In order to be an informed consumer of hospice care, it is important to understand the rules under which hospice programs operate, and the standards to which they are held accountable. This section includes information on specific sections from the Code of Maryland Regulations that apply to hospice programs in the state, and accreditation of hospice programs.
CODE OF MARYLAND REGULATIONS
Hospice programs in Maryland are licensed by the Department of Health and Mental Hygiene and must adhere to the regulations set forth in the Code of Maryland Regulations (COMAR) for hospice programs.
The portions of the regulations of greatest interest to hospice patients and their families are listed below:
- COMAR
10.07.21.03 Licensing Required: This regulation describes
the requirement that hospice programs be licensed as either general
hospice care programs (which provide both skilled and unskilled care)
or limited hospice care programs (which provide only unskilled care).
- COMAR
10.07.21.05 Inspections: The requirement for periodic inspection
of hospice programs by the Department of Health and Mental Hygiene (DHMH)
is described. The regulation states that DHMH also conducts investigations
in response to complaints.
- COMAR
10.07.21.05 Policies and Procedures: This regulation states
that hospice programs are required to have written policies and procedures
which include the use of advance
directives, the resolution of ethical dilemmas, the initiation of
resuscitation, and the use of specific treatments such as palliative
chemotherapy and radiation, criteria for admission, transfer and discharge,
and procedures for obtaining informed consent.
- COMAR
10.07.21.08 Personnel: The composition of the hospice interdisciplinary
team is described here. It must include a physician with training in
palliative care, an attending physician, registered nurse, masters level
social worker, volunteer, and a spiritual counselor. This regulation
discusses the requirement that the hospice have a written agreement
with outside contractors, and it details the training required for staff
and volunteers.
- COMAR
10.07.21.10 The Interdisciplinary Plan of Care: In this regulation,
requirements for the written plan of care are described. The plan must
show that efforts will be made to help the patient be as independent
as possible and that services will be provided in a manner that is convenient
for the patient and the family. Services that must be included in the
plan are listed.
-
COMAR
10.07.21.12 Transfer or Discharge: It is stated that hospice
programs that do not have inpatient services must have a written transfer
agreement with a program that provides those services. The circumstances
under which a patient may be discharged are listed. It is required that
the hospice make referrals to appropriate services before discharging
a patient.
- COMAR
10.07.21.16 Counseling: This regulation requires that social
work services as well as spiritual, nutritional, and bereavement counseling
must be provided.
- COMAR
10.07.21.17 Emergency Services: The services that must be
provided in an emergency are outlined. These include 24-hour access
to nursing and physician services, palliative medications, and other
services necessary to meet immediate patient needs.
- COMAR
10.07.21.21 Patient's Rights: This regulation states
that the patient or representative must be provided with a written
notice of patient's rights before care is provided. A list
of patient's rights is included here. They include: confidentiality,
privacy, freedom from abuse, participation in the care plan, and the
right to refuse treatment.
- COMAR
10.07.21.22 Complaint Procedure: This regulation states that
a hospice must establish a process to make a complaint
and must inform families and patients of this process.