1. (1) The following definitions apply in this rule and ARM 37.106.2305 and 37.106.2311:

   1. (a) "Bereavement" means that period of time during which survivors mourn a death and experience grief.
   2. (b) "Bereavement services" means support services to be offered during the bereavement period.
   3. (c) "Contract services" means persons or organizations who, under written agreement, provide goods and services to the hospice and its patients and their families.
   4. (d) "Core services" means physician services, nursing services, pastoral counseling, services provided by trained volunteers, and counseling services routinely provided by hospice staff.
   5. (e) "Family" means individuals who are closely linked with the hospice patient, including the immediate family, the primary care giver, and individuals with significant personal ties.
   6. (f) "Hospice" or "hospice program" means a public agency or private organization (or a subdivision thereof) as defined in 50-5-101(22), MCA, which is primarily engaged in providing hospice care.
   7. (g) "Hospice care" means palliative and supportive care to meet the needs of a terminally ill patient and the patient's family arising out of physical, psychological, spiritual, social, and economic stresses experienced during the final stages of illness and dying, and that includes a formal bereavement component.
   8. (h) "Hospice staff" means paid or unpaid persons, including volunteers, who are directly supervised by the hospice program.
   9. (i) "Interdisciplinary team" means the number of appropriately qualified interdisciplinary health care professionals and volunteers that are needed to meet the hospice's patients' care needs.
   10. (j) "Managed directly by" means that core services are provided by a hospice program.
   11. (k) "Palliation" means controlling pain and other symptoms which are manifested during the dying process and are consistent with professional practice and regulations of the Montana Board of Pharmacy.
   12. (l) "Respite care" means short-term in-patient care provided to the individual only when necessary to relieve the family members or other persons caring for the individual.

2. (2) A hospice program may be licensed to operate either:

   1. (a) as a part of a licensed hospital without its own license when the department finds that the hospital's hospice program meets the requirements set forth in this rule; or
   2. (b) with its own hospice license when the department finds that it meets the requirements set forth in this rule.

3. (3) A hospice program must have the following organizational components:

   1. (a) a formally established governing body, individual, group, or corporation with authority to make decisions affecting the operation of the hospice;
   2. (b) an organization chart defining reporting relationships among hospice workers;
   3. (c) a statement of patient rights and the rights of a patient's family;

   4. (d) established policies for the administration and operation of the program, including but not limited to:

      1. (i) written criteria for program admission and discharge;
      2. (ii) procedures for bereavement referrals and assistance;
      3. (iii) development of a plan of care;
      4. (iv) agreements with other licensed health care facilities for proper transfer of patients and follow up of plans of care;
      5. (v) system(s) for recordkeeping;
      6. (vi) patient care procedures; and
      7. (vii) in-service education.
   5. (e) development of annual budgets; and
   6. (f) annual evaluation of each aspect of the hospice program, including the program's quality assessment and improvement measures and a system to implement recommendations for future program planning.

4. (4) A hospice program must have an interdisciplinary team responsible for the provision of hospice care. The interdisciplinary team must:

   1. (a) confer or meet regularly;
   2. (b) have responsibility for implementation of each individual plan of care as directed by an identified coordinator; and
   3. (c) encourage the patient/family to participate in developing the interdisciplinary team plan of care and in the provision of hospice services.
5. (5) A hospice program must assure that each patient has a physician who is the patient's primary physician and assists in the development of the patient's care plan.

6. (6) A hospice program must maintain a medical record for every individual accepted as a hospice patient. The medical record must include:

   1. (a) patient identification, diagnosis, and prognosis;
   2. (b) patient's medical history:
   3. (c) patient's plan of care;
   4. (d) a record of doctor's hospice orders;
   5. (e) progress notes, dated and signed; and
   6. (f) evidence of timely action by the patient care team.

7. (7) A hospice program which utilizes volunteers must provide volunteer training which includes:

   1. (a) information concerning hospice philosophy;
   2. (b) instruction on the volunteer's role, responsibilities, restrictions, and expectations; and
   3. (c) information concerning the physical, emotional, and spiritual issues encountered by hospice patients and families.
8. (8) A hospice program must allow the patient and the patient's family to make the decision to participate in a hospice program and shall encourage the patient and the patient's family to assume as much responsibility for care as they choose.
9. (9) A hospice program must assure that all services identified in the hospice plan of care for a patient, including skilled nursing services, are offered to the patient.

10. (10) A hospice program must:

    1. (a) have a plan for providing bereavement follow up for families desiring it;
    2. (b) monitor and assess the quality of contract services through annual review;
    3. (c) ensure that hospice nursing emergency care is available on a 24-hour basis;
    4. (d) hire, train, and supervise hospice staff and ensure that hospice staff adhere to hospice policies; and
    5. (e) establish, update, and implement infection control policies and procedures that are sufficient to prevent transmission of disease.
11. (11) The hospice program must comply with ARM 37.106.2901, 37.106.2902, 37.106.2904, 37.106.2905, and 37.106.2908, pertaining to restraints, safety devices, assistive devices, and postural supports.

Authorizing statute(s): 50-5-103, 50-5-210, MCA

Implementing statute(s): 50-5-103, 50-5-204, 50-5-210, MCA

History: NEW, 1983 MAR p. 1460, Eff. 10/14/83; AMD, 1984 MAR p. 879, Eff. 6/1/84; AMD, 1994 MAR p. 2436, Eff. 8/26/94; TRANS, from DHES, 2002 MAR p. 185; AMD, 2009 MAR p. 351, Eff. 3/27/09.