CSSB 96(FIN): "An Act relating to hospice care."

00CS FOR SENATE BILL NO. 96(FIN) 01 "An Act relating to 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. 18.18.005. Policy declaration. It is the policy of the state that regulation 07 of hospice programs should ensure an appropriate standard of care for hospice clients 08 without unduly burdening the programs with requirements that consume staff time and 09 financial resources that are essential for the delivery of services to hospice clients. In 10 furtherance of this policy, this chapter establishes two sets of standards for hospice 11 programs that recognize the more limited staff time and financial resources available 12 to voluntary hospice programs while requiring all programs to comply with basic 13 minimum program standards. 14  Sec. 18.18.010. License required. A person, including a partnership,

01 association, or corporation, may not represent itself as a hospice program or operate 02 a hospice program unless the person, partnership, association, or corporation has 03 obtained a license from the department. 04  Sec. 18.18.020. Issuance and renewal of license. (a) Upon receiving an 05 application and fee, if any, for a license under this chapter, the department shall issue 06 a license if the applicant meets the applicable requirements of this chapter. 07  (b) If an applicant under (a) of this section does not meet the applicable 08 requirements but makes continued efforts to comply with them and any noncompliance 09 does not directly affect the safety of clients, the department may issue a temporary or 10 provisional license that is valid for a reasonable period of time, as determined by the 11 department. 12  (c) A license under this chapter shall be issued in the name of the person, 13 agency, or other entity specified in the application and is not transferable or assignable 14 without the written approval of the department. 15  (d) The department shall, by regulation, establish the application fee, license 16 fee, length of time that a license is valid, and the standards for license renewal. A 17 license is not renewable during the time it has been suspended or revoked under this 18 chapter. 19  Sec. 18.18.030. Denial, suspension, or revocation of license. (a) The 20 department may deny a license, reduce a license to a provisional license, or revoke a 21 license if the department finds that the applicant or licensee, as appropriate, or the 22 program director or medical director of the applicant or licensee, as applicable, has 23  (1) endangered the health, safety, or welfare of a client; 24  (2) a history of deficiencies in quality of care; 25  (3) had a license to operate a hospice program suspended or revoked 26 in another licensing jurisdiction for a reason other than failure to pay a licensing fee; 27  (4) been convicted of operating a hospice program without a license in 28 any jurisdiction; 29  (5) an insufficient number of staff with the training, experience, or 30 judgment to provide adequate hospice care; 31  (6) committed fraud, deceit, misrepresentation, or an offense involving

01 dishonesty associated with the license application or with the operation of a hospice 02 program in any jurisdiction; or 03  (7) violated this chapter or a regulation adopted under this chapter. 04  (b) The department may, without a hearing, summarily suspend a license of 05 a hospice program if it finds that the actions or deficiencies of the program have 06 caused, or present an immediate threat of causing, serious injury to a hospice program 07 client. A licensee is entitled to a hearing before the department to appeal the summary 08 suspension within seven days after the order of suspension is issued. A licensee may 09 appeal an adverse decision of the department on an appeal of a summary suspension 10 to the superior court. A summary suspension remains in effect until the department 11 finds that the actions or deficiencies are corrected, the license is revoked, or the 12 licensee is successful in appealing the suspension. 13  (c) The department may, without a hearing, reduce a hospice license to a 14 provisional license for a period of time established by the department if the department 15 finds that the licensee is temporarily unable to comply with this chapter or is in the 16 process of becoming decertified under the Medicare program but is taking appropriate 17 steps to bring the program into compliance with this chapter or Medicare certification 18 requirements. A licensee is entitled to a hearing before the department to appeal a 19 reduction to a provisional license under this subsection within seven days after the 20 order to reduce the license is issued. A licensee may appeal an adverse decision of 21 the department on an appeal of the order reducing the license to a provisional license 22 to the superior court. A program with a provisional license under this subsection may 23 not accept new clients. If the program fails to correct its deficiencies and does not 24 successfully appeal the order reducing the license to provisional status within the 25 period stipulated in the provisional license, the department shall revoke the license. 26  Sec. 18.18.040. Right of entry and inspection. A duly designated employee 27 of the department may enter the premises of a hospice program that has applied for 28 a license or who is licensed under this chapter. These employees may inspect 29 documents of the hospice program to determine whether the program is in compliance 30 with this chapter and regulations adopted under this chapter. The right of entry and 31 inspection extends to premises and documents of persons whom the department has

01 reason to believe are operating a hospice program without a license. 02  Sec. 18.18.100. Requirements for licensure. (a) Except as provided in 03 AS 18.18.200 for volunteer hospice programs, a hospice program shall meet the 04 requirements of this section. If a hospice program meets the requirements of this 05 section and AS 18.18.010 - 18.18.040, the department shall issue a license for the 06 program. 07  (b) A hospice program shall have a clear mission statement that is consistent 08 with hospice philosophy. 09  (c) A hospice program shall have at least the following features: 10  (1) a governing body; 11  (2) an established set of admission criteria for determining appropriate 12 clients; 13  (3) a program director; 14  (4) an interdisciplinary team; 15  (5) volunteers; and 16  (6) a medical director. 17  (d) A hospice program may only provide services to a person if the person 18  (1) consents to receive those services; and 19  (2) fits the admissions criteria of the hospice program. 20  (e) Hospice services shall be delivered in accordance with a care plan 21 approved by the interdisciplinary team regardless of whether the hospice services are 22 provided by hospice program staff or by contractors. The care plan must be reviewed 23 periodically by the interdisciplinary team and revised as needed. The client, and the 24 client's family if the client desires, must be given the opportunity to participate in the 25 development of the care plan and must be informed of the opportunity to attend 26 interdisciplinary team meetings. The interdisciplinary team must consider the need for 27 at least the following services when developing the care plan: 28  (1) social services; 29  (2) nursing care; 30  (3) counseling; 31  (4) pastoral care;

01  (5) volunteer visits to provide comfort, companionship, and respite; 02  (6) bereavement services for at least one year after the death of the 03 person who is terminally ill; and 04  (7) medical services. 05  (f) Nursing services provided by a hospice program shall be provided in 06 accordance with a care plan and must be under the direction and supervision of a nurse 07 supervisor. The nurse supervisor shall 08  (1) develop nursing objectives, policies, and procedures consistent with 09 hospice philosophy; 10  (2) develop job descriptions for nursing personnel consistent with 11 hospice philosophy; 12  (3) establish staffing and on-call schedules for nursing staff to ensure 13 the availability of nursing services 24-hours a day, seven days a week; and 14  (4) develop and implement orientation and training programs for 15 nursing staff. 16  (g) Before providing a hospice service in a hospice program, a direct service 17 provider shall receive an orientation of at least four hours specific to hospice service. 18 The policy and procedures of the hospice program define the agenda of the hospice 19 orientation program. The hospice program shall document in personnel files that staff 20 members have completed the four-hour orientation. Indirect service volunteers shall 21 be oriented according to program policies. The hospice orientation program must 22 include the following subjects: 23  (1) hospice philosophy; 24  (2) personal death awareness; 25  (3) communication skills; 26  (4) personnel issues; 27  (5) identification of hospice resource people; 28  (6) stress management; 29  (7) ethics; 30  (8) stages of dying; and 31  (9) funeral arrangements.

01  (h) A hospice program shall provide an educational program that offers a 02 comprehensive overview of hospice philosophy and hospice care. A minimum of 18 03 hours of education, received within a one-year period, including four hours of 04 orientation, is required for all direct service providers delivering hospice care. 05 Documentation of completion of this program is transferable from one hospice program 06 to another. The educational program must include the following subjects: 07  (1) hospice philosophy; 08  (2) family dynamics; 09  (3) pain and symptom management; 10  (4) grief, loss, and transition; 11  (5) psychological perspectives on death and dying; 12  (6) spirituality; 13  (7) communication skills; 14  (8) volunteer roles; and 15  (9) multidisciplinary management. 16  (i) Direct service providers in a hospice program shall complete a minimum 17 of eight hours of continuing education or in-service training each year after the first 18 year, based on date of hire. 19  (j) A hospice program shall maintain, at a minimum, the following records: 20  (1) a record for each client that includes copies of the client's care 21 plan, progress notes, assessments, and a description of services provided to the client 22 and the client's family; 23  (2) minutes of governing body meetings; 24  (3) all receipts and expenditures; and 25  (4) training provided to paid staff and volunteers. 26  (k) A hospice program shall have and follow written policies and procedures 27 governing its operation, including policies relating to confidentiality, training, and 28 admissions. 29  (l) A person who enters a hospice program shall be given information 30 regarding living wills and durable health care powers of attorney. 31  (m) The hospice program shall have a functional quality assurance or

01 improvement plan in place that 02  (1) continually monitors and evaluates the care provided; 03  (2) identifies issues and potential issues; 04  (3) proposes and implements improvements; and 05  (4) reevaluates the care provided to determine if further improvement 06 is possible or needed. 07 Article 2. Licensing of Volunteer Hospice Programs. 08  Sec. 18.18.200. Licensing requirements. (a) The department shall issue a 09 license to a volunteer hospice program that complies with this section and with 10 AS 18.18.010 - 18.18.040 and 18.18.100(a), (b), (c) (1) - (3) and (5), (d), (g), and (j) - 11 (l). 12  (b) A direct service volunteer must 13  (1) submit a written application; 14  (2) undergo a screening interview and an interview after training; 15  (3) attend an 18-hour standard training program; 16  (4) submit a confidentiality statement in which the volunteer agrees to 17 follow the program's policy regarding confidentiality required by AS 18.18.100(k) and 18 (a) of this section; and 19  (5) if the volunteer will transport individuals, have proof of auto 20 insurance and a valid driver's license. 21  (c) Volunteer hospice programs shall develop and maintain policies and 22 procedures that address the following with respect to volunteers in the program: 23  (1) recruitment, retention, and dismissal; 24  (2) screening; 25  (3) orientation; 26  (4) scope of function; 27  (5) supervision; 28  (6) ongoing training and support; 29  (7) team conferencing; 30  (8) records of volunteer activities; and 31  (9) bereavement services.

01  (d) Volunteer services in a volunteer hospice program must be directed by a 02 coordinator of volunteer services who shall 03  (1) implement a direct service volunteer program; 04  (2) coordinate the orientation, education, support, and supervision of 05 direct service volunteers; and 06  (3) coordinate the use of direct service volunteers with other hospice 07 staff and community resources. 08 Article 3. General Provisions. 09  Sec. 18.18.300. Individual licenses. A program license received under this 10 chapter does not relieve an individual who is an employee, volunteer, or contractor 11 with the licensed hospice program from requirements outside this chapter pertaining 12 to licensure of the individual. 13  Sec. 18.18.310 Sanctions. A person who violates this chapter commits a civil 14 violation for which a fine not to exceed $100 a day of violation may be assessed by 15 a court. 16  Sec. 18.18.320. Administrative Procedure Act. Regulations and contested 17 cases under this chapter are governed by AS 44.62 (Administrative Procedure Act). 18  Sec. 18.18.330. Regulations. The department may adopt regulations to 19 implement this chapter that are consistent with the policy expressed in AS 18.18.005. 20  Sec. 18.18.340. Immunity for hospice program volunteers. Unless the act 21 or omission constituted gross negligence, recklessness, or intentional misconduct, a 22 person may not recover damages for personal injury, death, or damage to property for 23 an act or omission to act in the course and scope of official hospice program duties 24 from a volunteer who works for a hospice program that is licensed under this chapter. 25  Sec. 18.18.390. Definitions. In this chapter, 26  (1) "bereavement services" means emotional support services related 27 to the death of a family member, which may include counseling, provision of written 28 material, social reorientation, and group support for up to one year following the death 29 of the client who was terminally ill; 30  (2) "care plan" means a written service delivery plan that the 31 interdisciplinary team, in conjunction with the client, shall develop to reflect the

01 changing care needs of the client; 02  (3) "client" means the person who is receiving the hospice services; 03  (4) "department" means the Department of Health and Social Services; 04  (5) "direct service provider" means employees or volunteers who 05 provide hospice services directly to a client under a hospice program; 06  (6) "family" means a spouse, primary caregiver, biological relatives, 07 and individuals with close personal ties to the client; 08  (7) "governing body" means the entity that establishes policy and is 09 legally responsible for the overall operation of a hospice program; 10  (8) "hospice philosophy" means a philosophy that is life affirming, 11 recognizes dying as a normal process of living, focuses on maintaining the quality of 12 remaining life, neither hastens nor postpones death, strengthens the client's role in 13 making informed decisions about care, and stresses the delivery of services in the least 14 restrictive setting possible and with the least amount of technology necessary by 15 volunteers and professionals who are trained to help clients with the physical, social, 16 psychological, spiritual, and emotional issues related to terminal illness so that the 17 clients can feel better prepared for the death that is to come; 18  (9) "hospice program" means a program that provides hospice services; 19  (10) "hospice services" means a range of interdisciplinary palliative and 20 supportive services provided in a home or at an inpatient facility to persons who are 21 terminally ill and those persons' families in order to meet their physical, psychological, 22 social, emotional, and spiritual needs; 23  (11) "interdisciplinary team," for a hospice program providing 24 comprehensive services, means a group comprised of at least a primary health care 25 provider, a licensed registered nurse, a social worker, a pastoral or other counselor, and 26 a volunteer coordinator or representative; 27  (12) "medical director" means a licensed physician who oversees the 28 medical components of hospice services and the interdisciplinary team; 29  (13) "nurse supervisor" means a licensed registered nurse with 30 education, experience, and training in hospice nursing care who is designated by the 31 program director to oversee nursing services for the hospice program;

01  (14) "primary health care provider" means the physician or advanced 02 nurse practitioner identified by the client or by the person authorized to make decisions 03 for the client under a durable health care power of attorney; 04  (15) "program director" means the person designated by the governing 05 body of a hospice program as responsible for the day-to-day operations of the program; 06  (16) "terminally ill" means that a person has a life expectancy of less 07 than one year, in the opinion of the person's primary physician or the medical director, 08 and is no longer receiving curative treatment; 09  (17) "volunteer" means a trained individual who works for a hospice 10 program without compensation; 11  (18) "volunteer hospice program" means a hospice program that 12 provides all direct patient care at no charge.