{"ref":"TX-HSP-GOV-02","title":"Organizational Structure, Branch Offices and Alternate Delivery Sites","category":"Governance","summary":"Requires a current written description of the Agency’s organization, from the governing body down to the patient care level, and sets out how any alternate delivery site is supervised by the parent office so that every location is run as one hospice with one line of authority.","inShort":["The organizational chart shows who you report to. Check it at orientation and whenever your role changes.","Take direction only from the people shown above you on the chart, except in an emergency to protect a patient.","Every location of Sample Hospice, LLC follows the same policies as the main office.","A leader from the main office visits each other location at least once a month and writes down what was discussed.","If you do not know who to go to, call the office at (512) 555-0100."],"primaryCitation":"26 TAC §558.242","citations":["26 TAC §558.242","26 TAC §558.243(d)","26 TAC §558.856","26 TAC §558.322","26 TAC §558.321","26 TAC §558.220(a)"],"federalCitations":["42 CFR §418.100(f)","42 CFR §418.116(a)"],"surveyorAsks":["Show me your current organizational chart. Does it show every service, the IDT, and lines of authority down to the patient care level?","Do you operate any alternate delivery site? Show me the monthly supervisory visit records for the last three months."],"forms":[{"ref":"TX-HSP-GOV-02-A","title":"Alternate Delivery Site Monthly Supervisory Visit Record"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (26 TAC §558.242)","5. Preparing and Maintaining the Organizational Description","6. Supervision of Alternate Delivery Sites (26 TAC §558.243(d); §558.322)","6.1 Monthly on-site supervisory visit","6.2 Policies and records at the site","6.3 What the parent monitors","7. Responsibilities","8. Records and Compliance Monitoring","9. Staff Training","10. References","11. Related Policies and Forms","12. Approval","13. Revision History"],"version":"1.0","sample":false,"pack":"tx-hospice","state":"Texas","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 Hospice","legalName":"Sample Hospice, LLC","logo":null}}