Social Security Act §1861

(J)meets suchother conditions of participation as the Secretary may find necessaryin the interest of the health and safety of individuals who are furnishedservices by such facility, including conditions concerning qualificationsof personnel in these facilities.Hospice Care; Hospice Program(dd)(1)Theterm hospice care means the following items and servicesprovided to a terminally ill individual by, or by others under arrangementsmade by, a hospice program under a written plan (for providing suchcare to such individual) established and periodically reviewed bythe individuals attending physician and by the medical director(and by the interdisciplinary group described in paragraph (2)(B))of the program(A)nursingcare provided by or under the supervision of a registered professionalnurse,(B)physicalor occupational therapy, or speech-language pathology services,(C)medicalsocial services under the direction of a physician,(D)(i)services ofa home health aide who has successfully completed a training programapproved by the Secretary and(ii)homemakerservices,(E)medicalsupplies (including drugs and biologicals) and the use of medicalappliances, while under such a plan,(F)physiciansservices,(G)short-terminpatient care (including both respite care and procedures necessaryfor pain control and acute and chronic symptom management) in an inpatientfacility meeting such conditions as the Secretary determines to beappropriate to provide such care, but such respite care may be providedonly on an intermittent, nonroutine, and occasional basis and maynot be provided consecutively over longer than five days,(H)counseling(including dietary counseling) with respect to care of the terminallyill individual and adjustment to his death, and(I)any otheritem or service which is specified in the plan and for which paymentmay otherwise be made under this title.The care and services described in subparagraphs (A) and (D)may be provided on a 24-hour, continuous basis only during periodsof crisis (meeting criteria established by the Secretary) and onlyas necessary to maintain the terminally ill individual at home.(2)Theterm hospice program means a public agency or privateorganization (or a subdivision thereof) which(A)(i)is primarilyengaged in providing the care and services described in paragraph(1) and makes such services available (as needed) on a 24-hour basisand which also provides bereavement counseling for the immediate familyof terminally ill individuals and services described in section 1812(a)(5),(ii)provides forsuch care and services in individuals homes, on an outpatientbasis, and on a short-term inpatient basis, directly or under arrangementsmade by the agency or organization, except that(I)the agencyor organization must routinely provide directly substantially allof each of the services described in subparagraphs (A), (C), and (H)of paragraph (1), except as otherwise provided in paragraph (5), and(II)in thecase of other services described in paragraph (1) which are not provideddirectly by the agency or organization, the agency or organizationmust maintain professional management responsibility for all suchservices furnished to an individual, regardless of the location orfacility in which such services are furnished; and(iii)providesassurances satisfactory to the Secretary that the aggregate numberof days of inpatient care described in paragraph (1)(G) provided inany 12-month period to individuals who have an election in effectunder section 1812(d) with respect to that agency or organization does not exceed 20 percentof the aggregate number of days during that period on which such electionsfor such individuals are in effect;(B)has an interdisciplinarygroup of personnel which(i)includes atleast(I)one physician(as defined in subsection (r)(1)),(II)one registeredprofessional nurse, and(III)onesocial worker,employed by or, in the case of a physician described in subclause(I), under contract with the agency or organization, and also includesat least one pastoral or other counselor,(ii)provides (orsupervises the provision of) the care and services described in paragraph(1), and(iii)establishesthe policies governing the provision of such care and services;(C)maintainscentral clinical records on all patients;(D)does notdiscontinue the hospice care it provides with respect to a patientbecause of the inability of the patient to pay for such care;(E)(i)utilizes volunteersin its provision of care and services in accordance with standardsset by the Secretary, which standards shall ensure a continuing levelof effort to utilize such volunteers, and(ii)maintainsrecords on the use of these volunteers and the cost savings and expansionof care and services achieved through the use of these volunteers;(F)in the caseof an agency or organization in any State in which State or applicablelocal law provides for the licensing of agencies or organizationsof this nature, is licensed pursuant to such law; and(G)meets suchother requirements as the Secretary may find necessary in the interestof the health and safety of the individuals who are provided careand services by such agency or organization.(3)(A)An individualis considered to be terminally ill if the individualhas a medical prognosis that the individuals life expectancyis 6 months or less.(B)The term attending physician means, with respect to an individual,the physician (as defined in subsection (r)(1)), the nurse practitioner(as defined in subsection (aa)(5)) or the physician assistant (asdefined in such subsection), who may be employed by a hospice program,whom the individual identifies as having the most significant rolein the determination and delivery of medical care to the individualat the time the individual makes an election to receive hospice care.[528](4)(A)An entitywhich is certified as a provider of services other than a hospiceprogram shall be considered, for purposes of certification as a hospiceprogram, to have met any requirements under paragraph (2) which arealso the same requirements for certification as such other type ofprovider. The Secretary shall coordinate surveys for determining certificationunder this title so as to provide, to the extent feasible, for simultaneoussurveys of an entity which seeks to be certified as a hospice programand as a provider of services of another type.(B)Any entitywhich is certified as a hospice program and as a provider of anothertype shall have separate provider agreements under section 1866 and shall fileseparate cost reports with respect to costs incurred in providinghospice care and in providing other services and items under thistitle.(C)[529]Any entity that is certified as a hospice program shall besubject to a standard survey by an appropriate State or local surveyagency, or an approved accreditation agency, as determined by theSecretary, not less frequently than once every 36 months beginning6 months after the date of the enactment of this subparagraph andending September 30, 2025.(5)(A)The Secretarymay waive the requirements of paragraph (2)(A)(ii)(I) for an agencyor organization with respect to all or part of the nursing care describedin paragraph (1)(A) if such agency or organization(i)is located inan area which is not an urbanized area (as defined by the Bureau ofthe Census);(ii)was in operationon or before January 1, 1983; and(iii)has demonstrateda good faith effort (as determined by the Secretary) to hire a sufficientnumber of nurses to provide such nursing care directly.(B)Any waiver,which is in such form and containing such information as the Secretarymay require and which is requested by an agency or organization undersubparagraph (A) or (C), shall be deemed to be granted unless suchrequest is denied by the Secretary within 60 days after the date suchrequest is received by the Secretary. The granting of a waiver undersubparagraph (A) or (C) shall not preclude the granting of any subsequentwaiver request should such a waiver again become necessary.(C)The Secretarymay waive the requirements of paragraph (2)(A)(i) and (2)(A)(ii) foran agency or organization with respect to the services described inparagraph (1)(B) and, with respect to dietary counseling, paragraph(1)(H), if such agency or organization(i)is located inan area which is not an urbanized area (as defined by the Bureau ofCensus), and(ii)demonstratesto the satisfaction of the Secretary that the agency or organizationhas been unable, despite diligent efforts, to recruit appropriatepersonnel.(D)In extraordinary,exigent, or other non-routine circumstances, such as unanticipatedperiods of high patient loads, staffing shortages due to illness orother events, or temporary travel of a patient outside a hospice programsservice area, a hospice program may enter into arrangements with anotherhospice program for the provision by that other program of servicesdescribed in paragraph (2)(A)(ii)(I). The provisions of paragraph(2)(A)(ii)(II) shall apply with respect to the services provided undersuch arrangements.(E)A hospiceprogram may provide services described in paragraph (1)(A) other thandirectly by the program if the services are highly specialized servicesof a registered professional nurse and are provided non-routinelyand so infrequently so that the provision of such services directlywould be impracticable and prohibitively expensive.Discharge Planning Process(ee)(1)A discharge planningprocess of a hospital shall be considered sufficient if it is applicableto services furnished by the hospital to individuals entitled to benefitsunder this title and if it meets the guidelines and standards establishedby the Secretary under paragraph (2).(2)The Secretaryshall develop guidelines and standards for the discharge planningprocess in order to ensure a timely and smooth transition to the mostappropriate type of and setting for post-hospital or rehabilitativecare. The guidelines and standards shall include the following:(A)The hospitalmust identify, at an early stage of hospitalization, those patientswho are likely to suffer adverse health consequences upon dischargein the absence of adequate discharge planning.(B)Hospitalsmust provide a discharge planning evaluation for patients identifiedunder subparagraph (A) and for other patients upon the request ofthe patient, patients representative, or patients physician.(C)Any dischargeplanning evaluation must be made on a timely basis to ensure thatappropriate arrangements for post-hospital care will be made beforedischarge and to avoid unnecessary delays in discharge.(D)A dischargeplanning evaluation must include an evaluation of a patientslikely need for appropriate post-hospital services, including hospicecare and post-hospital extended care services and the availabilityof those services, including the availability of home health servicesthrough individuals and entities that participate in the program underthis title and that serve the area in which the patient resides andthat request to be listed by the hospital as available and, in thecase of individuals who are likely to need post-hospital extendedcare services, the availability of such services through facilitiesthat participate in the program under this title and that serve thearea in which the patient resides.(E)The dischargeplanning evaluation must be included in the patients medicalrecord for use in establishing an appropriate discharge plan and theresults of the evaluation must be discussed with the patient (or thepatients representative).(F)Upon therequest of a patients physician, the hospital must arrangefor the development and initial implementation of a discharge planfor the patient.(G)Any dischargeplanning evaluation or discharge plan required under this paragraphmust be developed by, or under the supervision of, a registered professionalnurse, social worker, or other appropriately qualified personnel.(H)Consistentwith section 1802, the discharge plan shall(i)not specifyor otherwise limit the qualified provider which may provide post-hospitalhome health services, and(ii)identify (ina form and manner specified by the Secretary) any entity to whom theindividual is referred in which the hospital has a disclosable financialinterest (as specified by the Secretary consistent with section 1866(a)(1)(S))or which has such an interest in the hospital.(3)With respectto a discharge plan for an individual who is enrolled with a Medicare+Choiceorganization under a Medicare+Choice plan and is furnished inpatienthospital services by a hospital under a contract with the organization(A)the dischargeplanning evaluation under paragraph (2)(D) is not required to includeinformation on the availability of home health services through individualsand entities which do not have a contract with the organization; and(B)notwithstandingsubparagraph (H)(i), the plan may specify or limit the provider (orproviders) of post-hospital home health services or other post-hospitalservices under the plan.Partial Hospitalization Services