{"ref":"CA-HSP-PR-02","title":"Informed Consent, Election Counseling and Disclosure of Services and Charges","category":"Client rights","summary":"Explains how the Agency obtains informed consent to hospice care: who may counsel on hospice and complete the consent (only a registered nurse, licensed vocational nurse, medical social worker, chaplain or counselor employed by the Agency), what the patient is told about services, limits and charges, how capacity and representatives are handled, and how consent forms are provided in the patient's primary language.","inShort":["Only a registered nurse, LVN, medical social worker, chaplain or counselor employed by the Agency may explain hospice and get consent and election signatures.","If you are paid in any way for referrals or admissions, do not talk with patients or families about hospice services, election or consent.","Before signing, explain what hospice covers, what it does not cover, and what the patient may have to pay.","Use consent forms in the patient's or representative's primary language.","If the patient cannot decide, only a person with legal authority may sign. Ask the social worker to confirm who that is."],"primaryCitation":"22 CCR §74860(b)","citations":["22 CCR §74860(b)","Cal. Health & Safety Code §1746.50","Cal. Health & Safety Code §1749(d)","22 CCR §74892(a)(16)","Cal. Prob. Code §§4609, 4670 et seq.","Cal. Civ. Code §§56.10, 56.11"],"federalCitations":["42 CFR §418.52(a), (c)(3), (c)(7)-(8)","42 CFR §418.24(b)(5)","42 CFR §418.400","42 CFR §418.402","45 CFR §92.11(c)(5)(vii)"],"surveyorAsks":["Who in your agency may explain hospice and obtain the patient's signature on consent and election forms? Are any of them paid for referrals or admissions?","Show me a signed consent. What language was it in, and how do you handle a patient whose primary language is not English?"],"forms":[{"ref":"CA-HSP-PR-02-A","title":"Hospice Consent to Care and Service Agreement"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (22 CCR §74860(b); Health & Safety Code §1746.50)","5. Who May Counsel and Obtain Consent","6. What the Patient Is Told Before Signing","7. Disclosure of Charges and Cost-Sharing","8. Capacity and Decisions by a Representative","9. Information Sharing","10. Primary Language and the Signing Visit","11. Withdrawal of Consent","12. Responsibilities","13. Records and Compliance Monitoring","14. Staff Training","15. References","16. Related Policies and Forms","17. Approval","18. Revision History"],"version":"1.0","sample":false,"pack":"ca-hospice","state":"California","service":"Hospice","guides":[{"path":"/guides/hospice-policies/","h1":"What policies are required for hospice?"},{"path":"/guides/hospice-conditions-of-participation/","h1":"Hospice Conditions of Participation: which policies each one needs"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}