The purpose of the proposed rule amendments is to add language, provide clarification of terms and update a form incorporated by reference as recommended by the legislative Joint Administrative Procedures Committee (JAPC).

DEPARTMENT OF ELDER AFFAIRS
Federal Aging Programs

RULE NO: RULE TITLE
58A-2.010: Quality Assurance and Utilization Review (QAUR) Committee and Plan
58A-2.014: Medical Direction
58A-2.0232: Advance Directives
PURPOSE AND EFFECT: The purpose of the proposed rule amendments is to add language, provide clarification of terms and update a form incorporated by reference as recommended by the legislative Joint Administrative Procedures Committee (JAPC).
SUBJECT AREA TO BE ADDRESSED: Quantification of “bereavement period” and definitions of “high risk, high volume and problem-prone activities” under Rule 58A-2.010, F.A.C.; adding language to emphasize that the hospice director's designee shall be a “licensed hospice physician” under Rule 58A-2.014; and updating the Form SCHS-4-2006, Health Care Advance Directives – The Patient’s Right to Decide, incorporated by reference in Rule 58A-2.0232, F.A.C.
THIS WORKSHOP WILL BE CONDUCTED IN CONJUNCTION WITH THE WORKSHOP SCHEDULED FOR RULES 58A-2.002, 2.003, 2.004, 2.005, & 2.012, F.A.C., THAT IS NOTICED IN THIS SAME EDITION OF THE FLORIDA ADMINISTRATIVE WEEKLY UNDER SECTION VI, NOTICES OF MEETINGS, WORKSHOPS AND PUBLIC HEARINGS.”
SPECIFIC AUTHORITY: 400.605, 765.110 FS.
LAW IMPLEMENTED: 400.605, 400.60501, 400.605, Ch. 765 FS.
A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
DATE AND TIME: May 30, 2007, 9:00 a.m. – 12:30 p.m.
PLACE: Department of Elder Affairs, 4040 Esplanade Way, Conference Room 225F, Tallahassee, Florida 32399-7000
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 72 hours before the workshop/meeting by contacting: Jim Crochet, Department of Elder Affairs, Office of the General Counsel, 4040 Esplanade Way, Tallahassee, Florida 32399-7000; Telephone number: [phone]; E-mail address: [e-mail]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Jim Crochet, Department of Elder Affairs, Office of the General Counsel, 4040 Esplanade Way, Tallahassee, Florida 32399-7000; Telephone number: [phone]; E-mail address: [e-mail]

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:

58A-2.010 Quality Assurance and Utilization Review (QAUR) Committee and Plan.

Each hospice shall appoint a committee which shall develop, document and implement a comprehensive quality assurance and utilization review plan pursuant to Section 400.610(2), F.S. The QAUR plan shall 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 plan shall establish a process for revising policies, procedures and practices when reviews have identified problems. The QAUR committee shall review the QAUR 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 findings and recommendations are presented shall be kept in an administrative file.

(1) through (2) No change.

(3) The QAUR committee shall audit patient records, including interdisciplinary care records, on a regular and periodic basis. All records shall be stored in secured areas to protect patient confidentiality.

(a) No change.

(b) After the patient’s death and the end of the bereavement period, which is a minimum of one (1) year, the master record shall be stored in a secure and accessible location.

(4) No change.

(5) Activities undertaken in the QUAR process shall demonstrate a systematic collection, review, and evaluation of information and shall result in proposed actions to correct any identified problems. The information used by the QUAR committee shall include:

(a) through (e) No change.

(f) High-risk, high-volume and problem-prone activities defined as;

(g) High-volume activities defined as;

(h) Problem-prone activities defined as; and

(i)(g) 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-2.014 Medical Direction.

(1) No change.

(2)(a) The medical director or his or her licensed hospice physician designee shall be a member of the hospice care team and shall be responsible for the direction and quality of the medical component of the care rendered to the patient by the hospice care team. The patient’s attending physician(s) may remain the primary physician(s) to the patient, depending upon the preferences of the patient and the patient’s family. The patient and the patient’s family may elect to have the hospice medical director assume all or part of the primary medical care functions, or act as a consultant to the patient’s attending physician(s). In either case, the hospice care team shall maintain liaison and a reporting relationship with the patient’s attending physician(s).

(b) No change.

(3) through (4) No change.

Specific Authority 400.605 FS. Law Implemented 400.605, 400.6105 FS. History–New 5-6-82, Formerly 10A-12.14, 10A-12.014, Amended 4-27-94, Formerly 59A-2.014, Amended 6-5-97,_________.

 

58A-2.0232 Advance Directives.

(1) The administrator shall ensure the development, documentation and implementation of policies and procedures which delineate the hospice’s compliance with the state law and rules relative to advance directives. The hospice shall not base condition treatment or admission upon whether or not the patient has executed or waived an advance directive. In the event of conflict between the hospice’s policies and procedures and the patient’s advance directive, provision shall be made in accordance with Chapter 765, F.S.

(2) The hospice’s policies and procedures shall include:

(a) At the time of admission to a hospice program, 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,” as prepared by the Agency for Health Care Administration, 2727 Mahan Drive, Tallahassee, FL 32308, effective 4-2006 (April 2006) 1-11-93, which is hereby incorporated by reference, or with a copy of some other substantially similar document which incorporates information regarding advance directives included in is a written description of Chapter 765, F.S., regarding advance directives. The form 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) through (c) No change.

Specific Authority 765.110, 400.605 FS. Law Implemented 400.605, Ch. 765 FS. History–New 1-11-93, Formerly 59A-2.025, Amended 4-27-94, Formerly 58A-2.0232, Amended 6-5-97,________.