License Required, Administration of the Hospice, Quality Assurance and Utilization Review (QAUR) Committee and Plan, Program Reporting, Advance Directives
DEPARTMENT OF ELDER AFFAIRS
Federal Aging ProgramsRULE NO: RULE TITLE
58A-2.003: License Required
58A-2.005: Administration of the Hospice
58A-2.010: Quality Assurance and Utilization Review (QAUR) Committee and Plan
58A-2.012: Program Reporting
58A-2.0232: Advance DirectivesNOTICE OF CHANGE
Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 33 No. 48, November 30, 2007 issue of the Florida Administrative Weekly.
58A-2.003 License Requirements.
(1) In addition to the requirement specified in Section 400.602(1)(b), F.S., tThe face of the license must contain the following information:
(a) through (e) No change.
(2) through (4) No change.
Specific Authority 400.605 FS. Law Implemented 400.602, 400.605 FS. History–New 5-6-82, Formerly 10A-12.03, 10A-12.002, Amended 4-27-94, Formerly 10A-12.03, 10A-12.003, Amended 4-27-94, Formerly 59A-2.003, Amended 6-5-97,__________.
58A-2.005 Administration of the Hospice.
(1) through (3) No change.
(4) Outcome Measures.
(a) Effective with the report due by March 31, 2009, hospices must annually report the outcome measures outlined in this subsection on DOEA Form H-002, State of Florida Department of Elder Affairs Hospice Demographic and Outcome Measures Report, _______January 2008.
1. through 3. No change.
(b) No change.
(5) National Initiatives.
(a) No change.
(b) The department has also considered the national initiatives proposed that are under evaluation and development by the Centers for Medicare and Medicaid Services (CMS) located at 70 Fed. Reg., 30840-30893, dated May 27, 2005 in consultation with the NHPCO. These initiatives include patient-centered outcome measures, quality assessment and performance improvement (QAPI), and infection control. Hospices are encouraged to utilize these guidelines, along with the initiatives developed by the National Hospice and Palliative Care Organization available at http://www.nhpco.org, in developing their own comprehensive data collection and performance measurement process for these initiatives. Upon adoption of these initiatives by CMS in final regulation, all hospices shall be required to implement the initiatives consistent with this regulation.
(c) No change.
Specific Authority 400.605, 400.60501 FS. Law Implemented 400.605(1)(c), 400.60501 FS. History–New 5-6-82, Formerly 10A-12.05, 10A-12.005, Amended 4-27-94, Formerly 59A-2.005, Amended 6-5-97, 8-6-02, 8-10-03,__________.
58A-2.010 Quality Assurance and Utilization Review (QAUR QUAR)/Quality Assessment and Performance Improvement (QAPI) Committee and Plan.
Pursuant to Section 400.610(2), F.S. each hospice must appoint a committee which must develop, document and implement a comprehensive quality assurance and utilization review plan, also referred to as a quality assessment and performance improvement plan. The QAUR/QAPI plan must be in accordance with quality assessment and performance improvement (or QAPI) standards incorporated within the Medicare Conditions for Participation, 42 C.F.R., Part 418, and must include goals and objectives, provisions for identifying and resolving problems, methods for evaluating the quality and appropriateness of care, and the effectiveness of actions taken to resolve identified problems. The QAUR/QAPI plan must establish a process for revising policies, procedures and practices when reviews have identified problems. The QAUR/QAPI committee must review the QAUR/QAPI plan and report findings and recommendations to the governing body annually. Dated and signed minutes of those meetings of the governing body at which QAUR/QAPI findings and recommendations are presented must be kept in an administrative file.
(1) The QAUR/QAPI committee must be composed of individuals who are trained, qualified, supervised and supported by review procedures and written criteria related to treatment outcomes. These review procedures and written criteria must be established with involvement from physicians, and shall be evaluated and updated annually by the QAUR/QAPI committee.
(2) An incident or accident report shall be required in every instance of error in treatment, adverse reaction to treatment or medication, or injury to the patient. All of these incident or accident reports shall be reviewed by the QAUR/QAPI committee.
(3) The QAUR/QAPI committee must audit patient records, including interdisciplinary care records, on a regular and periodic basis. All records must be stored in secured areas to protect patient confidentiality.
(a) through (b) No change.
(4) The QAUR/QAPI committee shall assist the administrator in developing, documenting and implementing a formal training and orientation program for individuals conducting utilization review activities.
(5) Activities undertaken by the QAUR/QAPI committee must demonstrate a systematic collection, review, and evaluation of information and must result in proposed actions to correct any identified problems. The information used by the QAUR/QAPI committee must include:
(a) through (e) No change.
(f) High-risk, high-volume and problem-prone activities that would have a significant impact on patients, staff or the organization, even if adverse incidents occur infrequently. For example, high-risk activities may include review and evaluation of protocols for containment of communicable diseases, emergency evacuations and continuity of operations; high-volume activates might include collection of information regarding administration of medications; lastly, identifying problem-prone activities might include be deterioration or malfunction of equipment, including security of information systems, disposal of contaminated materials or other bio-medical waste; and
(g) No change.
(6) through (7) No change.
Specific Authority 400.605 FS. Law Implemented 400.605 FS. History–New 5-6-82, Formerly 10A-12.10, 10A-12.010, Amended 4-27-94, Formerly 59A-2.010, Amended 6-5-97,__________.
58A-2.012 Program Reporting Requirements.
(1) No change.
(2) The report shall include the information outlined on DOEA Form H-002, State of Florida Department of Elder Affairs Hospice Demographic and Outcome Measures Report, ______January 2008, incorporated by reference in Rule 58A-2.005, F.A.C.
(3) through (4) No change.
(5)(2) A copy of the annual report shall at all times be available to any member of the public.
Specific Authority 400.605 FS. Law Implemented 400.605 FS. History–New 5-6-82, Formerly 10A-12.12, 10A-12.012, Amended 4-27-94, Formerly 59A-2.012, Amended 6-5-97, ________.
58A-2.0232 Advance Directives.
(1) No change.
(2) The hospice’s policies and procedures must include:
(a) At the time of admission, providing each patient, or the patient’s surrogate or proxy, with a copy of Form SCHS-4-2006, “Health Care Advance Directives – The Patient’s Right to Decide,” effective 4-2006 (April 2006), or with a copy of some other substantially similar document which incorporates information regarding advance directives included in Chapter 765, F.S. The Fform SCHS-4-2006 is hereby incorporated by reference and is available from the Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop 34, Tallahassee, FL 32308, or the agency’s Web site at: http://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/HC_Advance_Directives/docs/adv_dir.pdf.
(b) At the time of admission to a hospice program, providing each patient, or the patient’s surrogate or proxy, with written information concerning the hospice’s policies regarding resuscitation and advance directives, including information concerning DH Form 1896, Florida Do Not Resuscitate Order Form, incorporated by reference in Rule 64E-2.031, F.A.C.
(b) through (c) No change.
(3) Pursuant to Section 400.6095(8), F.S., a hospice may honor a Do Not Resuscitate Order (DNRO) as follows:
(a) Cardiopulmonary resuscitation may be withheld or withdrawn from a patient only if a valid DNRO is present, executed pursuant to Section 401.45, F.S.
(b) Hospice personnel shall not be subject to criminal prosecution or civil liability, nor be considered to have engaged in negligent or unprofessional conduct for withholding or withdrawing cardiopulmonary resuscitation pursuant to such a DNRO and rules adopted by the department, pursuant to Section 400.6095(8), F.S. Any licensed professional hospice personnel, who, in good faith, obeys the directives of an existing DNRO, executed pursuant to Section 401.45, F.S., will not be subject to prosecution or civil liability for his or her performance regarding patient care.
(4) Pursuant to Section 765.110, F.S., a hospice health care provider or facility shall be subject to professional discipline and revocation of license or certification, and a fine, if the healthcare provider or facility requires an individual to execute or waive an advance directive as a condition of treatment or admission.
Specific Authority 765.110, 400.605, 400.6095(8) FS. Law Implemented 400.605, 400.6095(8), Ch. 765 FS. History–New 1-11-93, Formerly 59A-2.025, Amended 4-27-94, Formerly 58A-2.0232, Amended 6-5-97,_______.
