(a) Types of Documentation Required. A hospice must maintain the following information on each individual receiving Medicaid hospice services.      
        (1) Signed hospice election and discharge forms.       
        (2) Signed Physician's Certification of Terminal Illness.       
        (3) Physician narratives.       
        (4) Documentation of each face-to-face assessment.       
        (5) Patient history and physical exams before and during the provision of hospice services, including previous and new diagnoses, emergency room visits, and ability to perform activities of daily living.       
        (6) Physician consultation reports, orders, and progress notes.       
        (7) Hospital admission and discharge reports.       
        (8) Plans of care covering all periods during which the hospice provides services to the individual.       
        (9) Nursing assessments and nursing notes.       
        (10) IDT meeting notes.       
        (11) Medication administration records, including doses, frequency, and routes.       
        (12) Signs and symptoms, anthropometric measurements, weights, oral intake, and laboratory and diagnostic testing results supporting the conclusion that the individual's condition is terminal.       
        (13) Other documentation supporting the plan of care, service delivery, and outcome of services.       
        (14) Summary of circumstances surrounding the death, including date, time, family in attendance, and hospice staff in attendance.       
      (b) Requirements for Physician's Orders. A hospice must have a signed physician's order that:      
        (1) covers the time period for which hospice services were provided; and       
        (2) documents the terminal illness and related medical need for skilled nursing care, as provided.       
      (c) Requirements for the Plan of Care. A hospice must maintain a plan of care for each individual receiving Medicaid hospice services. The plan of care must meet the following criteria.      
        (1) The plan of care must relate to the identified terminal illness.       
        (2) The plan of care must be updated every 15 days, or when the individual's condition changes if sooner than 15 days, and include any change in the individual's status.       
        (3) The plan of care must include the following:                  (A) a description of the individual's service needs and how the hospice plans to meet those needs;                   (B) the baseline condition of the individual at the beginning of the election period including symptoms documented with location, severity, and frequency;                   (C) identification of the specific interventions and services necessary for the management of the symptoms including the intensity, frequency, duration, and scope of services;                   (D) physician orders for the specific interventions and services necessary; and                   (E) the measurable outcomes anticipated from implementing the plan of care and reasonable timeframes expected for achieving those measurable outcomes.         
      (d) Requirements for Physician Services on the Day of Discharge. To request payment for physician services on the day of discharge, the hospice must submit to HHSC proof that:      
        (1) the physician is a hospice employee; and       
        (2) the physician provided direct services to the patient on the day of discharge.       
      (e) Requirements for all documentation. All documentation must be:      
        (1) clearly labeled to indicate what type of documentation it is;       
        (2) legible to a reader other than the author; and       
        (3) signed and dated.       
     Source Note:        The provisions of this §266.221 adopted to be effective July 26, 2022, 47 TexReg 4331