CMS Centers for Medicare and Medicaid Services
Old 40 TAC 97.403 Standards Specific To Agencies Licensed To Provide Hospice Services, New 40 TAC 97 Subchapter H Agencies Licensed To Provide Hospice Services and 42 Code Of Federal Regulations 418 Hospice Services / October 31, 2013
Disclaimer: The information provided in this document is the result of the Texas and New Mexico Hospice Organization’s research and analysis. If you have specific questions on rules and interpretation, contact the Texas Department of Aging and Disability Services’ Regional or State Offices. In many instances, the new Chapter 97 requirements duplicate the Code of Federal Regulations and its interpretive guidelines. Please remember that many other rules and laws are specified within this new rule base. As a provider, you are required to refer not only to the licensure and CFR, but other state and CMS guidelines, manuals and laws. The more stringent of the rule base applies. Unless otherwise indicated, you may assume that the old rule is reflected in the new rule or that the intent of the old rule continues to be reflected in amended language. This crosswalk does not include cross references as you may see reflected by surveyor’s paperwork.
Acronyms
APRN – Advanced Practice Registered Nurses
CFR – Code of Federal Regulations
CMS – Centers for Medicare and Medicaid Services
DADS – Department of Aging and Disability Services
ICF/ID - Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions
IDT – Interdisciplinary Team
NF – Nursing facility
OT- Occupational Therapy
PT- Physical Therapy
QAPI – Quality Assessment-Performance Improvement
CROSSWALK BETWEENOLD 40 TAC 97.403 STANDARDS SPECIFIC TO AGENCIES LICENSED TO PROVIDER HOSPICE SERVICES, NEW 40 TAC 97 SUBCHAPTER H AGENCIES LICENSED TO PROVIDE HOSPICE SERVICES AND 42 CODE OF FEDERAL REGULATIONS 418 HOSPICE SERVICES
Old Rule §97.403 / New Rule: Chapter 97 Subchapter H / CFR 418 Hospice Services / Differences/Things to note
(a) Compliance / §98.801 / §418.3
§418.24 / Old rule reflected in new (a), (d), and (e)
New rule identifies new sections for inpatient, NF, and ICF/ID, additional definitions (reflected in CFR) and the language in the election statement.
(b) Use of term “hospice” / §98.801 (e) / Health and Safety Code § 142.002 (c)
(c) Policy, services and availability / §97.801(a)
§97.850 / §418.100
SSA §1861 (dd) (2)
(d) Medical Director / §97.858 / §418.102
§418.22 (b) / New (a)and(d) copy old rule
(e) Interdisciplinary
Team / §97.820
§97.821
§97.822
§97.823 / §418.56
(f) Arrangements / §97.854
§97.861
§97.880 / §418.100
(g) Initial assessments / §97.810 / §418.54 / Old rule (g) (1) and (3) are not verbatim in the new rules; but the CFR is clear that the physician oversees the client’s program of care. The new rule does not state that once the initial assessment is done, the physician services may begin as the old rule did.
New rule has no time frame for contacting the client as the old rule did under (g) (1), but the CFR states staff will see the client in 48 hours or less.
(h) Comprehensive assessment, updates and QAPI / §97.811
§97.812
§97.813 / §418.54
§418.58 / New rule reflect the CFR time frames.
Old §97.403 (h) (B) was rewritten in new §97.811 to reflect CFR. Staff deleted “food interactions and non-compliance with drug therapy”.
(i) Plan of Care, review and updates / §97.821
§97.822 / §418.56 / New rule reflects CFR time frames.
(j) IDT reassessments / §97.811
§97.812 / §418.54
§418.56
(k) Short term inpatient care information to family / §97.821 (6) / §418.52(c)
§418.108
(l) Clergy requests and visits / §97.834 / §418.56
(m) Core services/contracting / §97.830 / §418.100(e)
§418.64
(n) Nursing care and services / §97.832 / §418.64(b) / New rule addresses APRN requirements.
(o) Social services / §97.833 / §418.64(c)
418.114
(p) Hospice physician/attending / §97.831 / §418.64 (a)
(q) Counseling services / §97.834 / §418.56
§418.64 / §418.64 (L597) states if the RN is capable of meeting the consumer’s needs then the dietary counseling can be provided by the RN. If needs go beyond RNs knowledge/ ability then a more qualified person must step in.
(r) Arrangements for non-core services / §97.840 / §418.70
§418.56
§418.100(e)
(s) OT/PT/Speech / §97.841 / §418.72
(t) Home health aide and home maker services / §97.842
§97.843
§97.844
§97.845 / §418.76
§418.202(g) / Home health aide changed to hospice aide. Documentation is required in all aspects of education, training, evaluation etc. New rules identify what the documentation must contain. Providers must ensure that new hires who were trained and tested by another agency or person(s) comply with the licensure requirements.
(u) Medical supplies and medications / §97.860 / §418.106 / Old language in (u) (4) is not reflected in the new rule; however, per the CFR you must be able to demonstrate everyone has education and training on drug management.
(v) Inpatient care / §97.861 / §418.108
§418.54 / Old rule §97.403(v) has QAPI requirements which are reflected in the new rule.
(w) Freestanding inpatient care / §97.870
§97.871
§97.860 / §418.110 / There has been some consolidation of the old rule into the new rule. DADS identifies its phone number and the forms to use when death may be the result of restraints. Document the date and time it was reported to DADS.
Medication requirements are addressed under new §97.860.
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