23-17.4-07. Basic requirements for hospice program.
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A hospice program must comply with the following basic standards:
1. The hospice program's services must include physician services, nursing services,
medical social services, counseling, and volunteer services. The services must be
coordinated with those of the hospice patient's primary or attending physician.
2. The hospice program must coordinate its services with professional and
nonprofessional services already in the community. The hospice program may contract
for elements of its services; however, direct patient contact and overall coordination of
hospice services must be maintained by the hospice care team. Any contract entered
into between a hospice program and a health care facility or service provider must
specify that the hospice program retains the responsibility for planning and
coordinating hospice services and care on behalf of a hospice patient and the hospice
patient's family. No hospice which contracts for any hospice service may charge fees
for services provided directly by the hospice care team which duplicate contractual
services provided to the individual hospice patient or family.
3. The hospice care team is responsible for the coordination of home and inpatient care.
4. The hospice program must have a medical director who is a physician licensed
pursuant to chapter 43-17. The medical director has overall responsibility for medical
policy in relation to the care and treatment of hospice patients and their families
rendered by the hospice care team and must consult and cooperate with the hospice
patient's attending physician.
5. The hospice program must provide the services of a registered nurse, as defined
under chapter 43-12.1, to supervise and coordinate the palliative and supportive care
for patients and families provided by the hospice care team.
6. The hospice program must identify a member of the hospice team who will be
responsible for providing for coordination and administration of the hospice service
plan for patients and families.
7. The hospice program must have a bereavement program to provide a continuum of
supportive services for the family.
8. The hospice program must foster independence of the hospice patient and the hospice
patient's family by providing training, encouragement, and support so that the patient
and family can care for themselves as much as possible.
9. The hospice program may not impose the dictates of any value or belief system on
hospice patients or their families. 10. The hospice program must clearly define admission criteria. Decisions on admission
must be made by a hospice care team and are dependent upon the expressed request
of the patient; however, if the attending physician certifies that the patient is unable to
request admission, a family member may voluntarily request and receive admission of
the patient and family on the patient's behalf. Any request for admission must include
written evidence of informed consent signed by the person making the request, which
contains an explanation, in plain language of the nature and limitations of hospice
care. 11. The hospice program must keep accurate, current, and confidential records on all
hospice patients and their families. Upon reasonable notice, the records must be made
available to duly authorized officers or employees of the department. 12. The hospice program must use the services of trained volunteers. 13. The hospice program must consist of both home care and inpatient care which
incorporate the following characteristics:
a. The home care component must be the primary form of care, and shall be
available on a part-time, intermittent, regularly scheduled basis and on an on-call,
around-the-clock basis according to patient and family need.
b. The inpatient component may be used only if and while it is necessary. If feasible,
inpatient care should closely approximate a homelike environment, and provide
overnight family visitation within the facility.
23-17.4-08. Rules and standards. 1. The department shall adopt rules establishing minimum standards for hospice
programs, including:
a. Compliance with the standards of section 23-17.4-07.
b. The number and qualifications of persons providing direct hospice services.
c. The qualifications of those persons or entities contracted with to provide indirect
hospice services.
d. Palliative and supportive care and bereavement counseling provided to hospice
patients and their families.
e. Hospice services provided on an inpatient basis.
f. Utilization review of hospice patient care.
g. The quality of care provided to hospice patients.
h. Procedures for the accurate and centralized maintenance of records on hospice
services provided to hospice patients and their families.
i. The use of volunteers in the hospice program, and the training of those
volunteers.
j. The rights of the hospice patient and the hospice patient's family. 2. To avoid duplication in rules, the department shall incorporate rules applicable to
facilities licensed by the state as hospitals, skilled nursing homes, intermediate care
facilities, and organizations licensed by the state as home health agencies which are
also applicable to hospice programs in the rules to govern hospices. A person who
seeks to license, establish, or operate a hospice program and who has a pre-existing
valid license to operate a hospital, skilled nursing home, intermediate care facility, or
home health agency is in compliance with those rules which are applicable to both a
hospice and the facility for which it has a license.