{"ref":"NC-HSP-FAC-01","title":"Hospice Care for Residents of Nursing Facilities, ICF/IID and Adult Care Homes","category":"Hospice care","summary":"Sets out how the Agency cares for patients who live in a nursing facility, ICF/IID or adult care home: a written agreement signed before care starts with every provision 42 CFR §418.112(c) and NC Medicaid Policy 3D require, a single coordinated plan of care that says which provider does what and that only the Agency may change, a designated IDT member for each resident, the information the facility must be given, orientation of facility staff, reports of alleged violations to the facility administrator within 24 hours, and the NC Medicaid level of care, room and board and patient monthly liability steps.","inShort":["Do not start care in a nursing facility, ICF/IID or adult care home until a signed agreement is in place.","There is one plan of care that says who does what. Only the hospice approves changes to it.","Give the facility the plan of care, election form, advance directives, certification, orders, medication information, staff contacts and the 24-hour on-call number.","Talk with the charge nurse at every visit and document it.","Report alleged abuse, neglect or theft by anyone not connected with the hospice to the facility administrator within 24 hours, and tell the Administrator at once."],"primaryCitation":"42 CFR §418.112","citations":["10A NCAC 13K .0505","NC Medicaid Clinical Coverage Policy 3D, sections 5.2.2.3, 5.2.2.4, 5.12.1, 7.3, 7.3.2, 7.3.2.1, 7.3.2.2, 7.3.3.1","10A NCAC 23E .0210"],"federalCitations":["42 CFR §418.112","42 CFR §418.64(d)(1)(ii)","42 CFR §418.100(e)","42 CFR §418.108"],"surveyorAsks":["Show me your agreement with this nursing facility. Where does it say who reports alleged abuse and how fast?","Who is the designated IDT member for this resident? Show me what you gave the facility."],"forms":[{"ref":"NC-HSP-FAC-01-A","title":"Facility Agreement and Coordination Checklist"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (42 CFR §418.112)","5. The Written Agreement","5.1 Adult care homes","6. Professional Management","7. One Plan of Care","8. Coordination and Information for the Facility","8.1 Day-to-day coordination","9. Orientation of Facility Staff","10. Abuse, Neglect and Crimes in the Facility","11. NC Medicaid Residents of Nursing Facilities and ICF/IID","12. Bereavement","13. Responsibilities","14. Records and Compliance Monitoring","15. Staff Training","16. References","17. Related Policies and Forms","18. Approval","19. Revision History"],"version":"1.0","sample":false,"pack":"nc-hospice","state":"North Carolina","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}}