This week’s You Asked... We Answered questions ask: "Does the 'Change of Designated Hospice' process used when changing hospices also apply to patients in a Medicaid managed care plan? What is the best source of information for Ohio Medicaid regulations for managed care plans?" and "Who is responsible for destroying medications when a patient is in an assisted living facility? When medications are in a locked box in the patient's room in assisted living, are we responsible for destroying them versus in a nursing facility where nursing staff has possession?"
Does the 'Change of Designated Hospice' process used when changing hospices also apply to patients in a Medicaid managed care plan? What is the best source of information for Ohio Medicaid regulations for managed care plans?
The best reference for anything related to Ohio Medicaid Hospice are the seven hospice Medicaid rules located at: http://codes.ohio.gov/oac/5160-56.
In this case the 5160-56-03 rule has the information you want, and yes, you do need a change of designated hospice form signed by the patient/representative for Medicaid (just like with Medicare). With the recent revision of the Hospice Medicaid rules, we tried to mirror them as close to the Federal Conditions of Participation as possible.
Paragraph D of Ohio Administrative Code 5160-56-03 Hospice services: discharge requirements, states:
(D) The following requirements apply when an individual is discharged from the designated hospice's care due to individual's transfer to another hospice:
(1) The individual may change the designation of the hospice from which care is received once during each benefit period. The change of the designated hospice is not considered a revocation of the election from the period in which it is made.
(2) To change the designated hospice, the individual must file, with the hospice from which the individual has received care and the newly designated hospice, a signed statement which includes the following information:
(a) The name of the hospice from which the individual has received care;
(b) The name of the hospice from which the individual plans to receive care; and
(c) The date the change is to be effective.
(3) When an individual transfers from one hospice to another, his or her medicaid hospice benefit shall continue without interruption of care.
Who is responsible for destroying medications when a patient is in an assisted living facility? When medications are in a locked box in the patient's room in assisted living, are we responsible for destroying them versus in a nursing facility where nursing staff has possession?
If the patient is in assisted living, a skilled nursing facility (SNF) or extended care facility (ECF), and the medications are secured and administered by the facility, then it is the facility’s responsibility to destroy or return the medications to the pharmacy from where they received them, depending on their policy. Hospices should check each facility’s policy to ensure they are the ones destroying or returning the unused medications, as each facility is a little different.
If a person is in assisted living and their medications/controlled substances are in their room in a lock box, then that is considered their place of residence and you should destroy them as you would for any other home patient. Hospice is responsible for destroying controlled substances in the patient’s home only.
Ohio Administrative Code 3701-19-21 Medical supplies, drugs and biologicals, states:
(D) Each hospice care program licensed under this chapter that provides hospice care and services in a hospice patient's home shall establish a written policy establishing procedures to be followed in preventing the diversion of controlled substances containing opioids that are prescribed to its hospice patients. The policy shall include procedures for the disposal of any such drugs prescribed to a hospice patient as part of the patient's interdisciplinary plan of care that are relinquished to the program after the patient's death or that otherwise are no longer needed by the patient. The policy shall require that the disposal be documented by a program employee and conducted in any of the following ways:
(1) Performed by a program employee and witnessed by the patient or patient's family member;
(2) Performed by the patient or patient's family member and witnessed by a program employee;
(3) Performed by a program employee and witnessed by another program employee.
(E) Each hospice care program shall ensure that the patient, patient's representative, and the patient's family receive a copy of the hospice care program's written policies and procedures along with education on the management and disposal of controlled drugs when a controlled substance is ordered, and document such actions in the patient's clinical record.
If you have a question you would like to see featured in You Asked/We Answered, email Anne Shelley, Director of Professional Development & HH/Hospice Regulatory Relations at ashelley@leadingageohio.org or Stephanie DeWees, Quality & Regulatory Specialist for Long Term Care at sdewees@leadingageohio.org.