reglab/statecodes huggingface dataset:
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 1 - GENERAL PROVISIONS › Section 8:42C-1.1 - Compliance

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The rules in this chapter pertain to all
				hospice care programs in the State of New Jersey.
(b) The purpose of this chapter is to assure the
				provision of high quality hospice services to the residents of New Jersey in a
				coordinated and cost-effective manner.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 2 - LICENSURE AND LICENSURE PROCEDURES › Section 8:42C-2.1 - Functional review applicability

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An applicant for
				hospice care licensure may voluntarily seek guidance and consultation from the
				Department concerning proper implementation of licensure requirements and/or a
				preliminary determination of whether a proposed facility or service complies with
				applicable licensure standards, including, but not limited to, the provisions
				contained in this chapter.
(b) Requests
				for a functional review shall be in writing, specifying the type of facility and/or
				service proposed, and shall be forwarded to the Director, Certificate of Need and
				Healthcare Facility Licensure Program.
(c) There shall be no fee charged for functional
				review.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 2 - LICENSURE AND LICENSURE PROCEDURES › Section 8:42C-2.2 - Functional review procedure

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Applications for
				functional review shall include the following, as applicable:
1. A description of the project, including
				location and time frame for implementation;
2. Projected staffing levels and staff
				qualifications;
3. A physical plant
				description and floor plans with dimensions;
4. A statement that the applicant understands and
				will comply with all operational licensing and physical plant
				requirements;
5. Requests for waivers to
				operational licensing and physical plant requirements as permitted, including all
				arguments that would support approval of the request at
				N.J.A.C.
				8:42C-2.5;
6. A list of the name, location, type and Medicare
				provider number, where applicable, of all licensed health care facilities operated
				or managed by the applicant or any principals, both in New Jersey and for new
				licensees in all other states;
7. The
				licensure application information required at
				N.J.A.C.
				8:42C-2.4, where applicable; and
8. Other information determined by the applicant
				to be necessary and appropriate for the Department's
				consideration.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 2 - LICENSURE AND LICENSURE PROCEDURES › Section 8:42C-2.3 - Effect of functional review approval

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Functional review
				approval shall remain in effect for a period of two years from the date of
				approval.
(b) Notwithstanding any of the
				provisions as set forth in this chapter, functional review approval is advisory only
				and shall not be construed as a guarantee of eventual licensure approval in any
				case.
(c) Notwithstanding any of the
				provisions as set forth in this chapter, in order to obtain a license, every
				facility and/or service must comply with applicable licensure standards in effect at
				the time of the licensure application evaluation, including
				N.J.A.C.
				8:42C-2.2(a)1  through 8, and at
				all times thereafter.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 2 - LICENSURE AND LICENSURE PROCEDURES › Section 8:42C-2.4 - Licensure application

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Subject to the maximum fee caps at N.J.S.A.
				26:2H-12, an applicant shall submit to the Department:
1. A nonrefundable fee of $ 2,000 for the filing
				of an application for licensure of a hospice and $ 2,000 for the annual renewal of
				the license;
2. A nonrefundable fee of $
				150.00 for the filing of an application for licensure of each branch office of the
				hospice and $ 150.00 for the annual renewal of each branch office license;
				and
3. A nonrefundable fee of $ 1,500,
				plus $ 15.00 per each bed to be licensed for the filing of an application, to add an
				inpatient hospice care unit to a hospice license and for the annual renewal of an
				inpatient hospice care unit.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 2 - LICENSURE AND LICENSURE PROCEDURES › Section 8:42C-2.5 - Licensure

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A license shall be issued if surveys by the
				Department have determined that the hospice is being operated as required by
				N.J.S.A.
				26:2H-1 et seq. and amendments thereto, and by the
				rules in this chapter.
(b) At the
				request of the applicant, an office conference for review of the conditions for
				licensure and operation may take place between the Certificate of Need and
				Healthcare Facility Licensure Program and the applicant, who shall be advised that
				the purpose of the license is to allow the Department to determine whether the
				applicant complies with
				N.J.S.A.
				26:2H-1 et seq., 26:2H-79 through 80 specifically,
				and any relevant rules promulgated pursuant thereto, including this
				chapter.
(c) When the written
				application for licensure is submitted and the building is ready for occupancy
				and/or use, a survey of the facility by representatives of the Department shall be
				conducted to determine if the facility complies with the pertinent licensure
				rules.
(d) Survey visits may be made to
				a hospice any time, or to a patient's home with the patient's consent, by authorized
				staff of the Department. Such visits may include, but not be limited to, a review of
				all facility documents and patient records, and conferences with patients and/or
				their families.
(e) Surveys shall be
				conducted, deficiencies reported, disputes resolved, and plans of correction
				submitted in accordance with
				N.J.A.C.
				8:43E-2.
(f) A license shall be issued to a hospice for a
				period of one year when the following conditions are met:
1. Written approvals are on file with the
				Department from the local zoning, fire, health, and building authorities, or a
				certificate of occupancy or a certificate of continued occupancy has been issued by
				the local municipality; and
2. Survey(s)
				by representatives of the Department indicate that the hospice complies with the
				pertinent licensure rules.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 2 - LICENSURE AND LICENSURE PROCEDURES › Section 8:42C-2.6 - Surrender of license

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A hospice which intends to voluntarily close
				and to cease delivery of services shall notify the Department a minimum of 30 days
				in advance. A plan for closure shall be developed which provides for the orderly
				transfer of patients to another hospice of their choice. Such plan shall be
				submitted to the Department a minimum of 30 days prior to closure or cessation of
				service delivery.
(b) The hospice shall
				notify each patient, resident or client, their physicians or advanced practice
				nurses, and any guarantors of payment at least 30 days prior to the voluntary
				surrender of a license, or as directed under an order of revocation, refusal to
				renew, or suspension of license.
1. In such cases,
				the license shall be returned to the Department within seven working days after the
				voluntary surrender, non-renewal or suspension of license.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 2 - LICENSURE AND LICENSURE PROCEDURES › Section 8:42C-2.7 - Waiver

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The Commissioner or his or her designee may,
				in accordance with the general purposes and intent of this chapter, waive sections
				of the rules if, in his or her opinion, such waiver would not endanger the life,
				safety, or health of patients or the public.
(b) A hospice seeking a waiver of these rules
				shall apply in writing to the Director, Certificate of Need and Healthcare Facility
				Licensure Program.
(c) A written request
				for waiver shall include the following:
1. The
				specific rule(s) or part(s) of the rule(s) for which waiver is requested;
2. Reasons for requesting a waiver, including a
				statement of the type and degree of hardship that would result to the facility upon
				full compliance;
3. An alternative
				proposal which would ensure patient safety; and
4. Documentation to support the application for
				waiver.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 2 - LICENSURE AND LICENSURE PROCEDURES › Section 8:42C-2.8 - Action/hearing on a license

Current through Register Vol. 56, No. 14, July 15, 2024
All procedures for the imposition of penalties and other
				  enforcement actions/remedies as well as the rights and procedures available to
				  facilities to request a hearing to contest survey finding or the imposition of
				  penalties shall be in accordance with
				  N.J.A.C.
				  8:43E-3 and 4.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 3 - GENERAL REQUIREMENTS › Section 8:42C-3.1 - Compliance with rules and laws

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The hospice shall
				comply with the rules of the United States Department of Health and Human Services
				at 42 CFR Part 418 , incorporated herein by reference.
(b) In addition to a patient's private residence,
				hospice care may also be offered in the following types of licensed facilities,
				subject to the rules governing these facilities: assisted living residences,
				residential health care facilities, nursing homes, comprehensive personal care
				homes, or general or special hospitals, as well as facilities not subject to
				Department licensure but governed by other state, county or local
				agencies.
(c) The hospice shall provide
				palliative services to patients. This shall include, but not be limited to, nursing,
				homemaker-home health aide, social work and counseling services. Nursing services
				shall be available 24 hours a day, seven days a week.
(d) In order to be licensed to operate in this
				State, a hospice care program shall be certified for participation in the Federal
				Medicare program, in accordance with
				42 U.S.C. §§
										1395. et seq. In order to permit time for a new
				hospice provider to meet the Medicare requirement that it provide services for a
				number of qualified patients prior to certification, the license to operate shall be
				revoked if Medicare certification is not obtained within 180 days of licensure
				issuance.
(e) The hospice shall
				routinely provide nursing services through its own staff.
1. Nursing services provided under contract shall
				be rendered only if:
i. All available full and
				part-time employees have achieved maximum caseloads, or specialized care which is
				unavailable through existing staff can be provided under contract;
ii. Contracted nursing personnel are oriented to
				the policies and procedures of the facility and receive supervision from supervisor
				staff employed by the facility; and
iii.
				Provisions are made for continuity of patient care by the same contracted nursing
				personnel whenever possible.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 3 - GENERAL REQUIREMENTS › Section 8:42C-3.2 - Ownership

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The hospice shall disclose the ownership of
				the hospice and the property on which it is located to the Department and shall make
				proof of this ownership available in the facility.
(b) Any proposed change in ownership shall be
				reported to the Director, Certificate of Need and Healthcare Facility Licensure
				Program, in writing, at least 30 days prior to the change and in conformance with
				the requirements for Certificate of Need applications at
				N.J.A.C.
				8:33-3.3.
(c) A proposed transfer of ownership shall follow
				the process at N.J.A.C.
				8:42C-2.5(j).
(d) No health care facility shall be owned or
				operated by any person convicted of a crime relating adversely to the person's
				capability of owning or operating the facility.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 3 - GENERAL REQUIREMENTS › Section 8:42C-3.3 - Submission of documents

Current through Register Vol. 56, No. 14, July 15, 2024
The hospice shall, upon request, submit any documents which are
				  required by these rules to the Certificate of Need and Healthcare Facility Licensure
				  Program.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 3 - GENERAL REQUIREMENTS › Section 8:42C-3.5 - Policy and procedure manual

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The hospice shall
				establish, implement, and review at least annually, a policy and procedure manual(s)
				for the organization and operation of the hospice.
1. Each review of the manual(s) shall be
				documented, and the manual(s) shall be available in the hospice at all
				times.
2. The manual(s) shall include at
				least the following:
i. A written narrative of the
				hospice describing its philosophy and objectives, and the services provided by the
				facility;
ii. An organizational chart
				delineating the lines of authority, responsibility, and accountability, so as to
				ensure continuity of care to patients;
iii. A description of the quality assurance
				program for patient care and staff performance;
iv. Definition and specification of full-time
				employment; and
v. Policies and
				procedures for complying with applicable statutes and protocols to report child
				abuse and/or neglect, sexual abuse and abuse of elderly or disabled adults,
				specified communicable disease, rabies, poisonings and unattended or suspicious
				deaths including, but not limited to, the following:
(1) The development of written protocols for the
				identification and treatment of children and elderly or disabled adults who are
				abused and/or neglected;
(2) The
				designation of a staff member(s) to be responsible for coordinating the reporting of
				child abuse and/or neglect in compliance with
				N.J.S.A.
				9:6-1 et seq., memorializing the issuance of such
				a report to the Division of Child Protection and Permanency of the Department of
				Children and Families in the medical/health record, and serving as a liaison between
				the facility and the Division of Child Protection and Permanency; and
(3) The provision at least annually of education
				and/or training programs for all staff and subcontracted personnel who provide
				direct patient care regarding the identification and reporting of child abuse and/or
				neglect; sexual abuse; domestic violence; and abuse of the elderly or disabled
				adult.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 3 - GENERAL REQUIREMENTS › Section 8:42C-3.6 - Staffing

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The hospice shall make provision for staff
				with equivalent qualifications to provide services for absent staff members.
				Staffing schedules shall be implemented to facilitate continuity of care to
				patients. The hospice shall maintain staff attendance records.
(b) The hospice shall develop and implement a
				staff orientation and a staff education plan, including plans for each service and
				designation of the person(s) responsible for training.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 3 - GENERAL REQUIREMENTS › Section 8:42C-3.7 - Written agreements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The hospice shall have a written agreement, or
				its equivalent, for services provided by contract or subcontract. The written
				agreement or its equivalent shall:
1. Be dated and
				signed by a representative of the hospice and by the person or agency providing the
				service;
2. Specify each party's
				responsibilities, functions, and objectives, the time during which services are to
				be provided, the financial arrangements and charges, and the duration of the written
				agreement or its equivalent;
3. Specify
				that the hospice retain administrative responsibility for services rendered,
				including subcontracted services;
4.
				Require that services are provided in accordance with these rules and that personnel
				providing services meet training and experience requirements and are supervised in
				accordance with this chapter; and
5.
				Require the provision of written documentation of service provision to the facility
				within seven working days, including, but not limited to, documentation of services
				rendered by the person or agency providing the service.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 3 - GENERAL REQUIREMENTS › Section 8:42C-3.8 - Reportable events

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The hospice shall notify the Department
				immediately by telephone at (609) 292-5960 followed within 72 hours by written
				confirmation of the termination of employment of the administrator and/or the
				Director of Nursing, and the name and qualifications of his or her
				replacement.
(b) The facility shall
				provide statistical data as required by the Department in (a) above, and shall not
				be deemed in violation of
				N.J.S.A.
				26:1A-37.1 when such data is provided to the
				Department.
1. The Department shall maintain any
				personally identifiable information in confidence.
2. The hospice shall comply with patient
				confidentiality of N.J.A.C. 8:43G, Hospital Licensing Standards.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 3 - GENERAL REQUIREMENTS › Section 8:42C-3.9 - Notices

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The hospice shall conspicuously post a notice
				that the following information is available in the facility to patients and the
				public:
1. All waivers granted by the
				Department;
2. All documents required by
				this chapter;
3. A list of deficiencies
				from the last annual licensure inspection and certification survey report (if
				applicable), and the list of deficiencies from any valid complaint investigation
				during the past 12 months;
4. A list of
				the hospice's committees, or their equivalents, and the membership and reports of
				each;
5. The names and addresses of
				members of the governing authority;
6.
				Any changes of membership of the governing authority, within 30 days after the
				change; and
7. Policies and procedures
				regarding patient rights.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 3 - GENERAL REQUIREMENTS › Section 8:42C-3.10 - Reporting to professional licensing boards

Current through Register Vol. 56, No. 14, July 15, 2024
The hospice shall comply with all requirements of the professional
				  licensing boards for reporting termination, suspension, revocation or reduction of
				  privileges of any health professional licensed in the State of New Jersey, pursuant
				  to N.J.S.A.
				  45:1-33.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 4 - ADMINISTRATION › Section 8:42C-4.1 - Administration

Current through Register Vol. 56, No. 14, July 15, 2024
The governing authority shall comply with Federal rules at
				  42 CFR
				  418.100, Conditions of Participation--Organization
				  and administration of services, incorporated herein by reference.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 4 - ADMINISTRATION › Section 8:42C-4.2 - Administrator's responsibilities

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The administrator
				shall be responsible for at least the following:
1. Ensuring the development, implementation, and
				enforcement of all policies and procedures, including patient rights;
2. Planning for and administering the managerial,
				operational, fiscal, and reporting components of the facility;
3. Participating in the quality assurance program
				for patient care;
4. Ensuring that all
				personnel are assigned duties based upon their education, training, competencies,
				and job descriptions;
5. Ensuring the
				provision of staff orientation and staff education; and
6. Establishing and maintaining liaison
				relationships, communication, and integration with facility staff and services and
				with patients and their families, in accordance with the philosophy and objectives
				of the facility.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 4 - ADMINISTRATION › Section 8:42C-4.3 - Qualifications of the administrator

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An individual
				employed in the capacity of an administrator as of June 21, 1999 shall not be
				subject to (a)1 and 2 below while he or she continues in that position with the
				hospice that employed him or her prior to June 21, 1999, but an individual who
				begins employment in the capacity of an administrator after that date shall:
1. Have a master's degree in administration or a
				health related field, and at least two years of supervisory or administrative
				experience in hospice care or in a health care setting; or
2. Have a baccalaureate degree in administration
				or a health related field and four years of supervisor or administrative experience
				in hospice care or in a health care setting.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 6 - PATIENT CARE SERVICES › Section 8:42C-6.1 - Advisory group

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The governing authority shall appoint an
				advisory group which ensures participation by at least one physician, the hospice
				administrator, the director of nursing and/or nursing supervisor, a consumer, and at
				least one representative of the interdisciplinary team.
(b) At least one member of the advisory group
				shall be neither an owner nor an employee of the facility.
(c) The full advisory group shall meet at least
				annually.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 6 - PATIENT CARE SERVICES › Section 8:42C-6.2 - Role of interdisciplinary team

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The hospice shall
				designate an interdisciplinary team composed of individuals who provide or supervise
				the care and services offered by the hospice. The interdisciplinary team shall
				include at least the following individuals: a doctor of medicine or osteopathy, a
				registered nurse, a social worker, and a pastoral or other counselor.
(b) The interdisciplinary team shall be
				responsible for:
1. Participation in the plan of
				care, which shall be:
i. Initiated and implemented
				when the patient is admitted;
ii.
				Coordinated and maintained by the interdisciplinary team;
iii. Inclusive of, but not limited to, the
				patient's diagnosis, patient goals, means of achieving goals, and care and treatment
				to be provided;
iv. Current and
				available to all personnel providing patient care; and
v. Included in the patient's medical/health
				record;
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 6 - PATIENT CARE SERVICES › Section 8:42C-6.3 - Policies and procedures

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The hospice shall establish written policies
				and procedures governing patient care that are reviewed at least annually by the
				advisory group, revised as needed, and implemented. The written policies and
				procedures shall include at least the following:
1. Criteria for admission, discharge, and
				readmission of patients. Admissions criteria shall be based solely upon the
				patient's needs and the ability of the facility to meet safely the medical, nursing,
				and social needs of the patient. Discharge policies shall preclude punitive
				discharge;
2. Criteria for physicians
				orders for hospice, including time frames and other requirements for written,
				verbal, and renewal orders. Physician orders for physical therapy, occupational
				therapy, and speech therapy shall include the modality, frequency, and duration of
				treatment;
3. Protocols for initiation,
				implementation, review, and revision of plans of care and of the service
				plan;
4. Protocols for reassessment of
				patients, in accordance with time frames documented by each health care practitioner
				in the service plan;
5. Protocols for
				providing continuity of care by the same health care practitioner whenever
				possible;
6. Provision of care in
				accordance with the plan of care;
7.
				Provision of emergency care;
8. Policies
				and procedures for the use of restraints, including at least:
i. The need for written physician's
				orders;
ii. Indications and
				contraindications for use, including emergency use or use during medical
				procedures;
iii. Alternatives to
				physical restraints, such as environmental interventions or behavior
				management;
iv. The designation of staff
				who are authorized to use restraints according to scope of practice; and
v. Teaching the patient's family or primary
				caregiver the use of a progressive range of restraining procedures from the least
				restrictive to the most restrictive, the appropriate application and release of
				restraints, and observation of the patient; and
9. A requirement that progress notes be written,
				signed and dated by the practitioner providing care, within 48 hours of the
				provision of care, and that the patient's response to the care be included in the
				progress note; and
10. Policies and
				procedures for the pronouncement of death.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 6 - PATIENT CARE SERVICES › Section 8:42C-6.4 - Acceptance and disposal of prescription medication

Current through Register Vol. 56, No. 14, July 15, 2024
(a) A hospice may
				choose to accept for disposal a hospice care patient's unused prescription
				medication when the hospice care patient ceases to:
1. Use the prescription medication; or
2. Receive services from the
				hospice.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 7 - NURSING SERVICES › Section 8:42C-7.1 - Provision of nursing services

Current through Register Vol. 56, No. 14, July 15, 2024
The hospice shall provide nursing services to patients who need
				  these services, as delineated in the patient's plan of care.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 7 - NURSING SERVICES › Section 8:42C-7.2 - Nursing organization, policies, and procedures

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The hospice shall
				have written policies and procedures for the provision of nursing services that
				guide nursing practices in the hospice. These policies shall be reviewed annually,
				revised as needed, and implemented. These policies and procedures shall conform with
				the Nurse Practice Act at
				N.J.S.A.
				45:11-23 et seq.
(b) The hospice's current clinical and
				administrative nursing policies and procedures shall be available to all nursing
				personnel at all times.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 7 - NURSING SERVICES › Section 8:42C-7.3 - Nursing staff qualifications and responsibilities

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The
				governing authority shall appoint a full-time director of nursing or nursing
				supervisor who shall be available at the hospice. An alternate or alternates shall
				be designated in writing to act in the absence of the director. An individual
				employed in the capacity of a full-time director of nursing as of June 21, 1999
				shall not be subject to the qualifications for that position under
				N.J.A.C.
				8:42C-1.2 while he or she continues in that
				position with the hospice that employed him or her prior to June 21, 1999, but the
				individual who begins employment in the capacity of a full-time director after that
				date shall meet the qualifications for that position set forth at
				N.J.A.C.
				8:42C-1.2.
(b) The director of nursing or nursing supervisor
				shall be responsible for the direction, provision, and quality of nursing services.
				He or she shall be responsible for at least the following:
1. The overall planning, supervision, and
				administration of nursing services;
2.
				The coordination and integration of nursing services with other hospice services to
				provide a continuum of care for the patient;
3. The development of protocols for regular verbal
				communication, including case conferencing, between the nursing service and other
				disciplines based on the needs of each patient;
4. The development of written job descriptions and
				performance criteria for nursing personnel, and assigning duties based upon
				education, training, competencies, and job descriptions; and
5. Ensuring that nursing services are provided to
				the patient as specified in the nursing plan of care.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 7 - NURSING SERVICES › Section 8:42C-7.4 - Nursing entries in the medical/health record

Current through Register Vol. 56, No. 14, July 15, 2024
(a) In accordance with
				written job descriptions and with this chapter, nursing personnel shall document in
				the patient's medical/health record:
1. The
				nursing plan of care in accordance with the facility's policies and
				procedures;
2. Clinical notes and
				progress notes;
3. A record of
				medications administered which shall include the following, documented by the nurse
				who administered the drug:
i. The name and strength
				of the drug;
ii. The date and time of
				administration;
iii. The dosage
				administered;
iv. The method of
				administration; and
v. The signature of
				the licensed nurse who administered the drug.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 7 - NURSING SERVICES › Section 8:42C-7.5 - Nursing entries in the medical/health record

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The hospice shall
				provide homemaker-home health aide services, which services shall be directed and
				supervised by a RN.
1. The registered professional
				nurse shall assign the homemaker-home health aide to a patient and shall give
				written instructions to the homemaker-home health aide regarding the hospice
				services to be provided. The homemaker-home health aide shall document the hospice
				services provided. Copies of the written instructions shall be kept in the patient's
				home and documentation of services provided shall be kept in the patient's
				medical/health record.
2. If the
				registered professional nurse delegates selected tasks to the homemaker-home health
				aide, the registered professional nurse shall determine the degree of supervision to
				provide, based upon an evaluation of the patient's condition, the education, skill,
				and training of the homemaker-home health aide to whom the tasks are delegated, and
				the nature of the tasks and activities being delegated. The registered professional
				nurse shall delegate a task only to a homemaker-home health aide who meets the
				requirements specified and who has demonstrated the knowledge, skill, and competency
				to perform the delegated tasks.
3. The
				registered professional nurse shall make supervisory visits to the patient's home
				and document these visits in the patient's medical record, in accordance with the
				facility's policies and procedures.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 8 - PHARMACY SERVICES › Section 8:42C-8.1 - Pharmacy and supplies

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The hospice shall establish written policies
				and procedures governing pharmacy and supplies that are reviewed annually, revised
				as needed, and implemented. The written policies and procedures shall include at
				least the following:
1. Requirements for the
				purchase, storage, handling, safeguarding, accountability, use, and disposition of
				medications in accordance with the New Jersey State Board of Pharmacy rules
				(N.J.A.C. 13:39), the Federal Comprehensive Drug Abuse Prevention and Control Act of
				1970 and amendments thereto (popularly known as the Controlled Substances Act),
				21 U.S.C. §§
											801 et seq. and regulations promulgated pursuant
				thereto, and the New Jersey Controlled Dangerous Substances Act,
				N.J.S.A.
				24:21-1 et seq., and rules promulgated pursuant
				thereto; and
2. Reporting and
				documenting medication errors and adverse drug reactions.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 9 - MEDICAL/HEALTH RECORDS › Section 8:42C-9.1 - Maintenance of medical/health records

Current through Register Vol. 56, No. 14, July 15, 2024
(a) At least 14 days
				before a hospice plans to cease operations, it shall notify the Department in
				writing of the location and method for retrieval of medical/health
				records.
(b) Medical records shall be
				retained and preserved in accordance with
				N.J.S.A.
				26:8-5 et seq.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 10 - INFECTION PREVENTION AND CONTROL › Section 8:42C-10.1 - Infection prevention and control program

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The administrator
				shall ensure the development and implementation of an infection prevention and
				control program.
(b) The administrator
				shall designate a person who shall have education, training, completed course work,
				or experience in infection control or epidemiology, and who shall be responsible for
				the direction, provision, and quality of infection prevention and control services.
				The designated person shall be responsible for, at a minimum, developing and
				maintaining written objectives, a policy and procedure manual, a system for data
				collection, and a quality assurance program for the infection prevention and control
				service.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 10 - INFECTION PREVENTION AND CONTROL › Section 8:42C-10.2 - Infection control policies and procedures

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The hospice shall
				have an interdisciplinary committee which establishes and implements an infection
				prevention and control program.
(b) The
				interdisciplinary committee shall develop, implement, and review, at least annually,
				written policies and procedures regarding infection prevention and control,
				including:
1. A method of complying with the
				Department's rules on reportable communicable diseases at N.J.A.C. 8:57;
2. A staff education program on infection
				prevention and control which shall be conducted on an annual basis;
3. Surveillance techniques to identify infections
				and develop systems to reduce risk using "APIC - HICPAC Surveillance Definitions for
				Home Health Care and Home Hospice Infections," February 2008, incorporated herein by
				reference, as amended and supplemented, available electronically at
www.apic.org
or at
www.cdc.gov
; and
4. Sterilization and high level of disinfection of
				reusable medical devices, following guidelines recommended by the Association for
				the Advancement of Medical Instrumentation (AAMI, 901 North Glebe Road, Suite 300,
				Arlington, VA 22203 or available at the AAMI website at
www.aami.org
), and any amendments thereto, which are
				incorporated herein by reference, including, at a minimum:
i. "Comprehensive Guide to Steam Sterilization and
				Sterility Assurance in Health Care Facilities," ANSI/AAMI ST 79 (2006), incorporated
				herein by reference, as amended and supplemented, available electronically at
www.aami.org
or by telephone at (800)
				332-2264;
ii. "Chemical Sterilization
				and High-level Disinfection in Health Care Facilities," ANSI/AAMI ST 58:2013,
				incorporated herein by reference, as amended and supplemented, available
				electronically at
www.aami.org
or by telephone at
				(800) 332-2264;
iii. Aseptic transfer of
				sterile supplies; and
iv. Chemicals used
				for cleaning general environmental surfaces.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 10 - INFECTION PREVENTION AND CONTROL › Section 8:42C-10.3 - Infection control measures

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The hospice shall
				follow all recommendations in the following publications of the Centers for Disease
				Control and Prevention, incorporated herein by reference, as amended and
				supplemented:
1. Guideline for Prevention of
				Catheter-Associated Urinary Tract Infections, 2009, available on the CDC website at
https://www.cdc.gov/infectioncontrol/pdf/guidelines/cauti-guidelines-H.pdf
;
2. Guidelines for the Prevention of Intravascular
				Catheter-Related Infections, 2011, updated October 2017, available on the CDC
				website at
https://www.cdc.gov/infectioncontrol/pdf/guidelines/bsi-guidelines-H.pdf
;
3. Guideline for Prevention of Surgical Site
				Infection (2017), available on the CDC website at
https://www.cdc.gov/infectioncontrol/guidelines/ssi/index.html
;
4. Guideline for Hand Hygiene in Health-Care
				Settings, CDC Morbidity and Mortality Weekly Report (MMWR) 2002, Volume 51 (RR16),
				available on the CDC website at
https://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf
;
5. Infection Control in Healthcare Personnel:
				Infrastructure and Routine Practices for Occupational Infection Prevention and
				Control Services (October 2019), available on the CDC website at
https://stacks.cdc.gov/view/cdc/82043
;
6. Guidelines for Environmental Infection Control
				in Health-Care Facilities, CDC Morbidity and Mortality Weekly Report (MMWR), 2003,
				Volume 52 (RR10), updated July 2019, available on the CDC website at:
https://www.cdc.gov/infectioncontrol/pdf/guidelines/environmental-guidelines-P.pdf
;
7. 2007 Guideline for Isolation Precautions:
				Preventing Transmission of Infectious Agents in Healthcare Settings (last update
				July 2023), available on the CDC website at:
https://www.cdc.gov/infectioncontrol/pdf/guidelines/Isolation-guidelines-H.pdf
;
8. Management of Multidrug-Resistant Organisms in
				Healthcare Settings, 2006, available on the CDC website at
https://www.cdc.gov/infectioncontrol/pdf/guidelines/mdro-guidelines.pdf
;
				and
9. Guidelines for Preventing
				Health-Care-Associated Pneumonia, 2003, available on the CDC website at
https://www.cdc.gov/infectioncontrol/pdf/guidelines/healthcare-associated-pneumonia-H.pdf
.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 10 - INFECTION PREVENTION AND CONTROL › Section 8:42C-10.4 - Use and sterilization of patient care items

Current through Register Vol. 56, No. 14, July 15, 2024
Single use patient care items shall not be reused. Other patient
				  care items which may be reused shall be reprocessed and reused only in accordance
				  with manufacturers' recommendations.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 10 - INFECTION PREVENTION AND CONTROL › Section 8:42C-10.5 - Regulated medical waste

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The hospice shall comply with provisions of
				the Comprehensive Regulated Medical Waste Management Act at
				N.J.S.A.
				13:1E-48.1 et seq., and
				N.J.A.C.
				7:26-3A.
(b) The hospice shall develop and implement
				policies and procedures for the collection, storage handling and disposal of all
				solid waste.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 10 - INFECTION PREVENTION AND CONTROL › Section 8:42C-10.6 - Communicable diseases alert

Current through Register Vol. 56, No. 14, July 15, 2024
The hospice shall develop protocols for identifying patients who
				  have died with AIDS, or a contagious, infectious or communicable disease consistent
				  with N.J.S.A.
				  26:6-8.2 and 8.3
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 10 - INFECTION PREVENTION AND CONTROL › Section 8:42C-10.7 - Orientation, in-service, and education

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Orientation for all
				new personnel and staff, as well as volunteers, under contract to provide direct
				patient care shall include infection control practices for the employee's specific
				job duties and the rationale for those practices.
(b) The hospice shall provide infection control
				education to employees, contracted providers, patients and family members and other
				caregivers.
(c) The interdisciplinary
				committee shall coordinate educational programs to address specific problems at
				least annually for staff in all disciplines and patient care services that includes
				blood borne pathogens and tuberculosis (TB) exposure control.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 11 - INPATIENT HOSPICE CARE UNIT › Section 8:42C-11.1 - Scope

Current through Register Vol. 56, No. 14, July 15, 2024
(a) This subchapter sets forth the requirements
				for licensed inpatient hospice care providers to operate units.
(b) Inpatient hospice care providers shall:
1. Be licensed hospice providers in compliance
				with this chapter, except as this chapter may conflict with this subchapter.
i. In the event of a conflict, the licensed
				hospice provider shall comply with this subchapter;
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 11 - INPATIENT HOSPICE CARE UNIT › Section 8:42C-11.2 - Additional staffing requirements for inpatient hospice care units

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The governing
				body shall appoint a unit administrator who shall be:
1. Available at all times; and
2. In the building in which the unit is located at
				least half-time each week.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 11 - INPATIENT HOSPICE CARE UNIT › Section 8:42C-11.3 - SAdditional services required for inpatient hospice care units

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Inpatient hospice
				care providers shall provide, directly or through documented agreements, duly
				licensed radiology, laboratory, pathology, and other medically related services in
				accordance with physician orders.
1. Documented
				agreements shall be consistent with
				N.J.A.C.
				8:42C-3.7.
2. If a provider directly provides these services,
				the provider shall establish and implement written policies and procedures that
				govern the implementation of these services.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 11 - INPATIENT HOSPICE CARE UNIT › Section 8:42C-11.4 - Patient care area requirements for inpatient hospice care units

Current through Register Vol. 56, No. 14, July 15, 2024
(a) The patient care
				area requirements at (b) through (aa) below apply to inpatient hospice care
				units.
(b) The maximum unit size is 30
				beds.
(c) All beds in a unit are in a
				contiguous area on the same floor.
(d)
				The maximum room capacity is two patients.
(e) At least 50 percent of the unit rooms are
				single occupancy.
(f) The clear, usable
				floor area of a single bedroom is 100 square feet or greater, exclusive of the
				bathroom, vestibule, and closet or wardrobe unit.
(g) The clear, usable floor area of a shared
				(semi-private) bedroom is 80 square feet per bed or greater, exclusive of the
				bathroom, the vestibule, and the closet or wardrobe unit.
(h) Each bedroom shall have a four-foot clearance
				at each side and at the foot of each bed to permit the passage of equipment,
				patients, and staff.
(i) The space
				allocated for dining, recreation, and other common uses is 35 square feet or greater
				per licensed bed, not including physical therapy and occupational therapy
				space.
(j) Each patient shall have a
				closet or wardrobe unit of six square feet or greater for the storage of personal
				clothing.
(k) Each patient shall have
				the use of a bathroom, access to which does not require the patient to enter a
				corridor.
1. The bathroom door shall either:
i. Swing outward; or
ii. Be an inward-swinging door that complies with
				the clearance requirements of the Americans with Disabilities Act of 1990,
				42 U.S.C. §§
												12101 et seq.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 11 - INPATIENT HOSPICE CARE UNIT › Section 8:42C-11.5 - Inpatient hospice care unit infection control

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An inpatient hospice
				care provider shall develop and implement a system to investigate, report, evaluate,
				and maintain records of infections among patients and staff.
(b) The system established pursuant to (a) above
				shall:
1. Incorporate and adhere to the
				Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel:
				Recommendations from the National Tuberculosis Controllers Association and CDC,
				2019. MMWR 2019;68:439-443, available on the CDC website at:
https://www.cdc.gov/mmwr/volumes/68/wr/mm6819a3.htm?s_cid=mm6819a3_w
,
				in accordance with 29 U.S.C.
				§
											651, the Occupational Safety and Health Act
				of 1970; and
2. Include a procedure for
				isolating patients with infectious diseases.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 11 - INPATIENT HOSPICE CARE UNIT › Section 8:42C-11.6 - Pharmaceutical services for inpatient hospice care units

Current through Register Vol. 56, No. 14, July 15, 2024
(a) An inpatient hospice
				care provider shall employ, or have a documented agreement with, a licensed
				pharmacist to establish and implement written policies and procedures addressing
				ordering, storage, administration, disposal, and recordkeeping of drugs and
				biologicals.
(b) An inpatient hospice
				care provider shall establish and implement written policies and procedures
				governing:
1. The procurement, storage,
				administration, and disposal of all drugs and biologicals in accordance with Federal
				and State laws; and
2. Drug control and
				accountability.
New Jersey Administrative Code › Title 8 - HEALTH › Chapter 42C - HOSPICE LICENSING STANDARDS › Subchapter 11 - INPATIENT HOSPICE CARE UNIT › Section 8:42C-11.7 - Inpatient hospice care unit patients' rights

Current through Register Vol. 56, No. 14, July 15, 2024
Inpatient hospice care providers shall comply with
				  N.J.A.C.
				  8:42C-5.1.