If you have one or more hospice providers delivering end-of-life care in your nursing facility, be aware that your contract with the hospice will have to be amended in December 2008. Earlier this year, the Center for Medicare & Medicaid Services (CMS) issued new Medicare Conditions of Participation (COPs) for Medicare certified hospices. The new COPs are the first major revision to the Medicare hospice regulations in 25 years, and they substantially change the way hospices do business.

Included in the changes are a number of provisions specifically dealing with hospices that provide services in SNFs. Those provisions specifically require that certain issues be addressed in the hospice-SNF contract. The COPS become effective December 2, 2008, and, technically, hospice contracts with SNFs must comply with the new regulations by that date. Although CMS has not issued any formal statements on this issue, we don’t expect to see state or federal surveyors closely reviewing hospice-SNF contracts until January 2009, unless a complaint is filed that somehow implicates a hospice-SNF contract, but providers need to be prepared for these new regulations as soon as possible.

So, if you have a hospice operating in your facility, the hospice agency will almost certainly be asking you to agree to contract amendments in the next few weeks, if it hasn’t already. We wanted to give you the heads-up about this so you’ll know that the changes the hospice agencies will be requesting are coming directly from the Medicare hospice regulations. Existing hospice- SNF contracts will have to be amended now to comply with the new COPs, even if the contract is not yet up for renewal.

Some of the specific issues that must be addressed in hospice- SNF contracts as of December 2, 2008, include: 

• The manner in which the hospice and nursing facility are to communicate with each other; 
• A provision that requires the nursing facility to immediately notify the hospice of a significant change in the patient’s condition, clinical complications that suggest a need to alter the plan of care, a need to transfer the patient, or the hospice patient’s death; 
• A provision stating that the hospice assumes responsibility for determining the appropriate course of hospice care, including the level of care; 
• An agreement that the nursing facility is responsible for providing 24-hour room and board care, thus meeting the personal care and nursing needs of the patient that would have been provided by the primary caregiver at home at the same level of care provided before hospice was elected; 
• An agreement that the hospice is responsible for providing the same level and extent of services that would be provided if the resident were in his or her home; 
• A delineation of hospice responsibilities; 
• A provision that the hospice may use nursing facility staff, as specified by the nursing facility, to assist with prescribed therapies only to the extent that the hospice would routinely use the hospice patient’s family; 
• Specific abuse, neglect, and misappropriation of property reporting requirements; and 
• A delineation of the responsibilities pertaining to bereavement services provided by the hospice to nursing facility staff.

Also, sometime in 2009, CMS expects to release new Medicare hospice regulations that apply to nursing homes that offer hospice services in their facilities. CMS has indicated that these regulations will be consistent with the COPs it released this year for hospice agencies. Both parties to a hospice-SNF arrangement should have corresponding and consistent mutual obligations, many of which will probably have to be spelled out in the contract.