CMS Centers for Medicare and Medicaid Services

Crosswalk June 4, 2018 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

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 BETWEEN OLD 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: CFR 418 Differences/Thing Chapter 97 Hospice s to note Subchapter Services H (a) Compliance §98.801 §418.3 Old rule reflected §418.24 in new (a), (d), and (e) New rule identifies new sections for inpatient, NF, and ICF/ID, additional

¨ P.O. Box 1525, Austin, Texas 78767¨ 1108 Lavaca, Ste. 727, Austin, TX 78701 ¨ 1-800-580-9270 ¨ (512) 454-1247 ¨ ¨ FAX (512) 454-1248 ¨ [email protected] ¨ www.TxNMHospice.Org ¨ definitions (reflected in CFR) and the language in the election statement. (b) Use of term §98.801 (e) Health and Safety “hospice” Code § 142.002 (c) (c) Policy, services and §97.801(a) §418.100 availability §97.850 SSA §1861 (dd) (2) (d) Medical Director §97.858 §418.102 New (a)and(d) §418.22 (b) copy old rule (e) Interdisciplinary §97.820 §418.56 Team §97.821 §97.822 §97.823 (f) Arrangements §97.854 §418.100 §97.861 §97.880 (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 §97.811 §418.54 New rule reflect assessment, updates §97.812 §418.58 the CFR time and QAPI §97.813 frames.

¨ P.O. Box 1525, Austin, Texas 78767¨ 1108 Lavaca, Ste. 727, Austin, TX 78701 ¨ 1-800-580-9270 ¨ (512) 454-1247 ¨ ¨ FAX (512) 454-1248 ¨ [email protected] ¨ www.TxNMHospice.Org ¨ 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, §97.821 §418.56 New rule reflects review and updates §97.822 CFR time frames. (j) IDT reassessments §97.811 §418.54 §97.812 §418.56 (k) Short term §97.821 (6) §418.52(c) inpatient care §418.108 information to family (l) Clergy requests and §97.834 §418.56 visits (m) Core §97.830 §418.100(e) services/contracting §418.64 (n) Nursing care and §97.832 §418.64(b) New rule services addresses APRN requirements. (o) Social services §97.833 §418.64(c) 418.114 (p) Hospice §97.831 §418.64 (a) physician/attending (q) Counseling services §97.834 §418.56 §418.64 (L597) §418.64 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.

¨ P.O. Box 1525, Austin, Texas 78767¨ 1108 Lavaca, Ste. 727, Austin, TX 78701 ¨ 1-800-580-9270 ¨ (512) 454-1247 ¨ ¨ FAX (512) 454-1248 ¨ [email protected] ¨ www.TxNMHospice.Org ¨ (r) Arrangements for §97.840 §418.70 non-core services §418.56 §418.100(e) (s) OT/PT/Speech §97.841 §418.72 (t) Home health aide §97.842 §418.76 Home health aide and home maker §97.843 §418.202(g) changed to services §97.844 hospice aide. §97.845 Documentati on is required in all aspects of education, training, evaluation etc. New rules identify what the documentatio n 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 §97.860 §418.106 Old language in and medications (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 Old rule §418.54 §97.403(v) has QAPI requiremen ts which are reflected in the new rule. (w) Freestanding §97.870 §418.110 There has been inpatient care §97.871 some §97.860 consolidation of the old

¨ P.O. Box 1525, Austin, Texas 78767¨ 1108 Lavaca, Ste. 727, Austin, TX 78701 ¨ 1-800-580-9270 ¨ (512) 454-1247 ¨ ¨ FAX (512) 454-1248 ¨ [email protected] ¨ www.TxNMHospice.Org ¨ 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.

¨ P.O. Box 1525, Austin, Texas 78767¨ 1108 Lavaca, Ste. 727, Austin, TX 78701 ¨ 1-800-580-9270 ¨ (512) 454-1247 ¨ ¨ FAX (512) 454-1248 ¨ [email protected] ¨ www.TxNMHospice.Org ¨