{"ref":"MI-HSP-PR-02","title":"Informed Consent, Admission Agreement and Medicaid Admission Notices","category":"Client rights","summary":"Sets out how the Agency obtains informed consent to hospice care, what the written admission agreement contains, who may consent for a patient who cannot, what happens when consent is refused or withdrawn, and the Michigan Medicaid admission steps: reviewing the Conditions of Admission with the beneficiary, the signed CHAMPS admission copy, and the written conditions of admission and procedures for obtaining health care that must be given within ten days of the effective date of admission.","inShort":["Get signed consent on Form PR-02-A before any care. Explain hospice care, services, limits and costs in plain words first.","Only the patient, or a person with legal authority, may sign. Write down who signed and why they may sign, and keep a copy of the paper.","Not sure who may sign? Stop and call the director of nursing.","Medicaid patients: get the CHAMPS admission copy signed and give Form PR-02-B at the admission visit. The rule allows no more than ten days.","A patient may refuse any care. Explain what may happen, write it down, and tell the case manager the same day."],"primaryCitation":"Mich. Admin. Code R 325.45129","citations":["Mich. Admin. Code R 325.45129","Mich. Admin. Code R 325.45191(2)(n)","Mich. Admin. Code R 325.45231(2)","MCL 333.20201(2)(e), (f), (h), (i)","MCL 333.20202(7)","MCL 333.21418(2)","MCL 700.5508","Michigan Medicaid Provider Manual, Hospice, Sections 3.1, 3.2, 3.3, 3.5, 4.6, 7.2 and 7.3.B"],"federalCitations":["42 CFR §418.52(a), (c)(3), (c)(7)-(8)","42 CFR §418.24","42 CFR §418.100(d)","42 CFR §418.400","42 CFR §418.104(a)(2)"],"surveyorAsks":["Show me the signed consent and admission agreement for this patient. Who signed, and on what authority?","What does the patient learn about charges, covered services and the limits of hospice care before signing?"],"forms":[{"ref":"MI-HSP-PR-02-A","title":"Hospice Admission Agreement and Consent to Care"},{"ref":"MI-HSP-PR-02-B","title":"Medicaid Conditions of Admission and How to Get Care"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (Mich. Admin. Code R 325.45129)","5. Who May Consent","6. Information Given Before Consent","7. Obtaining Written Consent","8. Michigan Medicaid Admission Steps","9. Consent to Later Changes","10. Refusal and Withdrawal of Consent","11. Responsibilities","12. Records and Compliance Monitoring","13. Staff Training","14. References","15. Related Policies and Forms","16. Approval","17. Revision History"],"version":"1.0","sample":false,"pack":"mi-hospice","state":"Michigan","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}}