{"ref":"MO-HSP-PR-02","title":"Consent for Hospice Care and Admission Disclosures","category":"Client rights","summary":"Sets out the Missouri requirement that every patient who wishes to receive hospice care signs a consent form naming the Agency, acknowledging the palliative nature of hospice care and listing the care and services that may be provided; who may sign; the admission disclosures given in the same visit; how consent is kept separate from the Medicare and MO HealthNet election statement; and how refusals, withdrawals and changes are handled.","inShort":["No hospice care starts until the patient (or legal representative) signs the Consent for Hospice Services.","Explain in plain words that hospice care is about comfort, not cure, and go through the list of services that may be provided.","If someone signs for the patient, check and copy the power of attorney or guardianship paper first.","Consent and the election statement are two different forms. Both must be complete.","A patient may refuse any service or stop hospice care at any time. Respect it, write it down and tell the case manager."],"primaryCitation":"19 CSR 30-35.010(1)(C)","citations":["19 CSR 30-35.010(1)(C)","19 CSR 30-35.010(1)(A)18, 19","19 CSR 30-35.010(1)(D)1","19 CSR 30-35.010(1)(F)1-3","19 CSR 30-35.010(2)(K)5.E","RSMo §§404.800-404.872","RSMo §197.264.1"],"federalCitations":["42 CFR §418.52(a), (c)(3)","42 CFR §418.24","42 CFR §418.106(e)(2)(i)","42 CFR §489.102"],"surveyorAsks":["Show me this patient's signed consent form. Does it name your hospice and state that the patient was advised of and understands the palliative nature of hospice care?","Where does the consent list the specific types of care and services that may be provided?"],"forms":[{"ref":"MO-HSP-PR-02-A","title":"Consent for Hospice Services"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (19 CSR 30-35.010(1)(C))","5. What the Consent Form Contains","6. Who May Sign","7. The Admission Visit and Admission Disclosures","8. Timing and Exceptions","9. Refusal of a Service and Withdrawal of Consent","10. Responsibilities","11. Records and Compliance Monitoring","12. Staff Training","13. References","14. Related Policies and Forms","15. Approval","16. Revision History"],"version":"1.0","sample":false,"pack":"mo-hospice","state":"Missouri","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}}