Section He-P 824.15 - Required Services(a) The licensee shall provide the following core hospice care services:(1) Nursing services sufficient to meet the nursing needs of the patient, which are: a. Determined by the patient's care plan; andb. Available, as needed, 24 hours a day;(2) LNA and personal care services that are provided either directly or by contract as the needs of the patient dictate and as determined by the patient's care plan;(3) Providing patients with pharmaceutical services such as equipment, appliances, medical supplies and other pharmaceutical services as the needs of the patient dictate and as determined by the patient's care plan;(4) Medical social services shall be based on the patient's psychosocial assessment and the patient's and family's needs and acceptance of these services. Medical social services shall be provided by a qualified social worker;(5) Hospice volunteer services;(6) Nutritional counseling, physical or occupational therapy, and speech therapy that are provided or arranged for as needed in accordance with patient's care plan;(7) Spiritual services which are offered in accordance with the patient's and family's beliefs and values; (8) Bereavement services that are available to the family for up to one year following the death of the patient;(9) Health and safety services to minimize the likelihood of accident or injury, with care and oversight provided 24 hours a day regarding: a. The patients' functioning, safety, and whereabouts; andb. The patients' health status, including the provision of intervention as necessary or required; and(10) Medication services in accordance with He-P 824.17.(b) In addition to the services in (a) above the licensee shall provide the following services: (1) Food services in accordance with He-P 824.21;(2) Housekeeping, laundry, and maintenance services; and(3) Basic supplies necessary for patients to maintain personnel hygiene and grooming.(c) If, on a temporary basis, not to exceed 90 days, the hospice care provider cannot provide any of the core care and services in (a) above, the HH shall have a written agreement with another agency to provide the required services.(d) Any contractual agreement to provide care and services shall: (1) Identify the care and services to be provided;(2) Specify the qualifications of the personnel that will be providing the care and services;(3) Require that the HH must authorize the services; and(4) Stipulate the HH retains professional responsibility for all care and services provided.(e) The HH shall provide or arrange for the provision of short-term in-patient stays in a hospital or nursing home during those times when the patient's pain or symptoms are unable to be managed in the HH.(f) The HH shall retain professional management responsibility for all services that are provided including contracted services when a hospice patient is in another licensed facility. These responsibilities shall be defined in a written contractual agreement.(g) The licensee shall ensure that the following positions are staffed at the HH location: (2) A director of patient services, but the administrator may also be the director of patient services if the administrator meets the qualifications of the position;(3) A volunteer coordinator;(4) A social services coordinator; and(5) A spiritual and or bereavement coordinator.(h) Any administrator shall: (1) Have at least a bachelor's degree in business or a health-related field with a minimum of 3 years' experience in hospice or palliative care or;(2) Be a registered nurse; and(3) Designate, in writing, an alternate administrator who shall assume the responsibilities of the administrator in his or her absence.(i) The administrator shall be responsible for maintaining the HH in full compliance with all federal, state and local laws, rules, codes and ordinances at all times.(j) The director of patient services shall: (1) Be a New Hampshire-licensed registered nurse or an advanced practice registered nurse; or(2) Have a bachelor's degree in a health field related to hospice care.(k) The director of patient services shall: (1) Be responsible for the overall delivery of patient care and services;(2) Provide sufficient nursing personnel to meet the need of the patients;(3) Supervise the overall delivery of patient care and services; and(4) Coordinate the supervision of licensed practical nurses (LPN), licensed nurse aides (LNA) and or personal care attendants (PCA) by a registered nurse and determine if the LNA or PCA is providing care and services in accordance with the patient's care plan.(l) The medical director, who shall be a physician licensed in the state of New Hampshire, shall be responsible for:(1) The oversight of the medical component of the HH's patient care program;(2) Participating on the interdisciplinary patient care team if the patient's own licensed practitioner cannot participate; and(3) Determining, in consultation with the interdisciplinary team, that an individual is appropriate for hospice and or palliative care services.(m) Volunteer services shall be provided under the direction of a coordinator of volunteer services who: (1) Implements a direct service volunteer program;(2) Coordinates the orientation, education, support, and supervision of direct service volunteers; and(3) Coordinates the utilization of direct service volunteers with other hospice staff.(n) All volunteers shall be oriented and educated relative to their prescribed function according to the hospice care provider's policies and procedures.(o) The licensee shall develop and maintain policies and procedures for its volunteer services that address the following areas:(1) Recruitment and retention;(2) Health screening and 2-step TB testing;(6) Ongoing training and support;(7) Records of volunteer activities; and(8) Criminal record checks.(p) The social services coordinator shall have:(1) At least a master's degree from a graduate school of social work; or(2) A bachelor's degree in a related health or human services field, have at least 2 years' experience as a social worker and have established a consultative relationship with a person who qualifies in (1) above.(q) The social services coordinator shall:(1) Participate in the development of the care plan; and(2) Work in conjunction with the director of patient services to coordinate all social services required by the care plan and ensure their delivery.(r) The coordinator of bereavement and spiritual care services shall be a person who has at least a bachelor's degree in an applicable field such as theology of education, psychology or counseling and who has education in death and dying, grief, and bereavement.(s) Persons providing bereavement services shall have education in death and dying, grief and bereavement.(t) The coordinator of bereavement and spiritual care services shall be responsible for providing an organized program of bereavement services for up to 12 months after the death of the patient that includes but is not limited to:(1) Counseling to families after the patient's death; and(2) Developing a care plan that reflects the needs of the patient's family.(u) The licensee may only perform POCT, that are waived complexity as designated by the federal drug administration (FDA) and known as CLIA-waived laboratory tests, unless the facility is also licensed by the State of New Hampshire as a laboratory under He-P 808.(v) If CLIA-waived laboratory testing is performed by personnel, the licensee shall: (1) Obtain the appropriate CLIA certificate as per 42 CFR Part 493.15 ; and(2) Develop and implement a point of care testing policy, which educates and provides procedures for the proper handling and use of POCT devices, including the documentation of training and demonstrated competency of all testing personnel.(w) The licensee shall have current copies of manufacturer's instructions and package inserts and shall follow all manufacturer's instructions and recommendations for the use of POCT meters and devices to include, but not limited to: (1) Storage requirements for POCT meters and devices, test strips, test cartridges, and test kits;(2) Performance of test specimen requirements, testing environment, test procedure, troubleshooting error codes and messages, reporting results; and(3) All recommended and required quality control procedures for POCT meters and devices.(x) Licensee's performing CLIA-waived laboratory testing or specimen collection shall be in compliance with He-P 808, He-P 817, and 42 CFR 493.N.H. Admin. Code § He-P 824.15
Amended by Volume XXXVII Number 19, Filed May 11, 2017, Proposed by #12169, Effective 4/29/2017, Expires 10/26/2017.Amended by Number 15, Filed April 13, 2023, Proposed by #13572, Effective 3/1/2023, Expires 3/1/2033.