(a) Administration shall provide and document the following:

1. (1) Job descriptions for all employees and volunteers;
2. (2) Policies and procedures for each available service;

3. (3) In-services pertinent to hospice care shall be ongoing for:

   1. (A) Employees;
   2. (B) Volunteers; and
   3. (C) Contracted staff;

4. (4) Orientation for all:

   1. (A) Employees;
   2. (B) Volunteers; and
   3. (C) Contracted staff;
5. (5) Annual review of policies and procedures; and
6. (6) Criminal history checks for employees and volunteers as required by Arkansas Code § 20-38-101 et seq.

(b) Services by arrangement.

1. (1) A hospice may arrange for another individual or entity to furnish services to the patients.

2. (2) If services are provided under arrangement (i.e., under contract), the following standards shall be met:

   1. (A)

(i) Continuity of care.

1. (ii) The hospice program shall ensure the continuity of patient/family care in home, outpatient, and inpatient settings; and

   1. (B)

      1. (i) Written agreement.
      2. (ii) The hospice shall have a written agreement for the provision of contracted services.
      3. (iii) The contract shall include at least the following:

(b) (b) Qualifications of personnel providing the services.

1. (c) Short-term inpatient care. The hospice shall have a written agreement approved with an area hospital, hospice inpatient facility, or qualified skilled nursing facility that states that the hospice may continue to follow any hospice patient admitted to that facility.

   1. (d) Continuation of care. A hospice may not discontinue or diminish care because of the lack of a payor source.

(f) Core services.

1. (1) A hospice shall ensure all core services (i.e., nursing, medical social services, and counseling) described in the following section are routinely provided directly by hospice employees.

2. (2) A hospice may use contracted staff if necessary to supplement hospice employees in order to meet the needs of patients:

   1. (A) During periods of peak patient loads; or
   2. (B) Under extraordinary circumstances.

3. (3) If contracting is used, the hospice shall:

   1. (A) Maintain professional, financial, and administrative responsibility for the services; and

   2. (B) Ensure the qualifications of staff and services provided meet the requirements specified for:

      1. (i) Nursing;
      2. (ii) Medical social services;
      3. (iii) Physician services; and
      4. (iv) Counseling.

4. (4) Note.

   1. (A) Physician services may be provided by an individual contract.
   2. (B) The contract must specify the physician will assume all responsibilities as outlined in 20 CAR § 47-110.

(h) Pet therapy.

1. (1) Pet therapy may be provided by the hospice in the patient’s home.
2. (2) Birds, cats, dogs, and other animals may be permitted in the patient’s home.
3. (3) Therapy animals shall have appropriate vaccinations and licenses.

4. (4) A veterinary record:

   1. (A) Shall be kept on all therapy animals to:

      1. (i) Verify vaccinations; and
      2. (ii) Be made readily available for review; and

   2. (B) Shall not negatively affect the well-being of the patient.

      1. (i) Employee health.
5. (1) It shall be the responsibility of administration, with advice and guidance from the medical staff and the Infection Control Committee, to establish and enforce policies concerning preemployment physicals and employee health.

6. (2) The policies shall include but are not limited to:

   1. (A) Requirements for an up-to-date health file for each employee;

   2. (B)

      1. (i) There shall be measures for prevention of communicable disease outbreaks, especially Mycobacterium tuberculosis (TB).
      2. (ii) All plans for preventing the transmission of TB shall conform to the most current Centers for Disease Control and Prevention Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Healthcare Settings; and

   3. (C)

      1. (i) Work restrictions shall be placed on personnel who are known to be affected with any disease in a communicable stage.
      2. (ii) Such individuals shall not work in any area in any capacity in which there is:

(j) Complaints.

1. (1) Each agency shall keep a record of complaints received.

2. (2) Documentation shall include the:

   1. (A) Name of the complainant;
   2. (B) Relationship to the patient;
   3. (C) Nature of the complaint; and
   4. (D) Action taken to resolve the complaint.

(k) Informed consent. An informed consent shall be signed by the patient or patient’s representative for provision of hospice care.

1. (l) Certification of terminal illness. The agency shall have certification signed by the attending physician and medical director or physician designee stating the patient has a terminal illness.

   1. (m) Election of hospice care.

2. (1) Duration of election. An election to receive hospice care shall be considered to continue as long as the patient remains:

   1. (A) In the care of a hospice or does not revoke the election for hospice care; and
   2. (B) Certified as appropriate for hospice.
3. (2) Effective date of election. A patient or patient’s representative may designate an effective date for the election period that begins with the first day of hospice care.
4. (3) Waiver of other benefits. A patient or patient’s representative can elect hospice care from only one (1) hospice provider at any given time.

(n) Elements of the election statement. The election statement shall include the following:

1. (1) Identification of the hospice that provides care to the patient;
2. (2) The patient’s or the patient’s representative’s acknowledgment that he or she has been given a full understanding of the palliative rather than curative nature of hospice care as it relates to the patient’s terminal illness;
3. (3) The effective date of the election; and
4. (4) The signature of the patient or patient’s representative.

(o) Revoking the election of hospice care.

1. (1) A patient or patient’s representative may revoke the patient’s election of hospice care at any time during an election period.

2. (2) To revoke the election of hospice care, the patient or patient’s representative shall file a statement with the hospice that includes the following information:

   1. (A) A signed statement that the patient or patient’s representative revokes the patient’s election for hospice care; and

   2. (B)

      1. (i) The date the revocation is effective.
      2. (ii) A patient or patient’s representative may not designate an effective date earlier than the date that the revocation is made.