{"ref":"PA-HSP-PR-02","title":"Informed Consent, Service Agreement and Pre-Admission Disclosures","category":"Client rights","summary":"Explains how the Agency obtains informed consent to hospice care, who may consent for a patient who lacks capacity under Pennsylvania law (guardian, health care agent or health care representative in the statutory order), what the Hospice Service Agreement and Consent contains, and what the Agency tells patients before care begins about covered services, limitations, cost-sharing and, for Medical Assistance recipients, the written pre-admission information.","inShort":["Get the signed Hospice Service Agreement and Consent before care starts.","Adults are presumed able to decide. If you doubt it, a physician must document that the patient is incompetent before someone else decides.","Who decides for an incompetent patient: a court guardian, then a health care agent, then a health care representative in the order the law sets (spouse, adult child, parent, sibling, grandchild, close adult friend).","Agency staff never act as a patient's representative unless related to the patient.","Explain covered services, limits and any costs before care. Never stop care because a Medicare or Medical Assistance patient cannot pay."],"primaryCitation":"42 CFR §418.52(c)","citations":["55 Pa. Code §1130.52(a)(3)","20 Pa.C.S. §5422","20 Pa.C.S. §5454","20 Pa.C.S. §5461","20 Pa.C.S. §5462","20 Pa.C.S. §5428"],"federalCitations":["42 CFR §418.52(c)(3), (7)-(8)","42 CFR §418.24(b)(5)","42 CFR §418.3","42 CFR §418.400","42 CFR §418.100(d)","45 CFR §164.508"],"surveyorAsks":["Show me the signed consent and service agreement for this patient. Was it signed before care began?","This patient was found incompetent by the attending physician. Who consented, and how did you decide that person had authority?"],"forms":[{"ref":"PA-HSP-PR-02-A","title":"Hospice Service Agreement and Consent"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (42 CFR §418.52(c))","5. Deciding Who Gives Consent","5.1 Health care representatives in order of priority","5.2 Keeping the patient involved","6. What the Service Agreement Contains","7. Information About Covered Services and Limitations","8. Costs and Cost-Sharing","9. Medical Assistance Pre-Admission Information","10. Advance Directives Are Optional","11. Refusal and Withdrawal of Consent","12. Changes to the Agreement","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":"pa-hospice","state":"Pennsylvania","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}}