(a) When a nursing facility (NF) contracts for hospice services for residents, the nursing facility must:
  (1) have a written contract for the provision of arranged services, which must be signed by authorized representatives of the NF and hospice and must include the following:
    (A) the services to be provided;
    (B) a stipulation that hospice-related services performed by NF staff may be provided only with the express authorization of the hospice;
    (C) how the contracted services are to be coordinated, supervised, and evaluated by the hospice and the NF;
    (D) delineation of the roles of the hospice and the NF in the admission process, recipient and family assessment, and the interdisciplinary team case conferences;
    (E) a requirement for documentation of services furnished; and
    (F) the qualifications of the personnel providing the services;
  (2) provide room and board services, which include the performance of personal care services, including assistance in the activities of daily living, administration of medication, socializing activities, maintaining the cleanliness of a resident's room, and supervision and assisting in the use of durable medical equipment and prescribed therapies;
  (3) immediately notify the hospice of any significant changes in the hospice recipient's condition;
  (4) have joint procedures with the hospice provider for ordering medications that ensure the proper payor is billed and for reconciling billing between NF and hospice, including:
    (A) contacting the hospice prior to filling a new prescription; and
    (B) ensuring that drugs unrelated to the terminal illness are ordered through the Vendor Drug program; and
  (5) ensure that hospice documentation is a part of the current clinical record, which, at a minimum, must include the current and past:
    (A) Texas Medicaid Hospice Recipient Election/Cancellation form;
    (B) MDS assessment;
    (C) Physician Certification of Terminal Illness form;
    (D) Medicare Election Statement, if dually eligible;
    (E) verification that the recipient does not have Medicare Part A;
    (F) hospice interdisciplinary assessments;
    (G) hospice plan of care; and
    (H) current interdisciplinary notes, which include the following:
      (i) nurses notes and summaries;
      (ii) physician orders and progress notes; and
      (iii) medication and treatment sheets during the hospice certification period.
(b) The NF and hospice must ensure that the coordinated plan of care reflects the participation of the hospice, the NF, the recipient, and the recipient's legal representative to the extent possible. The plan of care must include directives for managing pain and other uncomfortable symptoms, and must be revised and updated as necessary to reflect the recipient's current status.
(c) The recipient has the right to refuse any services from the nursing facility and the hospice provider.
(d) The hospice retains overall professional management responsibility for directing the implementation of the plan of care related to the terminal illness and related conditions, which includes:
  (1) designation of a hospice registered nurse to coordinate the implementation of the plan of care;
  (2) provision of substantially all core services (physician, nursing, medical social work, and counseling services) that must be routinely provided directly by the hospice employees, and cannot be delegated to the NF, as outlined under 42 Code of Federal Regulations §418.80;
  (3) provision of drugs and medical supplies as needed for palliation and management of the terminal illness and related conditions; and
  (4) involvement of NF personnel in assisting with the administration of prescribed therapies in the plan of care only to the extent that the hospice would routinely use the services of a hospice patient's family or caregiver in the home setting.
(e) The hospice may arrange to have non-core hospice services provided by the NF if the hospice assumes professional management responsibility for the services and assures these services are performed in accordance with the policies of the hospice and the recipient's plan of care.

Source Note: The provisions of this §554.1926 adopted to be effective December 1, 2000, 25 TexReg 10374; amended to be effective January 1, 2002, 26 TexReg 10389; amended to be effective September 1, 2008, 33 TexReg 7264; transferred effective January 15, 2021, as published in the Texas Register December 11, 2020, 45 TexReg 8871