.

D. The hospice program shall provide the patient/patient's designated agent/family with written information concerning its policies on advance directives, including a description of any applicable state law.

11.5.12 Reporting of Patient Abuse or Neglect, Accidents and Death

A. Any physician, nurse, or other employee of a hospice program who has reasonable cause to believe that a patient has been abused, exploited, mistreated, or neglected shall within twenty-four (24) hours of the receipt of said information, transfer such to the Director. Any person required to make a report pursuant to this section shall be deemed to have complied with these requirements if a report is made to a high managerial agent. Once notified, the administrator or the director of nursing services shall be required to meet the above reporting requirements.

B. The hospice program shall maintain evidence that all allegations of abuse, neglect, and/or mistreatment have been thoroughly investigated and that further potential abuse has been prevented while the investigation is in progress. The results of said investigation shall be reported to the Department. Appropriate corrective action shall be taken, as necessary.

C. Accidents resulting in hospitalization or death of any patient shall be reported in writing to the licensing agency before the end of the next working day. A copy of each report shall be retained by the facility for review during subsequent surveys.

D. All patient deaths occurring within a hospice program or in a hospice inpatient facility that are under the following categories shall be reported to the program medical director and to the Office of the State Medical Examiners in accordance with R.I. Gen. Laws Chapter 23-4:

1. Suspicious or unnatural;

2. The result of trauma, remote or otherwise;

3. The decedent is less than eighteen (18) years of age;

4. As a result of a drug overdose or poisoning, remote or otherwise, and

5. As a result of an infectious disease with epidemic potential.

E. The death of any hospice patient occurring within twenty-four (24) hours of admission to a hospice program providing care in the home or a program at an inpatient hospice unit shall be reported to the Office of the State Medical Examiners, unless declared exempt by the Chief Medical Examiner.

F. Reporting requirements shall be posted, pursuant to R.I. Gen. Laws Chapter 23-17.8

Notes

216 R.I. Code R. 216-RICR-40-10-11.5

Amended effective 3/21/2023