This website publishes administrative rules on their effective dates, as designated by the adopting state agencies, colleges, and
universities.
| Rule |
Rule 3701-19-01 | Definitions.
Effective:
January 23, 2020
As used in this chapter: (A) "Advanced Practice Nurse"
means a registered nurse authorized to practice as a certified nurse
specialist, certified registered nurse anesthetist, certified nurse midwife or
certified nurse practitioner in accordance with section 4723.41 of the Revised
Code; (B) "Applicant" means a person or public agency that
submits an application for a license to provide a hospice care program under
rule 3701-19-03 of the Administrative Code. (C) "Attending physician" means the physician
identified by the hospice patient or the hospice patient's family as
having primary responsibility for the hospice patient's medical
care. (D) "Dietitian" means an individual licensed under
Chapter 4759. of the Revised Code to practice dietetics. (E) "Director" means the director of health or any
official or employee of the department of health designated by the director of
health. (F) For purposes of this chapter,
"follow-up inspection" means an inspection, which may include on-site
and off-site activities, conducted by the department to determine whether the
hospice care program has corrected a violation or violations cited on a
previous inspection. (G) "Governing body" means the entity that has
ultimate responsibility and authority for the overall operation of a hospice
care program, as specified in rule 3701-19-06 of the Administrative
Code. (H) "Home health aide" means an individual who,
in accordance with rule 3701-19-16 of the Administrative Code, provides home
care services for hospice patients and their families. (I) "Hospice aide," for the purpose of this
chapter, means a home health aide who has successfully completed a training and
competency evaluation program approved by the director under division (A) of
section 3721.31 of the Revised Code and Chapter 3701-18 of the Administrative
Code, is currently listed in good standing on the state nurse aide registry,
and is employed by a hospice care program. (J) "Hospice care program" or "program"
means a coordinated program of home, outpatient, and inpatient care and
services that is operated by a person or public agency and that provides the
following care and services to hospice patients, including services as
indicated below to hospice patients' families, through a medically
directed interdisciplinary team, under interdisciplinary plans of care
established pursuant to section 3712.06 of the Revised Code and rule 3701-19-11
of the Administrative Code, in order to meet the physical, psychological,
social, spiritual, and other special needs that are experienced during the
final stages of illness, dying, and bereavement: (1) Nursing care by or
under the supervision of a registered nurse; (2) Physical,
occupational, or speech or language therapy, unless waived by the department of
health pursuant to paragraph (B) of rule 3701-19-19 of the Administrative
Code; (3) Medical social
services by a social worker under the direction of a physician; (4) Services of a home
health aide; (5) Medical supplies,
including drugs and biologicals, and the use of medical
appliances; (6) Physician's
services which include medical services provided by a physician or an advanced
practice nurse acting within his or her scope of practice, as defined in
section 4723.01 of the Revised Code, or a physician assistant acting within his
or her scope of practice under the supervision, control, and direction of one
or more physicians as defined in section 4730.01 of the Revised
Code. (7) Short-term inpatient
care, including both palliative and respite care and procedures; (8) Counseling for
hospice patients and hospice patients' families; (9) Services of
volunteers under the direction of the provider of the hospice care
program; (10) Bereavement services
for hospice patients' families. (K) "Hospice patient" or "patient"
means a patient who has been diagnosed as terminally ill, has an anticipated
life expectancy of six months or less, and has voluntarily requested and is
receiving care from a person or public agency licensed under Chapter 3712. of
the Revised Code and this chapter to provide a hospice care
program. (L) "Hospice patient's family" or
"family" means a hospice patient's immediate family members,
including a spouse, brother, sister, child, or parent, and any other relative
or individual who has significant personal ties to the patient and who is
designated as a member of the patient's family by mutual agreement of the
patient, the relative or individual, and the patient's interdisciplinary
team. (M) "Inpatient facility" means a facility that
either is operated by or under contract with a hospice care program for the
purpose of providing inpatient care to the hospice care program's
patients. (N) "Inpatient hospice facility" means a building
or leased unit operated by a hospice care program that is separate and distinct
from another licensed or certified facility where the hospice program directly
provides accommodations and hospice services for its hospice
patients. (O) "Interdisciplinary plan of care" or
"plan of care" means the interdisciplinary plan for care of a hospice
patient and his or her family prepared under rule 3701-19-11 of the
Administrative Code. (P) "Interdisciplinary team" means a working unit
composed of professional and lay persons that includes at least a physician, a
registered nurse, a social worker, a member of the clergy or a counselor, and a
volunteer. (Q) "Licensed practical nurse" means a person
licensed under Chapter 4723. of the Revised Code to practice nursing as a
licensed practical nurse. (R) "Nurse" means a registered nurse or licensed
practical nurse. (S) "Palliative care" means specialized care for
a patient of any age who has been diagnosed with a serious or life-threatening
illness that is provided at any stage of the illness by an interdisciplinary
team working in consultation with other health care professionals, including
those who may be seeking to cure the illness and that aims to do all of the
following: (1) Relieve the
symptoms, stress, and suffering resulting from the illness; (2) Improve the quality
of life of the patient and the patient's family; (3) Address the
patient's physical, emotional, social, and spiritual needs;
and (4) Facilitate patient
autonomy, access to information, and medical decision making. Nothing in this chapter shall be interpreted to
mean that palliative care can be provided only as a component of a hospice care
program or pediatric respite care program. (T) "Person" means an individual, corporation,
business trust, estate, trust, partnership, and association. (U) "Physician" means a person authorized under
Chapter 4731. of the Revised Code to practice medicine and surgery or
osteopathic medicine and surgery. (V) "Physician assistant" means a person who
holds a certificate of authority to practice as a physician assistant issued
under Chapter 4730. of the Revised Code. (W) "Respite care" means hospice care program
services provided by the program in a patient's home or in an inpatient
facility to give temporary relief to a hospice patient's family or other
caregivers when the patient's family or other caregiver needs relief from
the daily demands of caring for the patient. (X) "Registered nurse" means a person registered
under Chapter 4723. of the Revised Code to practice professional
nursing. (Y) "Social worker" means a person licensed under
Chapter 4757. of the Revised Code to practice as a social worker or independent
social worker. (Z) "Staff member" or "staff" means an
individual working for a hospice care program including the owner; the
administrator; a full-time, part-time or temporary paid employee; or an
individual working on contract. (AA) "Volunteer" means a lay or professional
person who offers and provides his or her services to a hospice care program
without compensation.
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Rule 3701-19-02 | Applicability of licensure requirements.
Effective:
January 23, 2020
(A) Every person or public agency that
proposes to provide a hospice care program shall apply to the director for a
license in accordance with rule 3701-19-02 of the Administrative
Code. (B) A hospital, nursing home, home for
the aged, county medical care facility, or other health facility or agency that
provides a hospice care program shall be licensed to provide a hospice care
program under Chapter 3712. of the Revised Code and this chapter. (C) A nursing home licensed under Chapter
3721. of the Revised Code that does not hold itself out to be a hospice, does
not hold itself out as providing a hospice care program, does not use the term
"hospice" to describe or refer to its activities or facilities, and
that does not provide all of the services enumerated in division (A) of section
3712.01 of the Revised Code and paragraph (J) of rule 3701-19-01 of the
Administrative Code is not subject to the licensing provisions of Chapter 3712.
of the Revised Code and this chapter. (D) No person or public agency, other
than a person or public agency licensed under section 3712.04 of the Revised
Code and this chapter, shall hold itself out as providing a hospice care
program, or provide a hospice care program, or use the term "hospice"
or any term containing "hospice" to describe or refer to a health
program, facility, or agency. (1) A hospital, a home
providing nursing care, or a home health agency that provides services under
contract with a person or public agency providing a hospice care program that
is licensed under section 3712.04 of the Revised Code and this chapter shall
not be considered as providing a hospice care program in violation of paragraph
(D) of this rule. (2) Paragraph (D) of this
rule does not apply to the activities of regional, state, or national nonprofit
organizations of which providers of hospice care programs, individuals
interested in hospice care programs, or both are members and that do not
provide or represent that they provide hospice care programs. (3) As used in paragraph
(D) of this rule, "person" does not include a member of an
interdisciplinary team, as defined in paragraph (P) of rule 3701-19-01 of the
Administrative Code, or any individual who is employed by a person or public
agency licensed under section 3712.04 of the Revised Code and this
chapter.
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Rule 3701-19-03 | Initial license application process; renewal of license; and change of ownership license.
Effective:
January 23, 2020
(A) Application for a hospice care
program license shall: (1) Be made on forms
prescribed by the director; (2) Include such
information as the director requires, including the information prescribed in
paragraph (C) of this rule; and (3) Be accompanied by a
non-refundable license fee of six hundred dollars in the form of a
cashier's check or a postal money order payable to the "Treasurer,
State of Ohio." (B) Any person or public agency seeking
to be licensed to provide a hospice care program shall submit an application
for licensure at least sixty days prior to the requested date for the
inspection required by paragraph (A) of rule 3701-19-05 of the Administrative
Code. (C) An application for a license to
provide a hospice care program shall include: (1) The name, address,
and business telephone number of the hospice care program. A hospice care
program that operates from multiple locations shall include the addresses and
telephone numbers for all locations on the application for license. The
application shall indicate which location is to be issued the
license; (2) The names and
addresses of the persons having an ownership or a controlling interest in the
hospice care program and other information pertaining to ownership or control
of the program; (3) The corporate name of
the hospice care program, if any, and the names, titles, addresses, and
telephone numbers of its officers and statutory agent; (4) A list of the
services which are or will be provided by the hospice care program either
directly or indirectly through written contracts, the identities of any
contractors and the services they will provide, and the date the program will
be operational; (5) A description of the
geographic area in which the hospice care program will provide
services; (6) If the applicant is requesting a
waiver of the requirement for providing physical therapy, occupational therapy,
or speech or language therapy services pursuant to paragraph (B) of rule
3701-19-19 of the Administrative Code, the documentation required by that
paragraph; (7) If the program
provides hospice care and services in a hospice patient's home, a written
attestation that the applicant is in compliance with section 3712.062 of the
Revised Code; and (8) If a hospice care program operates
an inpatient hospice facility: (a) Documentation of compliance with the building code
standards required by paragraph (C) of rule 3701-19-08 of the Administrative
Code; (b) If the hospice intends to admit non-hospice palliative
care patients to the hospice inpatient unit in accordance with section 3712.10
of the Revised Code, a written attestation that the hospice care program
will: (i) Continue to be
primarily engaged as a hospice care program and at least fifty-one per cent of
all services provided by the hospice care program will be to hospice patients;
and (ii) Ensure the
availability of hospice inpatient care to hospice care program patients through
admission to the hospice care program's inpatient facility or through
contract with an inpatient facility that meets the requirements of rule
3701-19-22 of the Administrative Code. (D) The applicant or an authorized
representative shall sign an affidavit included in the application certifying
that, to the best of the applicant's knowledge, the information in the
application and any accompanying material is true and accurate. If a
representative signs the affidavit, the application shall include documentation
that they are the applicant's authorized representative. (E) When reviewing a license application,
the director may request, in writing, that an applicant furnish any additional
information that the director determines to be necessary to assess compliance
with Chapter 3712. of the Revised Code and this chapter. The applicant shall
furnish any requested information within fourteen days after the mailing of the
director's request. (F) Licensure of a hospice care program
providing services from multiple locations in Ohio. (1) Except as prohibited
by section 3712.08 of the Revised Code, the director may grant a license to a
hospice care program which provides services from multiple locations in Ohio,
if the applicant complies with all the following: (a) Each location provides the same full range of services that
is required of the hospice care program location issued the
license; (b) Each location is responsible to the same governing body and
central administration that governs the hospice care program location issued
the license, and the governing body and central administration is able to
adequately manage each location; (c) The hospice care program maintains clinical records for all
patients served by the hospice care program regardless of where services are
provided; and (d) All hospice patients' clinical records requested by the
director during an inspection are available at the hospice care program
location issued the license. (2) A hospice location
that does not comply with the requirements of paragraph (F)(1) of this rule is
operating as a separate hospice care program and shall obtain a separate
license and pay the appropriate license fee. (G) A hospice care program operating in
another state seeking to provide services to patients in Ohio shall establish
an administrative office in Ohio and comply with the rules of Chapter 3701-19
of the Administrative Code in order to obtain a license. All Ohio hospice
patients' clinical records shall be maintained at the Ohio administrative
office. (H) Application for renewal of a hospice
care program license shall be made at least ninety days prior to the expiration
of the license. The application shall be made and a renewal fee paid in
accordance with paragraph (A) of this rule in the same manner as for an initial
license. (1) In addition to the
application and fee requirements of this paragraph, a hospice care program that
operates an inpatient hospice facility shall: (a) Submit documentation of continued compliance with the Ohio
fire code required by paragraph (B) of rule 3701-19-08 of the Administrative
Code; (b) A certificate of use and occupancy required by paragraph (C)
of rule 3701-19-08 of the Administrative Code only if it is different than the
one previously submitted to the director; and (c) If the program provides hospice care and services in a
hospice patient's home, the application for renewal shall include a
written attestation that the applicant is in compliance with section 3712.062
of the Revised Code. (2) The director shall
renew the license if the program continues to meet the requirements of Chapter
3712. of the Revised Code and Chapters 3701-19 and 3701-13 of the
Administrative Code. If the program does not meet the requirements, the
director may deny renewal of the license, in accordance with Chapter 119. of
the Revised Code. (I) In addition to submitting the
application and renewal fee required by paragraph (A) of this rule, an
applicant applying for a license renewal pursuant to paragraph (J) of this rule
shall also submit: (1) Evidence of the
program's current medicare certification pursuant to Title XVIII of the
Social Security Act, 49 Stat. 620 (1935), 42 U.S.C. 301, as amended (1981),
with its expiration date noted; and (2) If the program is
certified or accredited by an entity other than the secretary of the United
States department of health and human services (under Title XVIII of the Social
Security Act, 49 Stat. 620 (1935), 42 U.S.C. 301, as amended (1981), a copy of
the most recent accreditation decision report. (J) The director shall renew licenses to
persons or public agencies to provide hospice care programs that are accredited
or certified to provide such programs by an entity whose standards for
accreditation or certification equal or exceed those provided for licensure set
forth in Chapter 3712. of the Revised Code and this chapter. (1) For purposes of this
paragraph, the standards for medicare certification set forth in Title XVIII of
the Social Security Act, 49 Stat. 620 (1935), 42 U.S.C. 301, as amended (1981),
shall be considered to equal or exceed the requirements for licensure set forth
in Chapter 3712. of the Revised Code and this chapter. If an applicant seeks
license renewal pursuant to this paragraph on the basis of accreditation or
certification by another entity, the director shall review the entity's
certification or accreditation standards and shall determine whether they equal
or exceed the standards set forth in Chapter 3712. of the Revised Code and this
chapter. (2) If the certification
or accreditation of a person or public agency providing a hospice care program
that was granted a license renewal pursuant to paragraph (J) of this rule is
terminated or expires and is not renewed: (a) The hospice care program shall send written notification of
the termination or expiration to the director prior to the effective date of
the termination, expiration, or non-renewal of the certification or
accreditation or within five business days after receipt of such notice of
termination, expiration, or non-renewal, which ever is sooner; and (b) The director shall inspect the program to determine whether
it otherwise meets the requirements of Chapter 3712. of the Revised Code and
this chapter. After conducting the inspection, the director may take whatever
action concerning the program's license that the director considers
appropriate. (K) Each licensed hospice care program
shall notify the director, in writing, of any of the following: (1) Any change in any of
the information specified in the license application under paragraphs (C)(1) to
(C)(5) and (C)(8) of this rule no later than fifteen days after the
change; (a) A change of ownership shall require the submission of a
change of ownership application on forms prescribed and provided by the
director; and (b) A non-refundable fee of two hundred dollars in the form of a
check or money order payable to the "Treasurer, State of
Ohio." (2) Any other change that
would render the information submitted in the license application inaccurate at
least twenty-one days prior to the effective date of the change.
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Rule 3701-19-04 | Issuance, denial, transfer, suspension, and revocation of licenses.
Effective:
January 23, 2020
(A) The director shall grant a license
for provision of a hospice care program to an applicant that complies with
Chapter 3712. of the Revised Code and this chapter. (B) The director shall mail written notice to the applicant
either granting or proposing to deny a license within thirty days after
receiving all information necessary to determine compliance with Chapter 3712.
of the Revised Code and this chapter, including the reports of the inspection
conducted pursuant to paragraph (A) of rule 3701-19-05 of the Administrative
Code. This thirty-day period shall be extended if the director has received a
complaint concerning an applicant. In such a case, the director shall conduct a
complaint investigation within thirty days after receipt of the complaint and
shall mail written notice of the determination regarding the license
application within thirty days after completion of the complaint
investigation. (C) If the applicant meets the requirements for licensure
prescribed in paragraph (A) of this rule, the director shall issue a license to
the applicant which shall: (1) Indicate the name and
address of the hospice care program location to which the applicant requested
the license be issued. The names and addresses of additional locations
operating under the same license shall be maintained on file; (2) Be valid for three
years only for the hospice care program at the address and additional locations
indicated in the application except as provided for in paragraph (F) of this
rule; and (3) Be posted in a
conspicuous place in the hospice care program location issued the
license. (D) Subject to Chapter 119. of the Revised Code, the
director may deny, suspend, or revoke a license if the licensee: (1) Made any material
misrepresentation in the application for licensure; or (2) No longer meets the
requirements of Chapter 3712. of the Revised Code or this chapter. (E) If, after a review of an application for license
renewal in accordance with paragraph (H) of rule 3701-19-03 of the
Administrative Code, the department determines that the program is not in
compliance with section 3712.062 of the Revised Code, the department may
suspend the hospice care program's license for not more than six months
and impose a fine not to exceed twenty thousand dollars. (F) A hospice care program that seeks to transfer its license to
another or new location shall submit a written request to the director of
health to transfer its license. The request shall indicate the name and address
of the hospice care location issued the license and the address to which the
hospice seeks to transfer the license. The request must be received by the
director no later than ninety days prior to the current license expiration date
or thirty days prior to the proposed transfer or relocation, whichever occurs
sooner. (1) When reviewing a
request for transfer of a license, the director may request any additional
written information he or she determines necessary to assess whether the
criteria in paragraph (F)(2) of this rule are met. (2) The director shall
allow a license to be transferred if the following criteria are
met: (a) The hospice care program currently meets all of the licensing
requirements and there are no pending complaints under investigation. Any
pending complaints shall be investigated within thirty days of the request for
transfer; (b) The hospice care program is not undergoing any enforcement
action at the time of the transfer or relocation or proposed transfer or
relocation; (c) The transfer or relocation is not due to a change in
ownership or control; (d) The transfer or relocation does not diminish the current
geographic area being served by the hospice care program; (e) The hospice care program continues to provide the same full
range of services at the new location that was required of the hospice care
program location that was issued the license; (f) All hospice patients' clinical records are available,
upon request of the director, at the new location to which the hospice license
is to be transferred; (g) If the hospice care program provides inpatient care directly,
the transfer of the license does not involve either the establishment of an
inpatient facility, or relocation of an existing inpatient facility, where the
hospice care program provides inpatient care directly; (h) The approval to transfer the license may be granted with no
less than sixty-one days remaining prior to the expiration of the current
license; and (i) If the hospice care program obtained its license pursuant to
paragraph (J) of rule 3701-19-03 of the Administrative Code, the hospice care
program is currently in compliance with the applicable accreditation or
certification standards (3) The director shall
notify the hospice care program of whether or not the license may be
transferred. If the director determines that the license is not transferable,
the director shall provide the hospice care program with an opportunity for a
reconsideration: (a) The hospice care program shall request a reconsideration in
writing within thirty days of the mailing of the notice of
determination; (b) The request shall include any written documentation or other
information not previously submitted to the director that the hospice care
program wishes to refute the determination; (c) The director's final determination is not appealable
under Chapter 119. of the Revised Code; and (d) The hospice care program shall obtain a license for the new
location prior to commencing services at the new location.
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Rule 3701-19-05 | Inspections.
Effective:
January 23, 2020
(A) Prior to issuing an initial license
for a hospice care program, the director shall conduct an announced inspection
of the applicant's facilities and services. (B) The director shall conduct an
unannounced inspection of each licensed hospice care program at a minimum
frequency of once every three years. The director may conduct additional
inspections of any licensed hospice care program at any other time the director
considers necessary including, but not limited to, investigation of
complaints. (C) The fees for inspections conducted by
the director pursuant to section 3712.03 of the Revised Code and paragraphs (A)
and (B) of this rule shall be as follows: (1) Licensure inspection
fee of one thousand six hundred twenty five dollars; (2) Complaint inspection
fee of eight hundred fifty dollars; (3) Follow-up inspection
fee of three hundred fifty dollars; and (4) Desk audit or
compliance review inspection fee of two hundred fifty dollars. (D) For purposes of inspections by the director, each hospice
care program shall provide access to its premises and staff at all times and to
pertinent records upon request. The program shall ensure that the director has
access to all parts of its facilities, services, and records, including the
inpatient facilities operated by or under contract with the program. The
inspections may include visits to hospice patients' homes and direct
interaction with patients and their families, with the patients' or
families' consent. (E) If an inspection of an applicant's hospice care program
or of a licensed hospice care program reveals a violation or violations of
Chapter 3712. of the Revised Code or of Chapter 3701-19 or 3701-13 of the
Administrative Code, the director, at their discretion, may require submission
of a plan of correction for each violation. The hospice care program shall
submit the plan within ten calendar days after receiving the director's
notification that a plan of correction is required. (F) When a hospice care program provides services at more than
one location under one license, a violation found at any location shall
constitute a violation for the entire hospice care program.
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Rule 3701-19-06 | Governing body; quality assessment and performance improvement.
Effective:
January 23, 2020
(A) The overall conduct and operation of
the hospice care program, including the quality of care and the provision of
services, shall be the full legal responsibility of a clearly defined,
organized governing body. (B) The governing body of a licensed
hospice care program may also provide governance for a pediatric respite care
program if the programs are dually-licensed and meet all requirements set forth
in this rule and chapter. (C) The governing body
shall: (1) Establish and review
policies for the management, operation, and evaluation of the hospice care
program, including, but not limited to: (a) Qualifications of employees and independent
contractors; and (b) Policies and procedures to receive and respond to
patient grievances regarding medical treatment, quality of care, the lack of
respect for person or property, mistreatment, neglect, exploitation, verbal,
mental, sexual, and physical abuse, including injuries of unknown source, and
misappropriation of patient property by any individual furnishing services on
behalf of the hospice care program. The policies and procedures developed by
the governing body shall, at a minimum, include: (i) Notification
procedures for hospice patients, employees and contracted staff to report
alleged violations to the hospice program administration; (ii) Documentation
requirements for reported alleged violations, including time frames for
response; (iii) Reporting
procedures for verified violations to the appropriate state licensing
authority, local authorities, or both where appropriate; and (iv) Requirements for
timely corrective actions for all verified violations. (2) Arrange for a
physician to serve as medical director for the hospice care program
who: (a) Shall be knowledgeable about the psychological, social,
and medical aspects of hospice care as the result of training, experience, and
interest; (b) May also serve as the physician representative on an
interdisciplinary team or teams or as an attending physician; (c) Maintain ultimate responsibility for physicians
designated to act on behalf of the medical director; and (d) Shall designate a physician to act in their
absence. (3) Appoint a qualified
individual to serve as the administrator of the hospice care program who shall
perform the following duties: (a) Be responsible for the day-to-day management of the
program and for assuring compliance with Chapter 3712. of the Revised Code,
Chapter 3701-13, and this chapter of the Administrative Code; (b) Implement the hospice care program's policies and
procedures regarding all activities and services provided by the hospice care
program; (c) Designate an individual to act in their
absence; (d) Implement the hospice care program's quality
assessment and performance improvement program under paragraph (D) of this
rule; (e) Implement the hospice care program's patient
grievance program established under paragraph (C)(1) of this rule; (f) Implement the drug diversion investigation and
reporting program required by section 3712.062 of the Revised Code. The hospice
administrator or the administrator's designee, must: (i) Receive reports of
suspected drug diversion from hospice staff; (ii) Within twenty four
hours of receipt, investigate reports of suspected drug diversion;
and (iii) No later than ten
days after receipt of a report of suspected drug diversion or upon conclusion
of an investigation, report to the law enforcement agency with jurisdiction
over the territory in which the hospice patient's home is located the
results of the hospice program's investigation when the investigation
substantiates that drug diversion has occurred or when the results of the
investigation are inconclusive. Nothing in this rule prohibits a hospice care
program from reporting the result of any other drug diversion investigation to
law enforcement. (g) Designate a registered nurse that is a member of an
interdisciplinary team to coordinate the overall functioning of the
interdisciplinary team. (4) Ensure that all services provided are
consistent with accepted standards of practice for hospice care. (D) Each hospice care program governing
body shall ensure that an ongoing, comprehensive, integrated, self-assessment
of the quality and appropriateness of care provided by the program, including
inpatient care, home care, and care provided under contracts with other persons
or public agencies is conducted. The assessment shall include all services that
were indicated and provided to the hospice care patients and their families and
the patients' and caregivers' responses or outcomes to those
services. (E) The hospice care program governing
body shall ensure the use of the findings of the quality assessment and
performance improvement program to correct identified problems and to revise
hospice care program policies if necessary. (F) The hospice care program governing
body shall ensure that an evaluation of the hospice care program's quality
assessment and performance improvement program is conducted on an annual
basis. (G) If the hospice care program operates
an inpatient hospice unit and admits non-hospice palliative care patients in
accordance with section 3712.10 of the Revised Code, the hospice care program
shall ensure that non-hospice palliative care patients and their families or
caregivers are included in the requirements of pargraphs (D), (E), and
(F).
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Rule 3701-19-07 | General requirements for hospice care programs after licensure.
Effective:
January 23, 2020
(A) Any person or public agency licensed
under section 3712.04 of the Revised Code and this chapter to provide a hospice
care program shall: (1) Provide a planned and
continuous hospice care program, the medical components of which shall be under
the direction of a physician; (2) Ensure that care is
available twenty-four hours a day and seven days a week; (3) Establish an
interdisciplinary plan of care for each hospice patient and the patient's
family that: (a) Is coordinated by one designated individual who shall ensure
that all components of the plan of care are addressed and
implemented; (b) Addresses maintenance of patient-family participation in
decision making; (c) Is periodically reviewed by the patient's attending
physician and by the patient's interdisciplinary team; and (d) Provides a list of services that will be provided by or
arranged for by the hospice care program. (4) Have an
interdisciplinary team or teams that provide or supervise the provision of care
and establish the policies governing the provision of the care; (5) Provide bereavement
counseling for hospice patients' families; (6) Not discontinue care
because of a hospice patient's inability to pay for the care; (7) Maintain central
clinical records on all hospice patients under its care; and (8) Provide care in
individual's homes, on an outpatient basis, and on a short-term inpatient
basis. (B) A component or components of the care
provided by a hospice care program may be provided under a written contract
with another person or public agency, pursuant to rule 3701-19-12 of the
Administrative Code. (C) After receiving a license, a hospice care program shall
comply with all requirements of Chapter 3712. of the Revised Code and Chapters
3701-13 and 3701-19 of the Administrative Code. (D) Each licensed hospice care program shall notify the
director, in writing, of any of the following: (1) Any change in any of
the information specified in the license application under paragraphs (C)(1) to
(C)(3) of rule 3701-19-03 of the Administrative Code no later than fifteen days
after the change; (2) Any other change that
would render the information submitted in the license application inaccurate at
least twenty-one days prior to the effective date of the change; (3) Any intent to cease
operation at least sixty days prior to ceasing operation. This notification
shall include a plan for assuring continuity of care for the program's
patients and their families after the program ceases operation;
and (4) Each hospice care
program that intends to cease operation shall do the following to assure the
continuity of care of hospice program patients and their families
by: (a) Providing a written notice of the proposed closure of
the program, at least sixty days prior to ceasing operation, to each patient or
patient's family; (b) Developing a written discharge plan to be placed in
each patient's record to assist the person or public agency that will be
responsible for care of the patient and the patient's family after the
program ceases operation; and (c) Obtaining from each patient or their authorized
representative a written approval of any transfer to another licensed hospice
care program and a written authorization to release pertinent clinical records
information to such a program or another person or public agency that will
assume responsibility for the patient's and family's
care.
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Rule 3701-19-08 | Standards for inpatient hospice facilities.
Effective:
January 23, 2020
(A) Each new inpatient hospice facility
shall be inspected by the director to determine compliance with provisions of
rules 3701-19-01 to 3701-19-24 of the Administrative Code. The new inpatient
hospice facility shall not admit patients until the director has determined
that the facility is in compliance with the requirements of this chapter of the
Administrative Code. (B) The inpatient hospice facility shall
meet all applicable provisions of the Ohio fire code, adopted pursuant to
section 3737.82 of the Revised Code. (C) The building or buildings in which an
inpatient hospice facility is located shall comply with the applicable
provisions of the Ohio building code adopted by the board of building standards
pursuant to Chapters 3781., 3783., and 3791. of the Revised Code, and have a
certificate of use and occupancy issued by the appropriate building
authority. (D) Each new inpatient hospice facility
shall be connected to one of the following dependent upon the location and size
of the facility: (1) A public sewer system
permitted under Chapter 6111. of the Revised Code; (2) A small flow on site
sewage treatment system permitted by a local health district under Chapter
3718. of the Revised Code; or (3) A household sewage
treatment system permitted by a local health district under Chapter 3718. of
the Revised Code. (E) Each new inpatient hospice facility
shall comply with the following requirements by: (1) Maintaining
appropriate space providing optimal comfort and privacy for patients and family
members designed and equipped for the comfort and privacy of each patient and
family members by: (a) Providing decor which is homelike in design and
function; (b) Providing accommodations for family members to remain with
the patient; and (c) Ensuring physical space for private patient and family
visiting and allowing patients to receive visitors, including small children,
at any hour. (2) Maintaining
appropriate patient rooms designed and equipped for adequate nursing care,
comfort, and privacy of patients. Each room must: (a) Be equipped with or conveniently located near toilet and
bathing facilities; (b) Be at or above grade level; (c) Contain an appropriate bed and other appropriate
furniture; (d) Have closet space providing security and privacy for clothing
and personal belongings; (e) Contain no more than four beds; (f) Measure at least one hundred square feet for a single patient
room or eighty square feet for each patient for a multipatient room;
and (g) Be equipped for calling the staff member on
duty. (3) Maintaining
appropriate bathroom facilities and plumbing and provide: (a) An adequate supply of hot water at all times for patient use;
and (b) Plumbing fixtures with control valves that automatically
regulate the temperature of the hot water used by patients. (4) Each facility shall
provide appropriate linens at all times in a quantity for the proper care and
comfort of patients. Linens must be handled stored, processed, and transported
in a manner that prevents the spread of infection. (5) Each facility shall
have provisions for isolating patients with infectious diseases. (6) Each facility must
provide meal service. A hospice facility providing its own meal service
must: (a) Obtain an appropriate food service license, unless exempt in
accordance with section 3717.42 of the Revised Code, or contracting with
another licensed food service provider; (b) Serve at least three meals or their equivalent each day at
regular times, with not more than fourteen hours between a substantial evening
meal and breakfast; (c) Procure, store, prepare, distribute and serve all food under
sanitary conditions; and (d) Have a staff member trained or experienced in food management
or nutrition who is responsible for: (i) Planning menus that
meet the nutritional needs of each patient, following the orders of the
patient's physician and, to the extent medically possible, the dietary
allowances recommended by the national academy of sciences; and (ii) Supervising the meal
preparation and service to ensure that the menu plan is followed. (7) Each facility must
provide pharmaceutical services and must: (a) Provide appropriate methods and procedures for dispensing,
administering and disposing of drugs and biologicals; (i) The facility is
responsible for drugs and biologicals for its patients, whether drugs or
biologicals are obtained from community or institutional pharmacists or stocked
by the facility; and (ii) The facility must
ensure that pharmaceutical services are provided in accordance with accepted
professional principles and appropriate federal, state and local
laws. (b) Employ a pharmacist or have a formal agreement with a
licensed pharmacist to advise the facility on ordering, storage,
administration, disposal and recordkeeping of drugs and biologicals;
and (c) Ensure that orders for medications are given by a physician,
physician assistant, or an advanced practice registered nurse acting within
their scope of practice; (i) If the medication
order is verbal, the physician, physician assistant, or advanced practice
registered nurse must give it only to a licensed nurse, pharmacist, or another
physician; and (ii) The individual
receiving the order must record and sign it immediately and have the
prescribing physician, physician assistant, or advanced practice registered
nurse sign it in a manner consistent with good medical practice.
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Rule 3701-19-09 | General requirements for hospice care program personnel.
Effective:
January 23, 2020
(A) Each hospice care program shall
utilize personnel that have appropriate training and qualifications for the
services that they provide. Any staff member, including a volunteer, who
functions in a professional capacity shall meet the standards applicable to
that profession, including but not limited to, possessing current Ohio
licensure, registration, or certification, if required by law, and practicing
within the applicable scope of practice. (B) The hospice care program shall
provide each staff member, including volunteer and contracted staff members,
with a written job description delineating his or her responsibilities. The
program shall assure that the services provided by staff members, including
volunteers and contracted staff, are provided: (1) In accordance with
the patients' plans of care; (2) In accordance with
the policies and procedures developed by the interdisciplinary
team; (3) In accordance with
current and accepted standards of practice; (4) By staff members who
comply with the program's employee health policies; (a) The hospice care program shall have written employee health
policies which include the following requirements for any staff, including
volunteers, temporary agency employees, or paid consultants used by the hospice
program who has direct patient contact; (b) The hospice care program shall have a written plan to ensure
the health and safety of hospice patients that includes policies and procedures
regarding screening of staff, including volunteers, for communicable
diseases; (c) The hospice care program shall have written policies and
procedures regarding measures taken to prevent staff, including volunteers,
with direct hospice patient contact who have been diagnosed with a communicable
disease from transmitting this disease to patients, care givers or other staff.
The policies shall indicate when infected or ill staff must not render direct
patient care; and (d) The hospice care program shall document, as applicable,
compliance with United States department of labor's occupational safety
and health administration, United States centers for disease control and
prevention, and applicable Ohio department of health standards concerning
health requirements for staff provision of services in health care settings,
including requirements for maintaining tuberculosis control. (5) Documented in the
patient's central clinical record. (C) Each hospice care program shall
ensure that all personnel treat each patient and each patient's property
with respect, do not abuse, exploit, or neglect patients, and do not
misappropriate a patient's property in accordance with section 3721.23 of
the Revised Code. (D) Each hospice care program shall employ personnel without
discrimination on the basis of sex, age, race, creed, national origin, or
handicap. (E) Each hospice care program shall provide both orientation and
ongoing training program for its personnel, including volunteers. (1) The orientation shall
be appropriate to the tasks each member will be expected to perform;
and (2) The continuing
training shall be designed to assure maintenance of appropriate skill levels
and ensure that all personnel are informed of changes in techniques,
philosophies, and goals of the hospice care program. (F) Each hospice care program shall evaluate the performance of
each staff member regularly. (G) Except as provided in Chapter 3701-13 of the Administrative
Code, no hospice care program shall employ a person who applies on or after
January 27, 1997, for a position that involves the provision of direct care to
an older adult, if the person: (1) Has been convicted of
or pleaded guilty to an offense listed in division (C)(1) of section 3712.09 of
the Revised Code; or (2) Fails to complete the
form(s) or provide fingerprint impressions as required by division (B)(3) of
section 3712.09 of the Revised Code.
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Rule 3701-19-10 | Medical director.
Effective:
January 23, 2020
(A) The medical director of a hospice
care program shall be a physician and have overall responsibility for the
medical components of the program. The medical director shall be either a paid
or contractual staff member or a volunteer. (B) The duties of the medical director
shall include: (1) Participating as a
member of the interdisciplinary team or teams in the development of individual
plans of care or assuring that one or more other qualified physicians
participate on the team or teams; (2) Reviewing patient
medical eligibility for hospice care services; (3) Maintaining responsibility and authority over all other
physicians employed by the hospice care program; (4) Consulting with attending physicians,
when appropriate, regarding pain and symptom management; (5) Assuring overall continuity of the
hospice care program's medical services, including availability of
physician services for both routine and emergency situations; (6) Acting as liaison between
patients' attending physicians and the interdisciplinary team or
teams; (7) Establishing health policies for
employees of the hospice care program; and (8) Serving as liaison with community
physicians, medical schools, healthcare facilities, and hospitals.
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Rule 3701-19-11 | Interdisciplinary team and interdisciplinary plan of care.
Effective:
January 23, 2020
(A) Each hospice care program shall have
an interdisciplinary team or teams that provides or supervises the provision of
hospice care and services. The registered nurse designated to coordinate each
interdisciplinary team shall ensure all of the following for that
team: (1) There is ongoing
assessment of the hospice patient's and family's needs; (2) That all components
of the plan of care are addressed by the interdisciplinary team;
and (3) The plan of care is
implemented in accordance with its terms. (B) If the hospice care program has more
than one interdisciplinary team, it shall designate which team is to be
responsible for establishing the policies and procedures or it shall specify
particular areas for which each team is to establish policies and
procedures. (C) The interdisciplinary team or teams
shall perform the following functions: (1) Establish policies
and procedures governing the provision of care; (2) Ensure that all of
its policies and procedures are available and accessible to all
personnel; (3) Establish an
interdisciplinary plan of care for each patient and family; (4) Review the
interdisciplinary plan of care on a periodic basis no less frequently than
every fifteen days; (5) Encourage and foster
active involvement of the patient and family in the development and
implementation of the interdisciplinary plan of care; and (6) Evaluate the hospice
care and services provided and monitor the continuity of care across all
settings for the hospice care program's patients and their
families. (D) As part of a hospice patient's
interdisciplinary plan of care required by paragraph (A) of rule 3701-19-07 of
the Administrative Code, each hospice care program that provides hospice care
and services in the patient's home shall do all of the
following: (1) Before providing
hospice care and services: (a) Distribute a copy of the written policy established
under division (A) of section 3712.062 of the Revised Code and paragraph (C) of
rule 3701-19-21 of the Administrative Code, to the patient and patient's
family and discuss the procedures included in the policy with the patient and
patient's family; and (b) Inform the patient and the patient's family that
the hospice care program will dispose of any controlled substances containing
opioids that are no longer needed by the patient and were included in the
patient's interdisciplinary plan of care. (2) Assess the patient,
the patient's family, and the care environment for any risk factors
associated with diversion; (3) Maintain records of
controlled substances containing opioids prescribed to the patient and included
in the patient's interdisciplinary plan of care, including accurate counts
of the numbers dispensed and used; (4) Monitor the use and
consumption of controlled substances containing opioids prescribed to the
patient and included in the patient's interdisciplinary plan of care,
including prescription refills, for signs of diversion; and (5) After the
patient's death or when no longer needed by the patient, request, in
writing, that the patient or patient's family relinquish any remaining
controlled substances containing opioids that were included in the
patient's interdisciplinary plan of care to the hospice care program for
disposal. (E) A hospice care program shall ensure
that each patient's attending physician, if any, is periodically sent a
copy of the patient's plan of care. The hospice care program shall
document the date that the copy of the patient's plan of care is sent to
the attending physician in the patient's clinical record.
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Rule 3701-19-12 | Contracted services.
Effective:
February 15, 2015
(A) A provider of a hospice care program may arrange for another person or public agency to furnish a component or components of the hospice care program pursuant to a written contract in compliance with 42 C.F.R. 418.64 (2008). (B) Any contract executed under paragraph (A) of this rule, including a contract to which paragraph (C) of this rule applies, shall be legally binding on both parties and shall do all of the following: (1) Identify the services that may be provided; (2) Stipulate that services may be provided only with the express authorization of the hospice care program; (3) Describe the manner in which the contracted services are coordinated, supervised, and evaluated by the hospice care program; (4) Delineate the role or roles of the hospice care program and the contractor in the admission process, patient and family assessment, and the interdisciplinary team reviews; (5) Stipulate the requirements for documenting that services are furnished in accordance with the contract and the requirements of Chapter 3712. of the Revised Code, Chapter 3701-13 and this chapter of the Administrative Code; (6) Set forth the qualifications of the personnel providing the services; and (7) Stipulate that the hospice care program shall provide hospice care orientation and training, in accordance with paragraph (E) of rule 3701-19-09 of the Administrative Code, to the contractor's personnel who provide the care under the contract. (C) When a provider of a hospice care program arranges for a hospital, a home providing nursing care, or home health agency to furnish a component or components of the hospice care program to its patient, the care shall be provided by a licensed, certified, or accredited hospital, home providing nursing care, or home health agency pursuant to a written contract under which: (1) The provider of hospice care program furnishes to the contractor a copy of the hospice patient's interdisciplinary plan of care that is established under division (C) of section 3712.06 of the Revised Code and rule 3701-19-11 of the Administrative Code and specifies the care that is to be furnished by the contractor; (2) The regimen described in the established plan of care is continued while the hospice patient receives care from the contractor, subject to the patient's needs, and with approval of the coordinator of the interdisciplinary team designated pursuant to division (C)(1) of section 3712.06 of the Revised Code and paragraph (A) of rule 3701-19-11 of the Administrative Code; (3) All care, treatment, and services furnished by the contractor are entered into the hospice patient's medical record; (4) The designated coordinator of the interdisciplinary team ensures conformance with the established plan of care; (5) A copy of the contractor's medical record and discharge summary is retained as part of the hospice patient's medical record; and (6) The contractor complies with the requirements of Chapter 3712. of the Revised Code, and this chapter as applicable to the contracted service. (D) The hospice care program shall encourage any hospital contracting for inpatient care to offer temporary limited privileges to the hospice patient's attending physician while the hospice patient is receiving inpatient care from the hospital. (E) The hospice care program shall assure the continuity of patient and family care in the home, outpatient, and inpatient settings. (F) The hospice care program shall retain professional management responsibility for contracted services and shall ensure that those services are furnished in a safe and effective manner, by persons meeting the qualifications prescribed by Chapter 3701-13 and this chapter of the Administrative Code, and in accordance with the patient's plan of care and the other requirements of this chapter. (G) The hospice care program shall retain responsibility for payment for services provided by a contractor which are related to the palliation and management of the terminal illness, arranged for by the hospice care program, and included in the patient's plan of care. (H) The hospice care program may contract with a durable medical equipment supplier, only if that supplier meets the medicare supplier quality and accreditation standards at 42 C.F.R. 424.57 (2011) and, as applicable, the requirements of Chapter 4752. of the Revised Code.
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Rule 3701-19-13 | Volunteer services.
Effective:
January 23, 2020
(A) Each hospice care program shall use
trained volunteers to assist with the provision of administrative or direct
patient care services and shall have trained volunteers available to provide
services to hospice patients and the patients' families as needed.
Volunteers shall provide services under the supervision of a designated
qualified and experienced hospice staff member. (B) Each hospice care program shall
provide orientation and training to the volunteers it uses that is consistent
with acceptable standards of hospice practice. The orientation and training
shall include: (1) The hospice care
program's goals and services; (2) Confidentiality and
the protection of patient and the patient's family's
rights; (3) The volunteer's
specific duties and responsibilities and the person or persons to contact if
the volunteer needs assistance or instructions regarding the performance of the
designated duties and responsibilities; (4) Procedures for responding to medical
emergencies or deaths; (5) The physiological and psychological
aspects of terminal illness; (6) Family dynamics, coping mechanisms,
and psychosocial issues surrounding terminal illness, death, and
bereavement; (7) Safety policies and procedures;
and (8) General communication
skills. (C) The hospice care program shall
document active and ongoing efforts to recruit and retain
volunteers.
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Rule 3701-19-14 | Nursing services.
Effective:
February 15, 2015
(A) Each hospice care program shall provide nursing care and services by or under the supervision of a registered nurse. The program shall direct and staff nursing services to meet the nursing needs of all of the hospice care program's patients. The program shall specify the patient care responsibilities of nursing personnel. (B) A registered nurse shall be responsible for the supervision and oversight of all nursing services. (C) As used in this rule, "supervision" means monitoring and directing the provision of nursing care and services by record review, written or verbal instructions, review of interdisciplinary care plans, or direct observation. (D) The hospice care program shall ensure that nursing care is available twenty-four hours a day and seven days a week: (1) To provide services to hospice care program patient's; and (2) In each inpatient facility used to provide inpatient care to its patients. (E) The registered nurse who provides or supervises the provision of nursing services also may serve as the interdisciplinary team coordinator or team member.
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Rule 3701-19-15 | Medical social services.
Effective:
January 23, 2020
(A) Each hospice care program shall make
medical social services available to each patient and the patient's family
as needed. Medical social services shall be provided by a social worker under
the direction of a physician. For the purposes of this rule, a physician's
approval of a patient's interdisciplinary plan of care shall constitute
direction. (B) The medical social service needs of
each hospice patient and the patient's family shall be considered in
conjunction with other services when the interdisciplinary team reviews the
patient's and family's status. (C) Medical social services shall be
provided in a timely manner in accordance with hospice care program's
policy.
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Rule 3701-19-16 | Home care services.
Effective:
January 23, 2020
(A) Each hospice care program shall
provide or make available home care services in the scope and frequency
required to meet the needs of the hospice care program's patients and
their families. Home care services include assistance with activities of daily
living, personal care, ambulation and passive exercise, household services
essential to health care at home, assistance with self-administration of
medications, and preparation of meals. (B) The patient and family shall be
informed of any limitations on home care services as required by paragraph (E)
of rule 3701-19-20 of the Administrative Code. (C) Home care services shall be provided by home health
aides or hospice aides who have been selected on the basis of such factors as a
sympathetic attitude toward patients and their families, ability to read,
write, carry out instructions, maturity, and ability to cope with the demands
of the job. (D) The hospice care program shall ensure that home health
aides or hospice aides providing home care services have been trained in the
following: (1) Methods of assisting
patients to achieve maximum self-reliance; (2) Principles of
nutrition and meal preparation; (3) The aging process and
emotional problems of illness; (4) Procedures for
maintaining a clean, healthful, and pleasant environment; (5) Changes in a
patient's condition that should be reported; (6) The philosophy of
hospice care and of the hospice care program; (7) Ethics; (8) Confidentiality;
and (9) Record
keeping. (E) A registered nurse from the patient's
interdisciplinary team shall prepare for each home health aide or hospice aide
written instructions for patient care which are consistent with the
interdisciplinary plan of care. (F) The registered nurse responsible for preparing written
instructions for home health aides and hospice aides shall make and document a
supervisory visit to the patient's residence at least every two weeks when
home health aide or hospice aide services are being provided to assess the
provision of the home health aide or hospice aide services. The supervisory
visit: (1) May be made either
when the home health aide or hospice aide is present or when the aide is
absent; and (2) Shall serve the
purpose of observing and assisting the home health aide or hospice aide, if
present, assessing the patient's and family's relationship with the
home health aide or hospice aide, and determining whether the patient's
and family's needs and goals are being met; and (3) May be conducted in
conjunction with a visit for other purposes.
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Rule 3701-19-17 | Medical services.
Effective:
January 23, 2020
(A) A hospice care patient may identify
their own attending physician or may designate the hospice care program medical
director or another hospice care program physician to be their attending
physician. (B) Each hospice care program shall
provide: (1) Effective palliation
and management of terminal illness and related conditions; and (2) Medical services
which meet the medical needs of the patient that are not otherwise met by the
patient's: (a) Attending physician; (b) A physician assistant, who is acting within their scope of
practice under the supervision, control, and direction of a physician;
or (c) An advanced practice registered nurse, who is acting within
their scope of practice and who is working in collaboration with a
physician. (C) All medical orders for treatment,
procedures, tests, and medications shall be signed by: (1) A
physician; (2) A physician
assistant, who is acting within their scope of practice under the supervision,
direction, and control of a physician; or (3) An advanced practice
registered nurse, who is acting within their scope of practice and who is
working in collaboration with a physician.
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Rule 3701-19-18 | Counseling and bereavement services.
Effective:
January 23, 2020
(A) Each hospice care program shall make
available counseling services to the hospice patient and the hospice
patient's family. Counseling services shall include dietary, spiritual,
bereavement and any other necessary counseling services while the patient is
enrolled in the hospice care program. Counseling services shall be provided by
a qualified interdisciplinary team member or one or more other qualified
individuals, as determined by the hospice care program. (B) Counseling services shall be
organized to meet the needs of the hospice patients and their
families. (1) The hospice care
program shall assess the needs of patients and families for spiritual
counseling, in accordance with their religious preferences. (2) The hospice care
program shall make reasonable efforts to arrange for visits of clergy and other
members of religious organizations in the community to patients who request
visits and shall apprise patients of this opportunity. (C) The hospice care program shall provide dietary
counseling. Dietary counseling shall include use of food and mealtime to
promote quality of life for hospice patients and to meet their needs for
symptom control. Dietary counseling shall be planned and provided by or under
the supervision of a dietitian or, if the program is unable to obtain the
services of a dietitian, by a nurse. (D) Each hospice care program shall provide bereavement
services, as needed, for hospice patients' families. These services shall
be provided for up to one year after the patient's death. Bereavement
services shall be provided under the supervision of a designated qualified
professional. (1) The professional
designated to supervise bereavement services shall have education or experience
or both in providing those services. (2) Bereavement services
shall be based on an assessment of the family's needs and its ability to
cope with grief. (3) The plan of care for
bereavement services shall reflect family needs and shall specify the frequency
services are to be delivered and the persons furnishing the
services.
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Rule 3701-19-19 | Physical therapy, occupational therapy, and speech therapy services.
Effective:
January 23, 2020
(A) Each hospice care program shall
provide or arrange for the provision of physical therapy, occupational therapy,
or speech or language therapy unless the provision of those services is waived
by the director pursuant to division (A)(4) of section 3712.03 of the Revised
Code and paragraph (C) of this rule. The services shall be adequate in
frequency to meet the needs of the hospice patients. (B) Physical therapy services,
occupational therapy services and speech or language therapy services must be
offered in a manner consistent with accepted standards of practice for the
provision of service to hospice patients. (C) The director may waive the requirement for providing
physical therapy, occupational therapy, or speech or language therapy when the
requirement would create a hardship because the therapy is not readily
available in the geographic area served by the provider of the hospice care
program. A request for a waiver under this paragraph shall be submitted to the
director in writing and shall be accompanied by documentation of the number and
location of therapists in the area served by the program and of the efforts
that the program has made to engage those therapists and to encourage other
therapists to serve the area. (D) Physical therapy shall be provided by a person who is
licensed as a physical therapist under Chapter 4755. of the Revised Code and
who meets the requirements under Chapter 3701-13 of the Administrative
Code. (E) Occupational therapy shall be provided by a person who
is licensed as an occupational therapist under Chapter 4755. of the Revised
Code and who meets the requirements under Chapter 3701-13 of the Administrative
Code. (F) Speech or language therapy shall be provided by a
person who is licensed as a speech pathologist or audiologist under Chapter
4753. of the Revised Code and who meets the requirements under Chapter 3701-13
of the Administrative Code.
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Rule 3701-19-20 | Admission of patients to the hospice care program.
Effective:
January 23, 2020
(A) A hospice care program shall not
admit any individual who does not meet the diagnosis and life expectancy
requirements of a hospice patient defined in paragraph (J) of rule 3701-19-01
of the Administrative Code. (B) A hospice care program shall admit
patients, provide care and services, and discharge or transfer patients without
discrimination on the basis of sex, age, race, creed, national origin, or
handicap. (C) A hospice care program shall require
that the patient or the patient's authorized representative sign an
informed consent form. This form shall include an acknowledgment by signature
of the patient or patient's representative, that they have
been: (1) Given a full
explanation of the palliative rather than curative nature of hospice care as it
relates to the patient's terminal illness; and (2) Informed that the
patient may withdraw consent at any time. (D) A hospice care program shall permit a
hospice patient to withdraw consent for hospice care at any time. (E) A hospice care program shall provide
a patient or the patient's representative with information regarding the
scope of services provided by the hospice care program, including any
limitations of the hospice care program and charges for the
services. (F) A hospice care program shall
distribute a copy of the written policy established under division (A) of
section 3712.062 of the Revised Code and paragraph (D) of rule 3701-19-21 of
the Administrative Code, to the patient and patient's family and discuss
the procedures included in the policy with the patient and patient's
family before providing hospice care and services; (G) Prior to or within forty-eight hours after admission of each
patient, a hospice care program shall obtain an oral statement from the
patient's attending physician, if any, and the medical director of the
hospice care program or the physician member of the interdisciplinary team,
certifying that the patient is terminally ill. The program shall obtain written
confirmation of the oral statement after admission. The written certification
statement shall be signed by the patient's attending physician, if any,
and the medical director of the hospice care program or the physician member of
the interdisciplinary team. (1) The program should obtain from each
patient's attending physician, if any, designation of an alternate
physician to contact for emergency care of the patient or review of the
patient's plan of care when the attending physician is not available;
and (2) The hospice care program should
obtain written confirmation of the oral statement certifying that the patient
is terminally ill within a reasonable period of time after
admission.
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Rule 3701-19-21 | Medical supplies, drugs, and biologicals.
Effective:
February 15, 2015
(A) Each hospice care program shall arrange for provision of medical supplies, appliances, drugs, and biologicals to hospice patients as needed for the palliation and management of the patient's terminal illness and related conditions. The program shall ensure that drugs and biologicals are available at all times. (B) Each hospice care program shall ensure that drugs and biologicals are administered only by the following individuals: (1) A registered nurse, a licensed practical nurse, or a physician; (2) A patient or a family member if approved by the attending physician; or (3) Any other individual authorized by the Revised Code to perform this task. (C) The individuals authorized to administer drugs or biologicals under paragraphs (B)(2) and (B)(3) of this rule and the drugs or biologicals they are authorized to administer shall be specified in the patient's plan of care. (D) Each hospice care program licensed under this chapter that provides hospice care and services in a hospice patient's home shall establish a written policy establishing procedures to be followed in preventing the diversion of controlled substances containing opioids that are prescribed to its hospice patients. The policy shall include procedures for the disposal of any such drugs prescribed to a hospice patient as part of the patient's interdisciplinary plan of care that are relinquished to the program after the patient's death or that otherwise are no longer needed by the patient. The policy shall require that the disposal be documented by a program employee and conducted in any of the following ways:. (1) Performed by a program employee and witnessed by the patient or patient's family member; (2) Performed by the patient or patient's family member and witnessed by a program employee; (3) Performed by a program employee and witnessed by another program employee. (E) Each hospice care program shall ensure that the patient, patient's representative, and the patient's family receive a copy of the hospice care program's written policies and procedures along with education on the management and disposal of controlled drugs when a controlled substance is ordered, and document such actions in the patient's clinical record.
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Rule 3701-19-22 | Short-term inpatient care; standards and services.
Effective:
January 23, 2020
(A) Each hospice care program shall
provide or arrange for the provision of short-term inpatient care to patients
who require it for pain control, symptom management, or respite
care. (1) The program may operate its own inpatient facility or
may contract with one or more other persons or public agencies that operate
inpatient facilities for provision of inpatient care; and (2) The inpatient facility or facilities that the program
uses to provide inpatient care shall be licensed, certified, or accredited in
accordance with applicable Ohio law and this rule. (B) The type of inpatient setting
selected for a particular episode shall be based upon the needs of the patient.
The program shall not place patients in an inpatient facility for the
convenience of the program. (C) Each inpatient facility used by a
hospice care program to provide inpatient care to its patients shall provide
nursing services twenty-four hours a day or the hospice care program shall
provide or arrange for nursing services twenty-four hours a day. (D) Inpatient care for pain control and
symptom management shall be provided only in a hospice inpatient facility,
hospital or a skilled nursing facility. Any such facility used by a hospice
care program shall be certified under Title XVIII of the Social Security Act,
49 Stat. 620 (1935), 42 U.S.C. 301(1981), as amended, or accredited by an
organization that the United States centers for medicare and medicaid services
has given deeming authority. Each inpatient facility used by the hospice care
program to provide pain control and symptom management shall: (1) Have a registered
nurse on staff and available at all times on each shift to render hands-on
direct care; and (2) Ensure that nursing
services are sufficient to meet the total nursing needs of the hospice patients
residing in the facility. (E) Inpatient care for respite purposes
shall be provided only: (1) In a hospice
inpatient facility, a hospital, a skilled nursing facility or nursing facility
certified under Title XVIII or XIX of the Social Security Act, or a nursing
home or residential care facility licensed under Chapter 3721. of the Revised
Code that provides nursing services twenty-four hours a day or the hospice care
program shall provide or arrange for nursing services twenty-four hours a day.
Nursing services shall be sufficient to meet the needs of the hospice patients
residing in the facility; and (2) On an occasional
basis and not for more than seven consecutive days unless further limited by
payor. (F) Each inpatient facility used by a
hospice care program to provide inpatient care to its patients shall ensure
that sufficient personnel are available to: (1) Provide each
patient's treatments, medications, and diets as prescribed; (2) Keep each patient
comfortable, clean, well-groomed; (3) Assure that each
patient's routine, special, and emergency needs are met at all
times; (4) Promptly respond to
patient calls; and (5) Protect each patient
from accident, injury, and infection through the use of appropriate safety and
infection control measures. (G) Each inpatient facility used by a
hospice care program to provide inpatient care to its patients
shall: (1) Have patient areas
that are designed and equipped for the comfort and privacy of patients and
their family members by: (a) Maintaining adequate lighting levels in patient areas
and designing patient areas that are devoid of glare and reflecting surfaces
that produce discomfort; (b) Minimizing sound level; (c) Maintaining a comfortable temperature; and (d) Providing adequate ventilation. (2) Have physical space
for private patient and family visiting; (3) Provide
accommodations for family members to remain with the patient throughout the
night; (4) Provide
accommodations for family privacy after a patient's death; (5) Have decor which is
homelike in design and function; (6) Permit patients to
bring personal items into patient areas; and (7) Permit patients to
receive visitors at all times, including small children.
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Rule 3701-19-22.1 | Admission of non-hospice palliative care patients to hospice inpatient facilities.
Effective:
January 23, 2020
(A) A hospice care program that operates
an inpatient hospice facility or unit may admit non-hospice palliative care
patients to the inpatient hospice facility or unit for medically necessary care
on a short-term basis in accordance with section 3712.10 of the Revised
Code. (B) A hospice care program that operates
an inpatient hospice facility or unit that admits non-hospice palliative care
patients shall admit patients, provide care and services, and discharge or
transfer patients without discrimination on the basis of sex, age, race, creed,
national origin, or handicap. (C) A hospice care program that operates
an inpatient hospice facility or unit that admits non-hospice palliative care
patients shall require that the non-hospice palliative care patient, or the
patient's authorized representative, sign an informed consent form. This
form shall include an acknowledgment by signature of the patient or
patient's representative, that they have been given a full explanation of
the palliative nature of the care they will receive while admitted to the
facility or unit and have been informed that the patient may withdraw consent
at any time. (D) A hospice care program that operates
an inpatient hospice facility or unit that admits non-hospice palliative care
patients shall permit a patient to withdraw consent for inpatient care at any
time. (E) A hospice care program that operates
an inpatient hospice facility or unit that admits non-hospice palliative care
patients shall provide a patient or the patient's representative with
information regarding the scope of services provided by the hospice inpatient
facility or unit, including any limitations of services and charges for the
services. (F) Each hospice care program that
operates an inpatient hospice facility or unit that has admitted non-hospice
palliative care patients under section 3712.10 of the Revised Code or intends
to admit non-hospice palliative care patients under this Chapter, shall provide
a written attestation in accordance with paragraph (C)(8)(b) of rule 3701-19-03
of the Administrative Code by April 1, 2020. (G) Each hospice care program that
operates an inpatient hospice facility or unit that admits non-hospice
palliative care patients in accordance with section 3712.10 of the Revised Code
and this chapter, shall ensure: (1) The director has
access to all facilities, services, and records for non-hospice palliative care
patients for the purpose of inspections conducted pursuant to rule 3701-19-05
of the Administrative Code; and (2) All non-hospice
palliative care patients and their families or caregivers are included in the
quality assurance and performance improvement requirements set forth in
paragraphs (D), (E), and (F) of rule 3701-19-06 of the Administrative
Code. (a) The records associated with the quality assurance and
performance improvement program for non-hospice palliative care patients and
their families or caregivers may be maintained and reviewed separate from the
hospice care program quality assessment and performance improvement program;
and (b) Beginning January 30, 2021, a report of the findings of
the quality assessment and performance improvement program review required by
this paragraph and the actions taken by the hospice care program to correct
identified problems, shall be submitted to the department of health in a manner
prescribed by the director. (H) In addition to the notification
requirements set forth in paragraph (D) of rule 3701-19-07 of the
Administrative Code, a hospice care program that operates a hospice inpatient
facility or unit that admits non-hospice palliative care patients shall notify
the director, in writing, of any intent to cease the admission of non-hospice
palliative care patients within thirty days of the discontinuation of the
service. (I) In addition to the orientation and training
requirements set forth in rules 3701-19-09 and 3701-19-13 of the Administrative
Code, all hospice care program personnel and volunteers that provide care to
non-hospice palliative care patients in a hospice care program inpatient
facility or unit shall be provided additional training in: (1) The philosophy of
palliative care; (2) The goals of
palliative care; and (3) Physiological and
psychosocial issues associated with palliative care. (J) In addition to the duties prescribed to the medical
director of a hospice care program in rule 3701-19-10 of the Administrative
Code, the hospice care program medical director, or the medical director's
designee, for a hospice care program that admits non-hospice palliative care
patients to the hospice's inpatient facility or unit shall: (1) Review all referrals
for admission of a non-hospice palliative care patient; (2) Ensure that an
assessment of the medical and psychosocial needs of the non-hospice palliative
care patient is conducted to determine whether the patient's needs can be
met by the hospice inpatient facility or unit. This assessment may include, but
is not limited to, a review of the patient's medical records from the
referring provider, a physical exam, assessment tools designed to determine the
patient's psychosocial needs, or other tools the medical director deems
appropriate; and (3) Document the
determination as follows: (a) If a determination is made to admit the non-hospice
palliative care patient and the patient accepts, written documentation of the
decision and the assessments conducted shall be included in the patient's
clinical record for a period of no less than six years; (b) If a determination is made to not admit the non-hospice
palliative care patient, the following information shall be maintained in a
manner that can be made available to the director upon request, for a period of
no less than six years: (i) Date of
referral; (ii) Diagnosis and reason
for the referral; (iii) The assessments
conducted, if any; and (iv) The reason the non-hospice palliative care patient was
not admitted. (K) Non-hospice palliative care patients admitted to a
hospice care program inpatient facility or unit, shall have an
interdisciplinary team or teams that provide or supervise the provision of care
and services to non-hospice palliative care patients. (1) The hospice care
program shall designate an interdisciplinary team to be responsible for
establishing the policies and procedures related to caring for non-hospice
palliative care patients admitted to the hospice care program inpatient
facility or unit. The team shall ensure that all policies and procedures are
available and accessible to all hospice care program inpatient facility or unit
personnel. (2) A registered nurse
shall be designated to coordinate each interdisciplinary team and ensure the
following: (a) A clinical record is created and maintained in
accordance with rule 3701-19-23 of the Administrative Code for each non-hospice
palliative care patient admitted to a hospice care program inpatient facility
or unit; (b) There is ongoing assessment of the non-hospice
palliative care patient's and and patient's family's
needs; (c) That all components of the plan of care are addressed
by the interdisciplinary team; and (d) The plan of care is implemented in accordance with its
terms. (3) Each
interdisciplinary team shall perform the following functions: (a) Establish an interdisciplinary plan of care for each
non-hospice palliative care patient and their family that is coordinated by one
individual who shall ensure: (i) All components of the
plan are addressed and implemented; and (ii) The non-hospice
palliative care patient and their family are encouraged to be actively involved
in the development of the plan of care. (b) Review the interdisciplinary plan of care on a periodic
basis, but no less frequently than every three days; and (c) Provide an ongoing evaluation of the palliative care
and services provided to the non-hospice palliative care patient and their
family. (4) As part of each
non-hospice palliative care patient's interdisciplinary plan of care, the
hospice care program inpatient facility or unit shall ensure: (a) That the medical components of care are provided under
the direction of a physician or a physician's designee prior to providing
care and services to the non-hospice palliative care patient; (b) A list of services that will be provided by or arranged
for by the hospice care program is provided to the non-hospice palliative care
patient; (c) Nursing care is available to the non-hospice palliative
care patient twenty-four hours a day seven days a week in accordance with rule
3701-19-14 of the Administrative Code; (d) The non-hospice palliative care patient's plan of
care is reviewed by the patient's attending physician and by the
interdisciplinary team; and (e) That each non-hospice palliative care patient's
attending physician, if any, is sent a copy of the patient's plan of care.
The date that the copy of the plan of care was sent to the attending physician
shall be documented in the patient's clinical record. (L) All medical social services provided to non-hospice
palliative care patients in a hospice care program inpatient facility or unit
shall be provided in accordance with rule 3701-19-15 of the Administrative
Code. (M) All medical services provided to non-hospice palliative
care patients in a hospice care program inpatient facility or unit shall be
provided in accordance with rule 3701-19-17 of the Administrative
Code. (N) All counseling services provided to non-hospice
palliative care patients in a hospice care program inpatient facility or unit
shall be provided in accordance with paragraphs (A), (B) and (C) of rule
3701-19-18 of the Administrative Code. If indicated, the hospice care program
may provide bereavement counseling for the non-hospice palliative care patient
and the patient's family (O) All necessary physical therapy, occupational therapy,
and speech therapy services provided to non-hospice palliative care patients in
a hospice care program inpatient facility or unit shall be provided in
accordance with rule 3701-19-19 of the Administrative Code. (P) Each hospice care program shall arrange for provision
of medical supplies, appliances, drugs, and biologicals to all non-hospice
palliative care patients as needed for the palliation and management of the
patient's illness and related conditions. The program shall ensure that
drugs and biologicals are available at all times. Each hospice care program
shall ensure that drugs and biologicals are administered only by a registered
nurse, a licensed practical nurse, a physician assistant, an advanced practice
registered nurse, or a physician.
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Rule 3701-19-23 | Central clinical record.
Effective:
January 23, 2020
(A) Each hospice care program shall
establish and maintain a central clinical record for each hospice patient
receiving care and services from the program and his or her family. The record
shall be established and maintained in accordance with accepted standards of
practice. (B) The clinical record shall be a
comprehensive compilation of information that is documented promptly for all
services provided. The record shall be organized systematically to facilitate
retrieval of information and meet the following requirements: (1) Documentation of all
services provided, whether furnished by employees, persons under contract, or
volunteers; (2) Documentation shall
be dated and be made within a responsible period of time after the services
were provided; and (3) Entries to the
clinical record shall be made and signed by the person providing the
service. (C) Each clinical record shall contain at
least the following information: (1) Identification
data; (2) Pertinent medical
history, including the physician's diagnosis of terminal
illness; (3) Consent and
authorization forms; (4) Initial and
subsequent assessments that include evaluations of physical, psychosocial,
nutritional, and spiritual needs, if any, and the need for volunteer or
bereavement services; (5) The interdisciplinary
plan of care; (6) Documentation of all
services and events, such as evaluations, treatments, and progress
notes; (7) A statement of
whether or not the patient, if an adult, has prepared an advanced directive.
"Advanced directive" has the same meaning as "declaration"
as defined in section 2133.01 of the Revised Code; and (8) Transfer and
discharge summaries. (D) The hospice care program shall
provide for storage of the central clinical records to protect them against
loss, destruction, and unauthorized use. The program also shall have policies
and procedures to ensure the confidentiality of records. (E) A hospice care program which
maintains a patient's clinical record electronically shall use an
electronic signature system that meets the requirements specified under
division (B) of section 3701.75 of the Revised Code. Electronic patient
clinical records shall be accessible to the director during
inspections.
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Rule 3701-19-24 | Variances; waivers.
Effective:
February 15, 2015
(A) The director may grant a variance or waiver from any requirement established by Chapter 3701-19 of the Administrative Code, unless the requirement is mandated by statute. (B) A hospice care program seeking a variance or waiver must submit a written request to the director. Such written request must include the following information: (1) The rule requirement for which the variance or waiver is requested, with a reference to the relevant Administrative Code provision; (2) The specific nature of the request, and the rationale for the request; (3) The time period for which the variance or waiver is requested; (4) If the request is for a variance, a statement of how the hospice care program will meet the intent of the requirement in an alternative manner; and (5) If the request is for a waiver, a statement regarding why application of the requirement will cause undue hardship to the hospice care program and why granting the waiver will not jeopardize the health and safety of any patient. (C) The decision regarding a variance or waiver is a discretionary act by the director and an informal procedure not subject to Chapter 119. of the Revised Code. Upon written request by a hospice care program, the director may grant: (1) A variance if the director determines that the requirement has been met in an alternative manner; or (2) A waiver if the director determines that the strict application of the license requirement would cause an undue hardship to the hospice care program and that granting the waiver would not jeopardize the health and safety of any patient. (D) The director may stipulate a time period for which a variance or a waiver is to be effective and may establish conditions that the hospice care program must meet for the variance or waiver to be operative. Such time period may be different than the time period sought by the hospice care program in the written variance or waiver request. (E) The director may establish conditions that the hospice care program must meet for the variance or waiver to be operative. The director may, in his discretion, rescind the waiver or variance at any time upon determining that the hospice care program is not meeting such conditions. (F) The granting of a variance or waiver by the director shall not be construed as constituting precedence for the granting of any other variance or waiver. All variance and waiver requests shall be considered on a case-by-case basis. (G) The provider whose request for a waiver or variance under this rule is denied may request reconsideration of the decision by the director. A request for reconsideration must: (1) Be received in writing by the director within thirty days of receipt of the director's denial of a waiver or variance request; (2) Present significant, relevant information not previously submitted to the director by the provider because it was not available to the provider at the time the waiver or variance request was filed; or (3) Demonstrate that there have been significant changes in factors or circumstances relied upon by the director in reaching the initial decision. (H) A decision on an appropriately filed request for reconsideration shall be issued within forty-five days of the director's receipt of the request for reconsideration and all information determined necessary by the director to make a decision. (I) The reconsideration process is an informal procedure not subject to Chapter 119. of the Revised Code. The director's decision on reconsideration is final.
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Rule 3701-19-30 | Definitions.
Effective:
February 19, 2024
As used in rules 3701-19-30 to 3701-19-52 of the
Administrative Code: (A) "Advanced Practice Nurse"
means a registered nurse authorized to practice as a certified nurse
specialist, certified registered nurse anesthetist, certified nurse midwife or
certified nurse practitioner in accordance with section 4723.41 of the Revised
Code; (B) "Applicant" means a person
or public agency that submits an application for a license to provide a
pediatric respite care program under rule 3701-19-32 of the Administrative
Code. (C) "Attending physician" means
the physician identified by the pediatric respite care patient or the pediatric
respite care patient's family as having primary responsibility for the
pediatric respite care patient's medical care. (D) "Child Life Specialist"
means an individual who has a minimum of a bachelor's degree in child
life, child development and other related field. (E) "Dietitian" means an
individual licensed under Chapter 4759. of the Revised Code to practice
dietetics. (F) "Director" means the
director of health or any official or employee of the department of health
designated by the director of health. (G) "Governing body" means the
entity that has ultimate responsibility and authority for the overall operation
of a pediatric respite care program, as specified in rule 3701-19-37 of the
Administrative Code. (H) "Inpatient facility" means
a facility that either is operated by or under contract with a pediatric
respite care program for the purpose of providing inpatient care to the
program's patients. (I) "Inpatient pediatric respite
care facility" means a building or leased unit operated by a pediatric
respite care program where the pediatric respite care program directly provides
accommodations and pediatric respite care services for its pediatric respite
care patients. (J) "Interdisciplinary plan of
care" or "plan of care" means the interdisciplinary plan for
care of a pediatric respite care patient and his or her family prepared under
rule 3701-19-40 of the Administrative Code. (K) "Interdisciplinary team"
means a working unit composed of professional and lay persons that includes at
a minimum a physician, a registered nurse, a social worker, a child life
specialist, and a member of the clergy or a counselor. (L) "Licensed Practical Nurse"
means a person licensed under Chapter 4723. of the Revised Code to practice
nursing as a licensed practical nurse. (M) "Nurse" means a registered
nurse or licensed practical nurse. (N) "Palliative care" means
treatment for a patient with a serious or life-threatening illness directed at
controlling pain, relieving other symptoms, and enhancing the quality of life
of the patient and the patient's family rather than treatment for the
purpose of cure. Nothing in this section will be interpreted to mean that
palliative care can be provided only as a component of a pediatric respite care
program. (O) "Pediatric respite care patient" or
"patient" means a patient, other than a hospice patient, who is less
than twenty-seven years of age who has been diagnosed with a disease or
condition prior to the age of eighteen that is life threatening and is expected
to shorten the life expectancy that would have applied to the patient absent
the patient's diagnosis, regardless of whether the patient is terminally
ill, who has voluntarily requested and is receiving care from a licensed
pediatric respite care program. (P) "Pediatric respite care program" means a
program operated by a person or public agency that provides inpatient respite
care and related services, including all of the following services, only to
pediatric respite care patients and pediatric respite care patients'
families, in order to meet the physical, psychological, spiritual, and other
special needs that are experienced during or leading up to the final stages of
illness, dying, and bereavement: (1) Short-term inpatient
care, including both palliative and respite care and procedures; (2) Nursing care by or
under the supervision of a registered nurse; (3) Physicians'
services; (4) Medical social services by a social
worker under the director of a physician; (5) Medical supplies, including drugs and
biologicals, and the use of medical appliances; (6) Counseling for pediatric respite care
patients and pediatric respite care patients' families; and (7) Bereavement services for respite care
patients' families. (Q) "Pediatric respite care program
patient's family" or "family" means a pediatric respite
care program patient's immediate family members, including a spouse,
brother, sister, child, parent, and any other relative or individual who has
significant personal ties to the patient and who is designated as a member of
the patient's family by mutual agreement of the patient, the relative or
individual, and the patient's interdisciplinary team. (R) "Pediatric transition care program" means a
program operated by a person or public agency that arranges for the provision
of health care and related services in a private home setting, only to
pediatric transition care patients, who are not related by birth or adoption to
the person that arranges for the provision of health care and related services,
and, as indicated in this paragraph, the parents of pediatric transition care
patients, in order to meet the physical, psychological, social, spiritual, and
other including all of the following services: (1) Inpatient care; (2) Skilled nursing care; (3) Nursing care by or under the supervision of a
registered nurse; (4) Physician's services; (5) Medical supplies, including drugs and biologicals, and
the use of medical appliances; and (6) For pediatric transition patients' parents,
counseling, education, and visitation to promote reunification. (S) "Pediatric transition care patient" means a
patient, other than a hospice patient, who is less than twenty-seven years of
age and to whom all of the following conditions apply: (1) The patient has been diagnosed with a disease or
condition that is life-threatening and is expected to shorten the life
expectancy that would have applied to the patient absent the patient's
diagnosis, regardless of whether the patient is terminally ill; (2) The diagnosis described in paragraph (M)(1) of this
rule occurred when the patient was less than eighteen years of age;
and (3) The patient, or the parent or guardian of the patient
if the patient is under eighteen years of age or under guardianship, has
voluntarily requested and is receiving care from a person or public agency
registered under this chapter to provide a pediatric transition care
program. (T) "Person" means an individual, corporation,
business trust, estate, trust, partnership, limited liability company, and
association. (U) "Physician" means a person authorized under
Chapter 4731. of the Revised Code to practice medicine and surgery or
osteopathic medicine and surgery. (V) "Registered nurse" means a person registered
under Chapter 4723. of the Revised Code to practice professional
nursing. (W) "Respite care" means inpatient care services
provided by the pediatric respite care program to give temporary relief to a
pediatric respite care patient's family or other caregivers. (X) "Short-term" means a period of respite care
up to and including, twenty-eight days. (Y) "Social worker" means a person licensed under
Chapter 4757. of the Revised Code to practice as a social worker or independent
social worker. (Z) "Volunteer" means a lay or professional
person who provides his or her services to a pediatric respite care program
without compensation.
Last updated February 20, 2024 at 8:43 AM
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Rule 3701-19-31 | Applicability of licensure requirements.
Effective:
February 19, 2024
(A) Every person or public agency that
proposes to provide a pediatric respite care program is obligated to apply to
the director for a license in accordance with rule 3701-19-31 of the
Administrative Code. (B) Except as provided in paragraph (C)
of this rule, no person or public agency, other than a person or public agency
licensed under section 3712.041 of the Revised Code and this chapter, will hold
itself out as providing a pediatric respite care program, or provide a
pediatric respite care program, or use the term "pediatric respite
care" or any term containing "pediatric respite care" to
describe or refer to a health program, facility, or agency. (C) Paragraph (A) of this rule does not
apply to any of the following: (1) A hospital; (2) A nursing home or
residential care facility, as those terms are defined in section 3721.01 of the
Revised Code; (3) A home health agency, if it provides
services under contract with a person or public agency providing a pediatric
respite care program licensed under section 3712.041 of the Revised
Code; (4) A regional, state, or
national nonprofit organization whose members are providers of pediatric
respite care programs, individuals interested in pediatric respite care
programs, or both, as long as the organization does not provide or represent
that it provides pediatric respite care programs; (5) A person or
government entity certified under section 5123.161 of the Revised Code as a
supported living provider; (6) A residential
facility licensed under section 5123.19 of the Revised Code; (7) A respite care home
certified under section 5126.05 of the Revised Code; (8) A person providing
respite care under a family support services program established under section
5126.11 of the Revised Code; (9) A person or
government entity providing respite care under a medicaid waiver component that
the department of developmental disabilities administers pursuant to section
5111.871 of the Revised Code; or (10) A pediatric
transitional care program.
Last updated February 20, 2024 at 8:43 AM
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Rule 3701-19-32 | License application, amended license, and renewal procedures.
Effective:
February 19, 2024
(A) Application for license as a
pediatric respite care program shall be made on forms prescribed and provided
by the director shall include such information as the director requests,
including the information prescribed by paragraph (C) of this rule, and shall
be accompanied by a non-refundable license fee of six hundred dollars in the
form of a check or money order payable to the 'Treasurer, State of
Ohio." (B) Any person or public agency seeking to be licensed to
provide a pediatric respite care program shall submit an application for
licensure at least sixty days prior to the requested date for the inspection
prescribed by paragraph (A) of rule 3701-19-34 of the Administrative
Code. (C) An application for a license to provide a pediatric
respite care program shall include: (1) The name, address,
and business telephone number of the pediatric respite care
program; (2) The names and
addresses of the persons having an ownership or control interest in the
pediatric respite care program and other information pertaining to ownership or
control of the program; (3) The corporate name of
the pediatric respite care program, if any, and the names, titles, addresses,
and telephone numbers of its officers and statutory agent; (4) A list of the
services which are or will be provided by the pediatric respite care program
either directly or indirectly through written contracts; (5) If services are to be
provided through contract, the identities of any contractors and the services
they will provide; (6) The number of
pediatric respite care patient rooms in the pediatric respite care program
facility; and (7) Documentation of compliance with the
building code standards prescribed by paragraph (C) of rule 3701-19-48 of the
Administrative Code. (D) The applicant or an authorized representative shall
sign an affidavit included in the application certifying that, to the best of
his or her knowledge, the information in the application and any accompanying
material is true and accurate. If a representative signs the affidavit, he or
she shall include documentation that he or she is the applicant's
authorized representative. (E) Renewal of license: (1) Pediatric respite care programs applying to renew a
license are obligated to: (a) Submit an application
for renewal at least ninety days prior to the expiration of the
license; (b) Include a renewal fee
paid in accordance with paragraph (A) of this rule in the same manner as for an
initial license; (c) Include documentation
of continued compliance with the Ohio fire code in accordance with paragraph
(C) of rule 3701-19-48 of the Administrative Code; and (d) Submit a certificate
of occupancy in accordance with paragraph (C) of rule 3701-19-48 of the
Administrative Code if it has changed in any way from the one submitted with
prior applications. (2) The director will renew the license if the program
continues to meet the requirements of Chapter 3712. of the Revised Code and
Chapters 3701-19 and 3701-13 of the Administrative Code. (3) If the program does not meet the requirements, the
director may deny renewal of the license, in accordance with Chapter 119. of
the Revised Code. (F) When reviewing a license application,
the director may request, in writing, that an applicant furnish any additional
information that the director determines to be necessary to assess compliance
with Chapter 3712. of the Revised Code and this chapter. The applicant is
obligated to furnish any requested information within fourteen days after the
mailing of the director's request. (G) A pediatric respite care program
operating in another state seeking to provide services to patients in Ohio is
obligated to establish an administrative office in Ohio and comply with the
rules of Chapter 3701-19 of the Administrative Code in order to obtain a
license. All pediatric respite patients' clinical records are to be
maintained at the Ohio administrative office. (H) Each licensed pediatric respite care
program will notify the director, in writing, of any of the
following: (1) Any change in any of
the information specified in the license application under paragraphs (C)(1) to
(C)(5) of this rule no later than fifteen days after the change; (a) Submission of a change of ownership application on
forms prescribed and provided by the director; and (b) A non-refundable fee of two hundred dollars in the form
of a check or money order payable to the "Treasurer, State of
Ohio." (2) Any other change that
would render the information submitted in the license application inaccurate at
least twenty-one days prior to the effective date of the change;
and (3) Any intent to cease
operation at least sixty days prior to ceasing operation. This notification is
obligated to include a plan for assuring continuity of care for the
program's patients and their families after the program ceases operation
and procedures for assuring continuity of care for all pediatric respite care
patients that includes the folowing: (a) Provision of written notice of the proposed closure of
the program, at least sixty days prior to ceasing operation, to each patient or
patient's family; (b) Development of a written discharge plan to be placed in
each patient's record to assist the person or public agency that will be
responsible for care of the patient and the patient's family after the
program ceases operation; and (c) Obtaining from each patient or the patient's
authorized representative written approval of any transfer to another licensed
pediatric respite care program and written authorization to release pertinent
clinical record information to such a program or another person or public
agency that will assume responsibility for the patient's and family's
care. (I) Each licensed pediatric respite care
program that seeks to increase or decrease the number of pediatric respite care
patient rooms as reported under paragraph (C)(6) of this rule, is obligated to
apply for an amended license. (1) Application for an
amended license will be made on forms prescribed and provided by the director,
include such information as the director requires, and be accompanied by a
non-refundable amended license fee in the form of a check or money order
payable to the "Treasurer, State of Ohio" in the following
amounts: (a) A decrease in the number of patient rooms not involving
a renovation, a fee of two hundred dollars; (b) An increase in the number of patient rooms not
involving a renovation, a fee of two hundred dollars; or (c) An increase in the number of patient rooms involving a
renovation, a fee of six hundred dollars. (2) Any increase in the
number of pediatric respite care patient rooms necessitates an inspection in
accordance with rule 3701-19-34 of the Administrative Code.
Last updated February 20, 2024 at 8:44 AM
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Rule 3701-19-33 | Issuance, denial, transfer, and revocation of a license.
Effective:
February 19, 2024
(A) The director may grant a license for
provision of a pediatric respite care program to an applicant that complies
with Chapter 3712. of the Revised Code and this chapter. A pediatric respite
care program is licensed to provide: (1) Short-term inpatient
care, including both palliative and respite care and procedures; (2) Nursing care by or
under the supervision of a registered nurse; (3) Physicians'
services; (4) Medical social
services by a social worker under the director of a physician; (5) Medical supplies,
including drugs and biologicals, and the use of medical
appliances; (6) Counseling for
pediatric respite care patients and pediatric respite care patients'
families; and (7) Bereavement services
for respite care patients' families. (B) The director will provide electronic
or written notice to the applicant granting a license or provide written notice
of proposal to deny a license, within thirty days after receiving all
information necessary to determine compliance with Chapter 3712. of the Revised
Code and this chapter, including the reports of the inspection conducted
pursuant to paragraph (A) of rule 3701-19-34 of the Administrative Code. This
thirty-day period will be extended if the director has received a complaint
concerning an applicant. In such a case, the director will conduct a complaint
investigation within thirty days after receipt of the complaint and mail a
written notice of the determination regarding the license application within
thirty days after completion of the complaint investigation. (C) The license will: (1) Indicate the name and
address of the pediatric respite care program location to which the applicant
requested the license be issued; (2) Indicate the facility
patient capacity; (3) Be valid for three years for the
pediatric respite care program at the address indicated in the application
except as provided for in paragraph (F) of this rule; and (4) Be posted in a conspicuous place in
the pediatric respite care program location issued the license. (D) Subject to Chapter 119. of the
Revised Code, the director may deny, suspend, or revoke a license if the
licensee made any material misrepresentation in the application for licensure
or if the pediatric respite care program no longer meets the requirements of
Chapter 3712. of the Revised Code or this chapter. (E) A pediatric respite care program that
seeks to transfer its license to another or new location is obligated to submit
to the director a license application and license application fee in accordance
with paragraph (A) of rule 3701-19-32 of the Administrative Code including all
information prescribed by paragraph (C) of rule 3701-19-21 of the
Administrative Code. no later than ninety days prior to the current license
expiration or ninety days prior to the proposed transfer or relocation,
whichever occurs sooner. (1) When reviewing a
request for transfer of a license, the director may request any additional
written information the director determines necessary to assess compliance with
Chapter 3712. of the Revised Code and this chapter are met. (2) The director will
allow a license to be transferred if the following criteria are
met: (a) The new location to which the pediatric respite care
program license is to be transferred successfully passes a licensure inspection
conducted in accordance with rule 3701-19-34 of the Administrative
Code; (b) The pediatric respite care program currently meets all
of the licensing requirements and there are no pending complaints against the
pediatric respite care program under investigation. Any pending complaints will
be investigated within thirty days of the request for transfer and must be
completed before any transfer of the license may occur; (c) The pediatric respite care program is not undergoing
any enforcement action at the time of the transfer or relocation or proposed
transfer or relocation; (d) The transfer or relocation is not due to a change in
ownership or control; (e) The pediatric respite care program continues to provide
the full range of services at the new location that were required of the
pediatric respite care program location that was issued the
license; (f) All pediatric respite patients' clinical records
are available, upon request of the director, at the new location to which the
pediatric respite license is to be transferred; and (g) The approval to transfer the license may be granted
with no less than sixty-one days remaining prior to the expiration of the
current license. (3) The director will
notify the pediatric respite care program of whether or not the license may be
transferred. If the director determines that the license is not transferable,
the director will provide the pediatric respite care program with an
opportunity for a reconsideration. To request a reconsideration, a pediatric
respite care program is obligated to: (a) Submit a request a reconsideration in writing within
thirty days of the mailing of the notice of determination. (b) Include any written documentation or other information
not previously submitted to the director that the pediatric respite care
program wishes to refute the determination. (c) The director's final determination is not
appealable under Chapter 119. of the Revised Code. (d) The pediatric respite care program is obligated to
obtain a license for the new location prior to commencing services at the new
location. (F) Upon written request, the director
may grant a variance from any requirement of this chapter, that is not a
statutory requirement, if the person or public agency requesting the variance
establishes that because of practical difficulties or other special conditions,
strict application of the requirement will cause unusual or unnecessary
hardship and that the variance will not jeopardize the health, safety, or
welfare of any pediatric respite patient or pediatric respite patient's
family.
Last updated February 20, 2024 at 8:44 AM
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Rule 3701-19-34 | Inspections.
Effective:
February 19, 2024
(A) Prior to issuing a license for a
pediatric respite care program, the director will conduct an announced
licensure inspection of the applicant's facilities and
services. (B) The director will conduct an
unannounced licensure inspection of each licensed pediatric respite care
program's facilities and services at a minimum frequency of once every
three years. The director may conduct additional inspections of any licensed
pediatric respite care program at any other time he or she considers necessary
including, but not limited to, investigating complaints. (C) Prior to issuing an amended license
for an increase in pediatric respite care patient rooms, the director will
conduct an announced licensure inspection of all pediatric respite care patient
rooms being added to the license; (D) For purposes of this paragraph, "follow-up
inspection" means an inspection, which may include on-site and off-site
activities, conducted by the department to determine whether the pediatric
respite care program has corrected a violation or violations cited on a
previous inspection. The fees for inspections conducted by the director
pursuant to section 3712.031 of the Revised Code and paragraphs (A) and (B) of
this rule are as follows: (1) Licensure inspection
fee of one thousand six hundred twenty-five dollars; (2) Amended license
inspection for an increase in pediatric respite care patient rooms fee of eight
hundred twenty-five dollars; (3) Complaint inspection fee of eight
hundred fifty dollars; (4) Follow-up inspection fee of three
hundred fifty dollars; and (5) Desk audit or compliance review
inspection fee of two hundred fifty dollars. (E) Each pediatric respite care program is obligated to provide
the director access to its premises and staff at all times and to pertinent
records upon request. The program is obligated to ensure that the director has
access to all parts of its facilities, services, and records, including any
services provided under contract with the program. The inspections may include
direct interaction with patients and their families, with the patients' or
families' consent. (F) If an inspection of an applicant's pediatric respite
care program or of a licensed program reveals a violation or violations of
Chapter 3712. of the Revised Code or of Chapter 3701-19 or 3701-13 of the
Administrative Code, the director, in his or her discretion, may require
submission of a plan of correction for each violation. The pediatric respite
care program is obligated to submit the plan within fourteen days after
receiving the director's notification that a plan of correction is
required.
Last updated February 20, 2024 at 8:44 AM
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Rule 3701-19-35 | Compliance actions and operating without a license.
Effective:
February 19, 2024
(A) The department of health will
petition the court of common pleas of any county in which a person or public
agency, without a license granted under section 3712.041 of the Revised Code,
is holding itself out as providing a pediatric respite care program, is
providing a pediatric respite care program, or is representing a health
program, facility, or agency as a pediatric respite care program, for an order
enjoining that person or public agency from conducting those activities without
a license. The court has jurisdiction to grant injunctive relief upon a showing
that the respondent named in the petition is conducting those activities
without a license. (B) Any person or public agency may
request the department to petition the court for injunctive relief under this
division, and the department will do so if it determines that the person or
public agency named in the request is violating paragraph (A) of this
rule.
Last updated February 20, 2024 at 8:44 AM
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Rule 3701-19-36 | General requirements for pediatric respite care programs.
Effective:
February 19, 2024
(A) Any person or public agency licensed
under section 3712.041 of the Revised Code and this chapter to provide a
pediatric respite care program is obligated to: (1) Provide a planned and
continuous pediatric respite care program, the medical components of which are
under the direction of a physician; (2) Ensure that care is
available twenty-four hours a day and seven days a week; (3) Establish an
interdisciplinary plan of care for each pediatric respite patient and their
family as prescribed by rule 3701-19-40 of the Administrative Code
that: (a) Is coordinated by one designated individual who ensures that
all components of the plan of care are addressed and implemented; (b) Addresses maintenance of patient-family participation in
decision making; and (c) Is periodically reviewed by the patient's attending
physician and by the patient's interdisciplinary team. (4) Have an
interdisciplinary team or teams that provide or supervise the provision of care
and establish the policies governing the provision of the care; (5) Provide bereavement
counseling as prescribed by rule 3701-19-46 of the Administrative Code for
pediatric respite patients' families if requested; (6) Maintain clinical records as
prescribed by rule 3701-19-50 of the Administrative Code on all pediatric
respite patients under its care in a central location. (B) A component or components of the care
provided by a pediatric respite care program may be provided under a written
contract with another person or public agency, pursuant to rule 3701-19-41 of
the Administrative Code. (C) After receiving a license, a
pediatric respite care program is obligated to comply with all requirements of
Chapter 3712. of the Revised Code, Chapter 3701-13 of the Adminsitrative Code,
and Chapter 3701-19 of the Administrative Code.
Last updated February 20, 2024 at 8:45 AM
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Rule 3701-19-37 | Governing body; quality assessment and performance improvement.
Effective:
February 19, 2024
(A) The overall conduct and operation of
the pediatric respite care program, including the quality of care and the
provision of services, are the full legal responsibility of a clearly defined,
organized governing body. (B) The governing body of a licensed
hospice care program may also provide governance for a pediatric respite care
program if the programs are dually licensed and meet all requirements set forth
in this rule and chapter. (C) The governing body is obligated to: (1) Establish and review
policies for the management, operation, and evaluation of the pediatric respite
program, including, but not limited to: (a) Qualifications of employees and independent
contractors; and (b) Policies and procedures to receive and respond to
patient grievances regarding medical treatment, quality of care, the lack of
respect for person or property, mistreatment, neglect, verbal, mental, sexual,
and physical abuse, including injuries of unknown source, and misappropriation
of patient property by any individual furnishing services on behalf of the
pediatric respite care program. The policies and procedures developed by the
governing body , at a minimum, will include: (i) Notification
procedures for pediatric respite care patients, employees and contracted staff
to report alleged violations to the pediatric respite care program
administration; (ii) Requirements for the
immediate investigation of alleged violations; (iii) Procedures for the reporting of verified violations to
the appropriate state licensing authority and/or local authorities where
appropriate; and (iv) Requirements for timely corrective actions for all
verified violations. (2) Arrange for a
physician to serve as medical director for the pediatric respite care program
who: (a) Should be knowledgeable about the psychological,
social, and medical aspects of pediatric respite care as the result of
training, experience, and interest; and (b) Designate a physician to act in their absence;
and (c) The medical director may also may serve as the
physician representative on an interdisciplinary team or teams or as an
attending physician. (3) Appoint a qualified
individual to serve as the director of the pediatric respite care program who
performs the following duties: (a) Assumes responsibility for the day-to-day management
of the program and for assuring compliance with Chapter 3712. of the Revised
Code, Chapter 3701-13, and this chapter of the Administrative
Code; (b) Implements the pediatric respite care program's
policies and procedures regarding all activities and services provided by the
pediatric respite care program; (c) Designates an individual to act in his or her
absence; (d) Implements the pediatric respite care program's
quality assessment and performance improvement program under rule 3701-19-52
the Administrative Code; and (e) Implements the pediatric respite care program's
patient grievance program established under paragraph (A)(2) of this
rule. (4) Ensures that all
services provided are consistent with accepted standards of practice for
pediatric respite care. (5) Evaluates the
pediatric respite care program's quality assessment and performance
improvement program on an annual basis. (D) Each pediatric respite care program governing body is
obligated to conduct an ongoing, comprehensive, integrated, self-assessment of
the quality and appropriateness of care provided by the program, including care
provided under contracts with other persons or public agencies. (E) The pediatric respite care program
governing body is obligated to designate an individual or individuals to be
responsible for the quality assessment and performance improvement program who
implements and reports on activities and mechanisms for monitoring the quality
of care, identifies and resolves problems, makes suggestions for improving and
provides their reports to the governing body of the program. The pediatric
respite care program is obligated to use the findings of the quality assessment
and performance improvement program to correct identified problems and revise
pediatric respite care program policies as necessary. (F) The pediatric respite care program
governing body shall use the findings of the quality assessment and performance
improvement program to correct identified problems and to revise pediatric
respite care program policies if necessary.
Last updated February 20, 2024 at 8:45 AM
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Rule 3701-19-38 | General requirements for pediatric respite care program personnel.
Effective:
February 19, 2024
(A) Each pediatric respite care program
is obligated to utilize personnel that have appropriate training and
qualifications for the services that they provide. Any staff member, including
a volunteer, who functions in a professional capacity, is obligated to meet the
standards applicable to that profession, including but not limited to
possessing current Ohio licensure, registration, or certification, if required
by law, and practicing within the applicable scope of practice. (B) The pediatric respite care program is
obligated to provide each staff member, including volunteer and contracted
staff members, with a written job description delineating his or her
responsibilities. The program is obligated to ensure that the services provided
by staff members, including volunteers and contracted staff, are
provided: (1) In accordance with
the patients' plans of care; (2) In accordance with
the policies and procedures developed by the interdisciplinary team;
(3) In accordance with
current and accepted standards of practice; (4) Documented in the
patient's central clinical record; and (5) By staff members who
comply with the program's employee health policies. (a) The pediatric respite care program is obligated to have
written employee health policies which include the following requirements for
any staff member, including a volunteer, temporary agency employee, or paid
consultant used by the pediatric respite care program who has direct pediatric
respite patient contact; (b) The pediatric respite care program is obligated to have
a written plan to ensure the health and safety of pediatric respite patients
that includes policies and procedures regarding screening of staff, including
volunteers, for communicable diseases. (c) The pediatric respite care program is obligated to have
written policies and procedures regarding measures taken to prevent staff,
including volunteers, with direct pediatric respite patient contact who have
been diagnosed with a communicable disease from transmitting this disease to
patients, care givers or other staff including when infected or ill staff must
not render direct patient care; and (d) The pediatric respite care program is obligated to
document compliance with U.S. department of labor's occupational safety
and health administration, U.S. centers for disease control and prevention and
applicable Ohio department of health standards concerning health requirements
for staff provision of services in health care settings, including requirements
for maintaining tuberculosis control. (C) Each pediatric respite care program
is obligated to ensure that all personnel treat each patient and the
patient's property with respect, not abuse or neglect patients, and not
misappropriate a patient's property. (D) Each pediatric respite care program is obligated to
provide both orientation and onging training for its personnel, including
volunteers if the pediatric respite care program utilizes
volunteers. (E) Each pediatric respite care program is obligated to
evaluate the performance of each staff member regularly. (F) Except as provided in Chapter 3701-13 of the
Administrative Code, no pediatric respite care program will employ a person who
applies on or after January 27, 1997, for a position that involves the
provision of direct care, if the person: (1) Has been convicted of
or pleaded guilty to an offense listed in division (C)(1) of section 3712.09 of
the Revised Code; or (2) Fails to complete the
form(s) or provide fingerprint impressions as required by division (B)(3) of
section 3712.09 of the Revised Code. (G) Nothing in this rule forbids the continuation of care
or provision of services by a home health agency, hospice care program, or
other personal care services provider that is under contract with the pediatric
respite care patient or the pediatric respite care patient's family while
the pediatric respite care patient is at the respite facility. If a pediatric
respite care patient or pediatric respite care patient's family wishes to
have privately contracted services continue while the pediatric respite care
patient is in the repsite facility, the pediatric respite care program
will: (1) Enter into a written
agreement with each of the following: (a) The pediatric respite care patient, the pediatric
respite care patient's family, or both; and (b) The provider of the identified service. (2) The written agreement
required by this paragraph will include a statement signed by all parties
acknowledging that they understand the agreement and that the pediatric respite
care patient's needs will be met while the pediatric respite care patient
is in the respite facility. The agreement will not be considered complete
without this signed statement, and the following information: (a) Identification of the services to be provided;
and (b) An attestation that: (i) All care will be
provided within the provider's scope of practice; (ii) All care provided
shall be documented and made part of the pediatric respite care patient's
medical record; and (iii) All services will
be furnished in accordance with the requirements of Chapter 3712. of the
Revised Code and Chapters 3701-13 and 3701-19 of the Administrative
Code.
Last updated February 20, 2024 at 8:45 AM
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Rule 3701-19-39 | Medical director.
Effective:
February 19, 2024
(A) The medical director of a pediatric
respite care program will be a physician with overall responsibility for the
medical component of the program. (B) The duties of the medical director
include: (1) Reviewing patient
medical eligibility for pediatric respite care services; (2) Participating as a member of the
interdisciplinary team or teams in the development of individual plans of care
or assuring that one or more other qualified physicians participate on the team
or teams; (3) Consulting with attending physicians,
when appropriate, regarding pain and symptom management; (4) Assuring overall continuity of the
pediatric respite care program's medical services, including availability
of physician services for routine and emergency situations; (5) Acting as liaison between
patients' attending physicians and the interdisciplinary team or
teams; (6) Establishing health policies for
employees of the pediatric respite care program; and (7) Serving as liaison with community
physicians, medical schools, and hospitals.
Last updated February 20, 2024 at 8:45 AM
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Rule 3701-19-40 | Interdisciplinary team and interdisciplinary plan of care.
Effective:
February 19, 2024
(A) Each pediatric respite care program
is obligated to have an interdisciplinary team or teams that provides or
supervises the provision of pediatric respite care and services. The governing
body of the pediatric respite care program is obligated to designate a
registered nurse that is a member of an interdisciplinary team to coordinate
the overall functioning of that interdisciplinary team to ensure all of the
following: (1) There is ongoing
assessment of the pediatric respite patient's and family's
needs; (2) That all components
of the plan of care are addressed by the interdisciplinary team;
and (3) The plan of care is
implemented in accordance with its terms. (B) The interdisciplinary team or teams
will perform the following functions: (1) Establish policies
and procedures governing the provision of care. If the pediatric respite care
program has more than one interdisciplinary team, it designate which team is to
be responsible for establishing the policies and procedures or it will specify
particular areas for which each team is to establish policies and
procedures. (2) Establish an
interdisciplinary plan of care for each pediatric respite care patient and
family; (a) The interdisciplinary plan of care should include a statement
indicating the expected frequency of admission to the pediatric respite care
program's facility; and (b) The interdisciplinary plan of care will be reviewed and
revised if necessary, upon each subsequent admission. (3) Review the
interdisciplinary plan of care on a periodic basis while the pediatric respite
care patient is at the respite facility, no less frequently than every seven
days; (4) Encourage and foster
active involvement of the patient and family in the development and
implementation of the interdisciplinary plan of care; and (5) Evaluate the
pediatric respite care and services provided and monitor the continuity of care
across all settings for the pediatric respite care program's patients and
their families. (C) A pediatric respite care program will
ensure that each patient's attending physician, if any, or the pediatric
respite care program medical director, periodically reviews the patient's
plan of care.
Last updated February 20, 2024 at 8:46 AM
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Rule 3701-19-41 | Contracted services.
Effective:
February 19, 2024
(A) A provider of a pediatric respite
care program may arrange for another person or public agency to furnish a
component or components of the pediatric respite care program pursuant to a
written contract. (B) When a provider of a pediatric
respite care program arranges for home health agency or hospice care program to
furnish a component or components of the pediatric respite care program to its
patient, the care is obligated to be provided by a licensed, certified, or
accredited hospital, home providing nursing care, home health agency, or
hospice care program pursuant to a written contract under which: (1) The provider of
pediatric respite care program furnishes to the contractor a copy of the
pediatric respite care patient's interdisciplinary plan of care that is
established under division (C) of section 3712.06 of the Revised Code and rule
3701-19-40 of the Administrative Code and specifies the care that is to be
furnished by the contractor; (2) The regimen described
in the established plan of care is continued while the pediatric respite care
patient receives care from the contractor, subject to the patient's needs,
and with approval of the coordinator of the interdisciplinary team designated
pursuant to division (C)(1) of section 3712.06 of the Revised Code and
paragraph (A) of rule 3701-19-40 of the Administrative Code; (3) All care, treatment,
and services furnished by the contractor are entered into the pediatric respite
patient's medical record; (4) The designated
coordinator of the interdisciplinary team ensures conformance with the
established plan of care; (5) A copy of the medical
record and discharge summary maintained by the contractor is retained as part
of the pediatric respite patient's medical record; and (6) The contractor
complies with the requirements of Chapter 3712. of the Revised Code, and this
chapter as applicable to the contracted service. (C) Any contract executed pursuant to this rule is legally
binding on both parties and is obligated to do all of the
following: (1) Identify the services
that may be provided; (2) Stipulate that
services may be provided only with the express authorization of the pediatric
respite care program; (3) Describe the manner
in which the contracted services are coordinated, supervised, and evaluated by
the pediatric respite care program; (4) Delineate the role or
roles of the pediatric respite care program and the contractor in the admission
process, patient and family assessment, and the interdisciplinary team
reviews; (5) Stipulate the
requirements for documenting that services are furnished in accordance with the
contract and the requirements of Chapter 3712. of the Revised Code, Chapter
3701-13 and this chapter of the Administrative Code; (6) Set forth the
qualifications of the personnel providing the services; and (7) Stipulate that the
pediatric respite care program is obligated to provide pediatric respite care
orientation and training, in accordance with paragraph (E) of rule 3701-19-38
of the Administrative Code, to the contractor's personnel who provide the
care under the contract. (D) The pediatric respite care program is
obligated to assure the continuity of patient and family care. (E) The pediatric respite care program
retains professional management responsibility for contracted services and
ensuring that those services are furnished in a safe and effective manner, by
persons meeting the qualifications prescribed by Chapter 3701-13 and this
chapter of the Administrative Code, and in accordance with the patient's
plan of care and the other requirements of this chapter.
Last updated February 20, 2024 at 8:46 AM
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Rule 3701-19-42 | Volunteers.
Effective:
February 19, 2024
(A) Each pediatric respite care program
may use volunteers to assist with the provision of administrative or direct
patient care services and may have trained volunteers available to pediatric
respite patients and pediatric respite patients' families as needed.
Volunteers will provide services under the supervision of a designated
qualified and experienced pediatric respite care program staff
member. (B) Each pediatric respite care program
that uses volunteers will provide orientation and ongoing training to the
volunteers it uses that is consistent with acceptable standards of pediatric
respite care practice. (1) The pediatric respite
care program's goals and services; (2) Confidentiality and
protection of patient and family rights; (3) Procedures for
responding to medical emergencies or death; (4) The physiological and
psychological aspects of the life-threatening diseases or conditions for which
the pediatric respite care program provides services; (5) Family dynamics,
coping mechanisms, and psychological issues surrounding life-threatening
disease or condition, death and bereavement; (6) Safety policies and
procedures; and (7) General communication
skills.
Last updated February 20, 2024 at 8:46 AM
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Rule 3701-19-43 | Nursing services.
Effective:
February 19, 2024
(A) Each pediatric respite care program
will provide nursing care and services by or under the supervision of a
registered nurse. The program will direct and staff nursing services to meet
the nursing needs of all of the pediatric respite care program's patients.
The program will specify the patient care responsibilities of nursing
personnel. (B) A registered nurse will be
responsible for the supervision and oversight of all nursing services. It is
recommended that the nursing services supervisor have education or experience
or both in the nursing care needs of pediatric respite patients and the needs
of pediatric respite patients' families. (C) As used in this rule,
"supervision" means monitoring and directing the provision of nursing
care and services by record review, written or verbal instructions, review of
interdisciplinary care plans, or direct observation. (D) The pediatric respite care program
will ensure that nursing care is available twenty-four hours a day and seven
days a week. (E) The pediatric respite care program
will ensure that all of its policies and procedures are available and
accessible to all nursing personnel.
Last updated February 20, 2024 at 8:46 AM
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Rule 3701-19-44 | Medical social services.
Effective:
February 19, 2024
(A) Each pediatric respite care program
will make medical social services available to each patient and his or her
family as needed. Medical social services will be provided by a social worker
under the direction of a physician. (B) The medical social service needs of
each pediatric respite patient and his or her family will be considered in
conjunction with other services when the interdisciplinary team reviews the
patient's and family's status. (C) Medical social services will be provided in a timely manner
in accordance with pediatric respite care program's policy.
Last updated February 20, 2024 at 8:46 AM
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Rule 3701-19-45 | Medical services.
Effective:
February 19, 2024
(A) A pediatric respite care patient may
identify his or her own attending physician or may designate the pediatric
respite care program medical director to be their attending
physician. (B) Each pediatric respite care program
will provide or coordinate: (1) Effective palliation
and management of life-threatening disease or condition and related conditions;
and (2) Medical services
which meet the medical needs of the patient that are not otherwise met by the
patient's: . (a) Attending physician; (b) A physician assistant under the supervision, control, or
direction of a physician; or (c) An advanced practice nurse, who is acting within his or her
scope of practice and who is working in collaboration with a
physician. (C) All medical orders for treatment,
procedures, tests, and medications will be signed by: (1) A
physician; (2) A physician assistant
under the supervision, control, or direction of a physician; or (3) An advanced practice
nurse, who is acting within his or her scope of practice and who is working in
collaboration with a physician.
Last updated February 20, 2024 at 8:47 AM
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Rule 3701-19-46 | Counseling and bereavement service.
Effective:
February 19, 2024
(A) Each pediatric respite care program
will provide counseling services to the pediatric respite patient and the
pediatric respite patient's family upon request. Counseling services will
include dietary, spiritual, bereavement and any other necessary counseling
services while the patient is a resident in the pediatric respite care program.
Counseling services will be provided by a qualified interdisciplinary team
member or one or more other qualified individuals, as determined by the
pediatric respite care program. (1) Counseling services
are organized to meet the needs of the pediatric respite patients and their
families; (2) The program will assess the needs of
patients and families for spiritual counseling, in accordance with their
religious preferences or self-determined goals; and (3) The pediatric respite care program
will provide dietary counseling. Dietary counseling will include the use of
food and mealtime to promote quality of life for pediatric respite care
patients and to meet their needs for symptom control. Dietary counseling will
be planned and provided by or under the supervision of a dietitian or, if the
program is unable to obtain the services of a dietitian, by a
nurse. (B) The pediatric respite care program
will make reasonable efforts to arrange for visits of clergy and other members
of religious organizations in the community to patients who request visits and
will apprise patients of this opportunity. (C) Each pediatric respite care program
will provide bereavement services, if requested, for pediatric respite
patients' families. Bereavement services will be provided under the
supervision of a designated qualified professional with education or experience
in providing those services. (1) The plan of care for
bereavement services will reflect family needs and specify that frequency
services are to be delivered and the persons furnishing the services;
and (2) Bereavement services
will be based on an assessment of the family's needs and its ability to
cope with grief.
Last updated February 20, 2024 at 8:47 AM
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Rule 3701-19-47 | Admission of patients to pediatric respite care.
Effective:
February 19, 2024
(A) A pediatric respite care program
won't admit any individual who does not meet the definition of a pediatric
respite patient. (B) A pediatric respite care program will
admit patients, provide care and services, and discharge or transfer patients
without discrimination on the basis of sex, age, race, creed, national origin,
or handicap. (C) A pediatric respite care program
will require that the patient, or the patient's authorized representative,
sign an informed consent form. This form will include an acknowledgment by
signature of the patient or patient's representative, that they have been
given a full explanation of the respite care program as it relates to the
patient's life-threatening disease or condition and have been informed
that the patient may withdraw consent at any time. (D) A pediatric respite care program
will permit a pediatric respite patient to withdraw consent for pediatric
respite care at any time. (E) A pediatric respite care program will
provide a patient or the patient's representative with information
regarding the scope of services provided by the pediatric respite care program,
including any limitations of the pediatric respite care program and charges for
the services. (F) Prior to or upon admission of each
patient, a pediatric respite care program will obtain an oral statement from
the patient's attending physician, if any, and the medical director of the
pediatric respite care program or the physician member of the interdisciplinary
team certifying that the patient has a life-threatening disease or
condition. (1) The program will
obtain written confirmation of the oral statement after admission within
acceptable written standards of practice; (2) The written
certification statement will be signed by the patient's attending
physician, if any, and the medical director of the pediatric respite care
program or the physician member of the interdisciplinary team; and (3) The program should obtain from each
patient's attending physician, if any, designation of an alternate
physician to contact for emergency care of the patient or review of the
patient's plan of care when the attending physician is not
available.
Last updated February 20, 2024 at 8:47 AM
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Rule 3701-19-48 | Standards for pediatric respite care program facilities.
Effective:
February 19, 2024
(A) Each new pediatric respite care
program facility will be inspected by the director to determine compliance with
provisions of this rule. The new pediatric respite care program facility
won't admit patients until the director has determined that the facility
is in compliance with the requirements of this chapter of the Administrative
Code. (B) The pediatric respite care program
facility will meet all applicable provisions of the Ohio fire code adopted
pursuant to section 3737.82 of the Revised Code. (C) The building or buildings in which a
pediatric respite care program facility is located will comply with the
applicable provisions of the Ohio building code adopted by the board of
building standards pursuant to Chapters 3781., 3783., and 3791. of the Revised
Code, and have a certificate of occupancy issued by the appropriate building
authority. (D) Each new pediatric respite care
program facility not using a public sewage disposal system will have its
facility sewage disposal system inspected and approved by the local health
department in accordance with Chapter 3701-29 of the Administrative
Code. (E) Each new pediatric respite care
program facility will: (1) Design and maintain
appropriate space providing optimal comfort and privacy for patients and family
members. (2) Maintain appropriate
patient rooms designed and equipped for adequate nursing care, comfort and
privacy of patients that will: (a) Be equipped with or conveniently located near toilet and
bathing facilities; (b) Be at or above grade level; (c) Contain an appropriate bed and other appropriate
furniture; (d) Have closet space providing security and privacy for clothing
and personal belongings; (e) Measure at least one hundred square feet for a single patient
room or eighty square feet for each patient for a multipatient room;
and (f) Be equipped for calling the staff member on
duty. (3) Maintain appropriate
bathroom facilities and plumbing. The facility will provide: (a) An adequate supply of hot water at all times for patient use;
and (b) Plumbing fixtures with control valves that automatically
regulate the temperature of the hot water used by patients. (4) Provide appropriate
linens. The pediatric respite care program facility will provide at all
times: (a) A quantity of linen for proper care and comfort of patients;
and (b) Linens must be handled, stored, processed and transported in
a manner that prevents the spread of infection. (5) Have provisions for
isolating patients with infectious diseases. (6) Provide meal
service; (a) The pediatric respite care program facility providing its own
meal service will: (i) Obtain an appropriate
food service license, unless exempt in accordance with section 3717.42 of the
Revised Code, or contracting with another licensed food service
provider; (ii) Serve at least three
meals or their equivalent each day at regular times, with not more than
fourteen hours between a substantial evening meal and breakfast; (iii) Procure, store,
prepare, distribute and serve all food under sanitary conditions; (iv) Have a staff member
trained or experienced in food management or nutrition who is responsible
for: (a) Planning menus that
meet the nutritional needs of each patient, following the orders of the
patient's physician and, to the extent medically possible, the dietary
allowances recommended by the national academy of sciences; (b) Supervising the meal
preparation and service to ensure that the menu plan is followed; (v) If the pediatric
respite care program has patients who require medically prescribed or ordered
special diets, have the menus for those patients planned by a dietitian who
supervises the preparation and serving of meals to ensure that the patient
accepts the special diet.
Last updated February 20, 2024 at 8:47 AM
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Rule 3701-19-49 | Twenty-four hour nursing services in pediatric respite care program facilities.
Effective:
February 19, 2024
(A) A pediatric respite care program will
ensure that nursing services are available twenty-four hours per day and seven
days a week in each facility used to provide care to its patients. (1) These services will
be sufficient enough to meet the nursing needs of the pediatric respite care
patients residing in the facility; and (2) Each shift will be
staffed by a nurse who provides direct patient care. If staffed by a licensed
practical nurse, a registered nurse will be on call and available. (B) The number and type of personnel will
be sufficient enough to meet the needs of the pediatric respite care
patients. (C) A pediatric respite care program facility will provide
each patient's treatments, medications, and diets as prescribed or
ordered. (D) The facility will keep each patient comfortable, clean,
well-groomed, and protected from accident, injury, and infection. (1) Patient's will
be protected from accident and injury through the use of appropriate safety
measures; (2) Routine, special
care, and emergency needs of all patients will be met at all times;
and (3) Patient calls will be
responded to promptly.
Last updated February 20, 2024 at 8:47 AM
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Rule 3701-19-50 | Clinical record.
Effective:
February 19, 2024
(A) Each pediatric respite care program
will establish and maintain a clinical record for each pediatric respite care
patient receiving care and services from the program and his or her family. The
record will be established and maintained in a central location in accordance
with accepted standards of practice and at a minimum: (1) The pediatric respite
care program will maintain the records and reports for seven years following
the date of the pediatric respite care patient's discharge, except if the
resident is a minor, the records will be maintained for three years past the
age of majority but not less than seven years. (2) Upon closure of the
pediatric respite care program facility, the operator will provide and arrange
for the retention of records and reports in a secured manner for not less than
seven years. The pediatric respite care program will notify the director of the
location where the records will be stored. (B) The clinical record will be a
comprehensive compilation of information that is documented promptly for all
services provided. The record will be organized in a manner that systematically
facilitates retrieval of information. Entries to the clinical record will be
made, dated, and signed by the person providing the service within acceptable
written standards of practice guidelines. All services furnished by employees,
persons under contract, or volunteers, will be documented in the clinical
record. (C) Each clinical record will contain at
least the following information: (1) Identification
data; (2) Pertinent medical
history, including the physician's diagnosis of a life-threatening disease
or condition; (3) Consent and
authorization forms; (4) Initial and
subsequent assessments that include evaluations of the psychological,
psychosocial, and spiritual needs, if any, of the patient as well as the need
for bereavement or volunteer services; (5) The interdisciplinary
plan of care; (6) Documentation of all
services and events, such as evaluations, treatments, and progress notes;
and (7) Transfer and
discharge summaries. (D) The pediatric respite care program
will provide storage for the clinical records to protect them against loss,
destruction, and unauthorized use. The program also will have policies and
procedures to ensure the confidentiality of records. (E) A pediatric respite care program
which maintains a patient's clinical record electronically will use an
electronic signature system that meets the requirements specified under
division (B) of section 3701.75 of the Revised Code. Electronic patient
clinical records will be accessible to the director during
inspections.
Last updated February 20, 2024 at 8:48 AM
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Rule 3701-19-51 | Medical supplies, drugs, biologicals, and medical appliances.
Effective:
February 19, 2024
(A) Each pediatric respite care program
will arrange for provision of medical supplies, appliances, drugs, and
biologicals to pediatric respite patients as needed for the palliation and
management of the patient's life-threatening disease or condition and
related conditions. The program will ensure that drugs and biologicals are
available at all times. (B) The pediatric respite care patient or
pediatric respite care patient's family may provide the pediatric respite
care program with the patient's current medical supplies, drugs,
biologicals, and medical appliances for administration and use while the
patient is enrolled in the pediatric respite care program. (C) Each pediatric respite care program will ensure that drugs
and biologicals are administered only by the following
individuals: (1) A physician,
registered nurse, or a licensed practical nurse; (2) A patient or a family
member if approved by the attending physician; or (3) Any other individual
authorized by the Revised Code to perform this task. (D) The individuals authorized to administer drugs or biologicals
under paragraphs (B)(2) and (B)(3) of this rule and the drugs or biologicals
they are authorized to administer will be specified in the patient's plan
of care. (E) Each pediatric respite care program will have a written
policy for disposing of controlled drugs maintained by the facility for the
pediatric respite care patient while the patient is enrolled in the pediatric
respite care program when those drugs no longer are needed by the
patient. (F) Each pediatric respite care program will ensure that the
patient, patient's representative, and the patient's family receive a
copy of the pediatric respite care program's written policies and
procedures along with education on the management and disposal of controlled
drugs when a controlled substance is ordered, and document such actions in the
patient's clinical record.
Last updated February 20, 2024 at 8:48 AM
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Rule 3701-19-52 | Variances; waivers.
Effective:
February 19, 2024
(A) The director may grant a variance or
waiver from any requirement established in rules 3701-19-30 to 3701-19-52 of
the Administrative Code, unless the requirement is mandated by
statute. (B) A pediatric respite care program
seeking a variance or waiver will submit a written request to the director.
Such written request will include the following information: (1) The rule requirement
for which the variance or waiver is requested, with a reference to the relevant
Administrative Code provision; (2) The specific nature
of the request, and the rationale for the request; (3) The time period for
which the variance or waiver is requested; (4) If the request is for
a variance, a statement of how the pediatric respite care program will meet the
intent of the requirement in an alternative manner; and (5) If the request is for
a waiver, a statement regarding why application of the requirement will cause
undue hardship to the pediatric respite care program and why granting the
waiver will not jeopardize the health and safety of any patient. (C) The decision regarding a variance or
waiver is a discretionary act by the director and an informal procedure not
subject to Chapter 119. of the Revised Code. Upon written request by a
pediatric respite care program, the director may grant: (1) A variance if the
director determines that the requirement has been met in an alternative manner;
or (2) A waiver if the
director determines that the strict application of the license requirement
would cause an undue hardship to the pediatric respite care program and that
granting the waiver would not jeopardize the health and safety of any
patient. (D) The director may stipulate a time
period for which a variance or a waiver is to be effective and may establish
conditions that the pediatric respite care program will meet before the
variance or waiver is operative. Such time period may be different than the
time period sought by the pediatric respite care program in the written
variance or waiver request. (E) The director may establish conditions
that the pediatric respite care program will meet before the variance or waiver
is operative. The director may, in his discretion, rescind the waiver or
variance at any time upon determining that the pediatric respite care program
is not meeting such conditions. (F) The granting of a variance or waiver
by the director will not be construed as constituting precedence for the
granting of any other variance or waiver. All variance and waiver requests will
be considered on a case-by-case basis. (G) The provider whose request for a
waiver or variance under this rule is denied may request reconsideration of the
decision by the director. A request for reconsideration will: (1) Be received in
writing by the director within thirty days of receipt of the director's
denial of a waiver or variance request; (2) Present significant,
relevant information not previously submitted to the director by the provider
because it was not available to the provider at the time the waiver or variance
request was filed; or (3) Demonstrate that
there have been significant changes in factors or circumstances relied upon by
the director in reaching the initial decision. (H) A decision on an appropriately filed
request for reconsideration will be issued within forty-five days of the
director's receipt of the request for reconsideration and all information
determined necessary by the director to make a decision. (I) The reconsideration process is an
informal procedure not subject to Chapter 119. of the Revised Code. The
director's decision on reconsideration is final.
Last updated February 20, 2024 at 8:48 AM
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