SB 96: "An Act regulating hospice care."

00SENATE BILL NO. 96 01 "An Act regulating hospice care." 02 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 03 * Section 1. AS 18 is amended by adding a new chapter to read: 04 Chapter 18. Hospice Care Programs. 05 Article 1. Licensing of Hospice Programs. 06  Sec. 18.18.010. License required. A person, including a partnership, 07 association, or corporation, may not represent itself as a hospice program, operate a 08 hospice program, or otherwise provide hospice services unless the person, partnership, 09 association, or corporation has obtained a license from the department. 10  Sec. 18.18.020 Licenses. (a) If, after receiving an application for a license, 11 the department finds that all the conditions of licensure are met, the department shall 12 issue a license to the applicant for a period of two years. If the department finds less 13 than full compliance with the conditions of licensure, the department may issue a 14 conditional license.

01  (b) The department may issue a conditional license if the applicant fails to 02 comply with applicable laws and regulations, but the best interest of the public would 03 be served by issuing a conditional license. The conditional license must specify when 04 and what corrections must be made during the term of the conditional license. 05  (c) When an applicant fails to comply with applicable laws and regulations, 06 the department may revoke or suspend or refuse to issue or renew a license. 07  Sec. 18.18.030. Medicare certified hospices. A Medicare certified hospice 08 is considered to meet the licensure requirements for a hospice program under this 09 chapter and shall be issued a state license if it applies and pays for a license under this 10 chapter and attests in writing that it meets all state licensure requirements. 11  Sec. 18.18.040. Right of entry and inspection. A duly designated employee 12 of the department may enter the premises of a hospice provider who has applied for 13 a license or who is licensed under this chapter. These employees may inspect relevant 14 documents of the hospice provider to determine whether the provider is in compliance 15 with this chapter and regulations adopted under this chapter. The right of entry and 16 inspection extends to premises and documents of providers whom the department has 17 reason to believe are providing hospice services without a license. These entries or 18 inspections must be made with the permission of the owner or person in charge unless 19 a warrant is first obtained. 20  Sec. 18.18.100. Requirements for licensure. (a) The department shall adopt 21 regulations under AS 44.62 (Administrative Procedure Act) that specify the 22 requirements for licensure under this chapter. The regulations must include the 23 requirements of this section. 24  (b) A hospice program shall have a clear mission statement that is consistent 25 with hospice philosophy. 26  (c) A hospice program shall be a discrete entity with at least the following 27 features: 28  (1) a governing body; 29  (2) an established set of admission criteria for determining appropriate 30 clients; 31  (3) a program director;

01  (4) an interdisciplinary team; 02  (5) volunteers; and 03  (6) a medical director. 04  (d) A hospice program may only provide services to a person if the person 05  (1) consents to receive those services; and 06  (2) fits the admissions criteria of the hospice program. 07  (e) Hospice services shall be delivered in accordance with a care plan 08 approved by the interdisciplinary team regardless of whether the hospice services are 09 provided by hospice program staff or by contractors. The care plan must provide for 10 24-hours-a-day, seven-days-a-week services. The care plan must be reviewed 11 periodically by the interdisciplinary team and revised as needed. The client, and the 12 client's family if the client desires, must be given the opportunity to participate in the 13 development of the care plan and must be informed of the opportunity to attend 14 interdisciplinary team meetings. The interdisciplinary team must consider the need for 15 at least the following services when developing the care plan: 16  (1) social services; 17  (2) nursing care; 18  (3) counseling; 19  (4) pastoral care; 20  (5) volunteer visits to provide comfort, companionship, and respite; 21  (6) bereavement services for at least one year after the death of the 22 person who is terminally ill; and 23  (7) medical services. 24  (f) Nursing services provided by a hospice program shall be provided in 25 accordance with a care plan and must be under the direction and supervision of a nurse 26 supervisor. The nurse supervisor shall 27  (1) develop nursing objectives, policies, and procedures consistent with 28 hospice philosophy; 29  (2) develop job descriptions for nursing personnel consistent with 30 hospice philosophy; 31  (3) establish staffing and on-call schedules for nursing staff; and

01  (4) develop and implement orientation and training programs for 02 nursing staff. 03  (g) Before providing a hospice service, a direct service provider shall receive 04 an orientation of at least four hours specific to hospice service. The policy and 05 procedures of the provider define the agenda of the hospice orientation program. The 06 provider shall document in personnel files that staff members have completed the four- 07 hour orientation. Indirect service volunteers shall be oriented according to provider policies. 08 The hospice orientation program must include the following subjects: 09  (1) hospice philosophy; 10  (2) personal death awareness; 11  (3) communication skills; 12  (4) personnel issues; 13  (5) identification of hospice resource people; 14  (6) stress management; 15  (7) ethics; 16  (8) stages of dying; and 17  (9) funeral arrangements. 18  (h) A hospice program shall provide an educational program that offers a 19 comprehensive overview of hospice philosophy and hospice care. A minimum of 18 20 hours of education, received within a one-year period, including four hours of 21 orientation, is required for all direct service providers delivering hospice care. 22 Documentation of completion of this program is transferable from one hospice to 23 another. The educational program must include the following subjects: 24  (1) hospice philosophy; 25  (2) family dynamics; 26  (3) pain and symptom management; 27  (4) grief, loss, and transition; 28  (5) psychological perspectives on death and dying; 29  (6) spirituality; 30  (7) communication skills; 31  (8) volunteer roles; and

01  (9) multidisciplinary management. 02  (i) Hospice direct service providers shall complete a minimum of eight hours 03 of continuing education or in-service training each year after the first year, based on 04 date of hire. 05  (j) A hospice program shall maintain, at a minimum, the following records: 06  (1) a medical record for each client that includes copies of the client's 07 care plan, progress notes, assessments, and a description of services provided to the 08 client and the client's family; 09  (2) minutes of governing body meetings; 10  (3) all receipts and expenditures; and 11  (4) training provided to paid staff and volunteers. 12  (k) A hospice program shall have and follow written policies and procedures 13 governing its operation, including policies relating to confidentiality, training, and 14 admissions. 15  (l) A person who enters a hospice program shall be given information 16 regarding living wills and durable health care powers of attorney. 17  (m) The hospice provider shall have a functional quality assurance or 18 improvement plan in place that 19  (1) continually monitors and evaluates the care provided; 20  (2) identifies issues and potential issues; 21  (3) proposes and implements improvements; and 22  (4) reevaluates the care provided to determine if further improvement 23 is possible or needed. 24  (n) If a hospice program is carried out in an inpatient facility, the facility must 25 be Medicare-certified in order for the hospice program to be eligible for licensure 26 under this chapter. 27 Article 2. Licensing of Volunteer Hospice Programs. 28  Sec. 18.18.200. Licensing requirements. (a) A volunteer hospice program 29 must comply with this section and with other provisions of this chapter that are 30 relevant to a volunteer hospice program. 31  (b) At a minimum, a direct service volunteer must

01  (1) submit a written application; 02  (2) undergo a screening interview and a posttraining interview; 03  (3) attend a 20-hour standard training program; 04  (4) submit a confidentiality statement in which the volunteer agrees to 05 follow the program's policy regarding confidentiality required by AS 18.18.100(k) and 06 (a) of this section; and 07  (5) if the volunteer will transport individuals, have proof of auto 08 insurance and a valid driver's license. 09  (c) Volunteer hospice programs shall develop and maintain policies and 10 procedures that address the following with respect to volunteers in the program: 11  (1) recruitment, retention, and dismissal; 12  (2) screening; 13  (3) orientation; 14  (4) scope of function; 15  (5) supervision; 16  (6) ongoing training and support; 17  (7) interdisciplinary team conferencing; 18  (8) records of volunteer activities; and 19  (9) bereavement services. 20  (d) Volunteer services in a volunteer hospice must be directed by a coordinator 21 of volunteer services who shall 22  (1) implement a direct service volunteer program; 23  (2) coordinate the orientation, education, support, and supervision of 24 direct service volunteers; and 25  (3) coordinate the use of direct service volunteers with other hospice 26 staff. 27  (e) Volunteers must demonstrate knowledge of and ability to gain access to 28 community resources that reflect the full scope of hospice care. 29 Article 3. General Provisions. 30  Sec. 18.18.300. Individual licenses. A program license received under this 31 chapter does not relieve an individual who is an employee, volunteer, or contractor

01 with the licensed hospice program from requirements outside this chapter pertaining 02 to licensure of the individual. 03  Sec. 18.18.310 Sanctions. A person who violates this chapter commits a civil 04 violation for which a fine not to exceed $100 a day of violation may be assessed by 05 a court. 06  Sec. 18.18.390. Definitions. In this chapter, 07  (1) "bereavement services" means emotional support services related 08 to the death of a family member, including counseling, provision of written material, 09 social reorientation, and group support for up to one year following the death of the 10 client who was terminally ill; 11  (2) "care plan" means a written service delivery plan that the 12 interdisciplinary team, in conjunction with the client, shall develop to reflect the 13 changing care needs of the client; 14  (3) "client" means the person who is receiving the hospice services; 15  (4) "department" means the Department of Health and Social Services; 16  (5) "direct service provider" means employees or volunteers who 17 provide hospice services directly to a client; 18  (6) "family" means a spouse, primary caregiver, biological relatives, 19 and individuals with close personal ties to the client; 20  (7) "governing body" means the entity that establishes policy and is 21 legally responsible for the overall operation of a hospice program; 22  (8) "hospice philosophy" means a philosophy that is life affirming, 23 recognizes dying as a normal process of living, focuses on maintaining the quality of 24 remaining life, neither hastens nor postpones death, strengthens the client's role in 25 making informed decisions about care, and stresses the delivery of services in the least 26 restrictive setting possible and with the least amount of technology necessary by 27 volunteers and professionals who are trained to help clients with the physical, social, 28 psychological, spiritual, and emotional issues related to terminal illness so that the 29 clients can feel better prepared for the death that is to come; 30  (9) "hospice program" or "hospice provider" means a distinct, clearly 31 recognizable entity that exists to provide hospice services;

01  (10) "hospice services" means a range of interdisciplinary palliative and 02 supportive services provided in a home or at an inpatient facility on a 24-hours-a-day, 03 seven-days-a-week basis to a person who is terminally ill and that person's family in 04 order to meet their physical, psychological, social, emotional, and spiritual needs; 05  (11) "interdisciplinary team," for a hospice providing comprehensive 06 services, means a group comprised of at least a medical director, a licensed nurse, a 07 licensed social worker, a pastoral or other counselor, and a volunteer coordinator or 08 representative; for a volunteer hospice program, "interdisciplinary team" means a 09 regularly scheduled case conference as defined by program policy; 10  (12) "medical director" means a licensed physician who oversees the 11 medical components of hospice services and serves on the interdisciplinary team; 12  (13) "nurse supervisor" means a licensed registered nurse with 13 education, experience, and training in hospice nursing care who is designated by the 14 program director to oversee nursing services for the hospice program; 15  (14) "primary physician" means the physician identified by the client 16 or by the person authorized to make decisions for the client under a durable health care 17 power of attorney; 18  (15) "program director" means the person designated by the governing 19 body of a hospice program as responsible for the day-to-day operations of the program; 20  (16) "terminally ill" means that a person has a life expectancy of less 21 than one year, in the opinion of the person's primary physician or the medical director, 22 and is no longer receiving curative treatment; 23  (17) "volunteer" means a trained individual who works for a hospice 24 program without compensation; 25  (18) "volunteer hospice program" means a hospice program that 26 provides all direct patient care at no charge.