Section 266.211 - Continuous Home CareCHC is provided only during a period of crisis for a maximum of five consecutive days to maintain an individual at the individual's place of residence.
(1) A minimum of eight hours of CHC must be provided during a 24-hour day that begins and ends at midnight. The care need not be continuous. For example, four hours could be provided in the morning and another four hours in the evening of that day.(2) Skilled nursing care must be provided for the identified crisis for more than half of the CHC period and must be provided by either an RN or licensed vocational nurse. The RN or licensed vocational nurse must be an employee of the hospice providing services. For an individual residing in a nursing facility, the skilled nursing care requirement is not met when facility staff provided skilled nursing care for the crisis. For the purpose of CHC, skilled nursing care includes at least one of the following:(A) administration of intravenous or intramuscular medications;(B) insertion, sterile irrigation, and replacement of catheters;(C) initial clinical assessment for specific therapeutic responses; or(D) application of dressings involving prescription medications.(3) Homemaker, home health aide services, medical social work, or chaplain services may be provided to supplement the nursing care. The hospice must document why the physician considers social work or chaplain services necessary to ameliorate the crisis and what these services accomplished during CHC. On-call staff may be used to provide CHC but must be on site, providing care to the individual in the individual's place of residence to be considered for inclusion in CHC hours.(4) The hospice must have a signed physician's order for skilled nursing care. The physician's order must: (A) be specific to the identified crisis and be dated before the initiation of CHC, but not more than three days before the initiation of CHC;(B) document the rationale for increased nursing needs and care; and(C) be in the individual's hospice record and plan of care.(5) The attending physician, hospice medical director or his designee, and the IDT must establish the plan of care before initiating CHC. The hospice RN must coordinate the plan of care. The plan of care must: (A) be updated when the individual's condition changes; and(B) include the following:(i) a description of the specific crisis and how the hospice plans to resolve the crisis;(ii) the needs of the individual;(iii) identification of the services needed to meet the needs of both the individual and family, including management of discomfort and symptom relief;(iv) the scope and frequency of the services needed to meet the needs of both the individual and family;(v) documentation of daily physician care plan oversight; and(vi) clinical findings and documentation that support the scope and frequency of crisis care needed.(6) Before initiating CHC, the hospice must advise and discuss with the family or responsible party that temporary alternate placement may be necessary at the end of the five consecutive days. The hospice must document the discussion with the family or responsible party in the individual's records, including: (A) the date and time of the discussion;(B) the names and titles of the participating IDT members;(C) at least one potential alternate placement; and(D) any other outcomes of the discussion.26 Tex. Admin. Code § 266.211
Adopted by Texas Register, Volume 47, Number 29, July 22, 2022, TexReg 4333, eff. 7/26/2022