A person, including a partnership, association, or corporation, may not represent itself as a hospice program or operate a hospice program unless the person, partnership, association, or corporation has obtained a license from the department.
Application for a license to operate a home health agency shall be made to the department on a form provided by the department and shall be accompanied by applicable fees established by the department under AS 18.18.420.
A person who violates 18.18.005 - 18.18.390 commits a civil violation for which a fine not to exceed $100 a day of violation may be assessed by a court.
Regulations and contested cases under 18.18.005 - 18.18.390 are governed by AS 44.62 (Administrative Procedure Act).
The department may adopt regulations to implement 18.18.005 - 18.18.390 that are consistent with the policy expressed in AS 18.18.005 .
(a) A final report on deficiencies and approved plans of correction that is prepared by the department after a licensure inspection or investigation of a home health agency it licenses under this chapter shall be made available by the department to the public within 14 calendar days after the final report is made available to the home health agency being reviewed.
(b) The department may not publicly disclose information that identifies patients or clients of the home health agency under review.
Unless the act or omission constituted gross negligence, recklessness, or intentional misconduct, a person may not recover damages for personal injury, death, or damage to property for an act or omission to act in the course and scope of official hospice program duties from a volunteer who works for a hospice program that is licensed under 18.18.005 - 18.18.390.
A program license received under 18.18.005 - 18.18.390 does not relieve an individual who is an employee, volunteer, or contractor with the licensed hospice program from requirements outside 18.18.005 - 18.18.390 pertaining to licensure of the individual.
(a) A final report on deficiencies and approved plans of correction that is prepared by the department after a licensure inspection or investigation of a hospice program it licenses under AS 18.18.005 - 18.18.390 shall be made available by the department to the public within 14 calendar days after the final report is made available to the hospice program being reviewed.
(b) The department may not publicly disclose information that identifies clients of the program under review.
It is the policy of the state that regulation of hospice programs should ensure an appropriate standard of care for hospice clients without unduly burdening the programs with requirements that consume staff time and financial resources that are essential for the delivery of services to hospice clients. In furtherance of this policy, AS 18.18.005 - 18.18.390 establishes two sets of standards for hospice programs that recognize the more limited staff time and financial resources available to voluntary hospice programs while requiring all programs to comply with basic minimum program standards.
(a) An entity that establishes, conducts, or represents itself to the public as a home health agency must have a license from the department authorizing it to be a home health agency under AS 18.18.410 - 18.18.490.
(b) A parent agency or subunit of a home health agency must be located in the state. Each subunit must independently meet the requirements of this section and be issued a separate license. A branch office of the parent agency or of one of its subunits is not required to independently meet the requirements for licensure.
(a) The purpose of AS 18.18.410 - 18.18.490 is to promote safe and adequate home health services for individuals by setting standards for home health agencies that will ensure quality of care, safeguard patient's rights, and otherwise protect public health, safety, and welfare.
(b) AS 18.18.410 - 18.18.490 and the regulations adopted under those sections apply to agencies for which licensure is required under AS 18.18.430.
A duly designated employee of the department may enter the premises of a hospice program that has applied for a license or who is licensed under 18.18.005 - 18.18.390. These employees may inspect documents of the hospice program to determine whether the program is in compliance with 18.18.005 - 18.18.390 and regulations adopted under 18.18.005 - 18.18.390. The right of entry and inspection extends to premises and documents of persons whom the department has reason to believe are operating a hospice program without a license.
The department may
(1) license home health agencies;
(2) inspect applicants and licensees, including subunits and branches of the licensee, and persons that the department reasonably believes are operating an agency without a license in violation of this chapter;
(3) consistent with the purposes identified in AS 18.18.410 , adopt regulations to implement AS 18.18.410 - 18.18.490, including regulations establishing licensure and renewal procedures, inspection procedures, standards, fees, and requirements for operation of home health agencies;
(4) accept accreditation by the Joint Commission on the Accreditation of Health Organizations or another national accreditation organization recognized by the department in lieu of an inspection of a home health agency by the department for the year in which the accreditation was granted if the accreditation standards are substantially similar to the inspection standards of the department.
(a) Upon receipt of an application for license and the license fee, the department shall issue a license if the applicant meets the requirements established under AS 18.18.410 - 18.18.490. If the applicant does not meet the requirements established under AS 18.18.410 - 18.18.490 but makes continued efforts to comply with them, the department may grant a temporary or provisional license for a limited period of time.
(b) Each license issued is for the person, agency, corporation, partnership, association, or other form of organization named on the application and is not transferable or assignable except with the written approval of the department.
(c) The department shall establish the standards for license renewal and determine the renewal period by regulation.
(d) A license is not renewable if it has been suspended or revoked under AS 18.18.460 .
(1) 'branch' means an office location from which a home health agency provides service within a portion of the total geographic area served by the parent home health agency and that is sufficiently close in geographic proximity to the parent home health agency that it shares administration, supervision, and services on a daily basis;
(2) 'department' means the Department of Health and Social Services;
(3) 'geographic area' means the location, site, or address of the clients served by the parent home health agency or its parents or subunits;
(4) 'home health agency' means a public agency or private organization, or a subdivision of a public agency or private organization, that primarily engages in providing skilled nursing services in combination with physical therapy, occupational therapy, speech therapy, or services provided by a home health aide to individuals in the individual's home, an assisted living home, or another residential setting;
(5) 'parent home health agency' means a licensed home health agency, which may have branches or subunits;
(6) 'subdivision' means a component of a multi-function home health agency, such as the home care division of a hospital or the nursing division of a health agency, that independently meets the requirements for licensure as a home health agency;
(7) 'subunit' means a home health agency that provides services beyond the geographic area served by the parent home health agency and is unable to share administration, supervision, and services on a daily basis with the parent home health agency.
(a) Upon receiving an application and fee, if any, for a license under 18.18.005 - 18.18.390, the department shall issue a license if the applicant meets the applicable requirements of 18.18.005 - 18.18.390.
(b) If an applicant under (a) of this section does not meet the applicable requirements but makes continued efforts to comply with them and any noncompliance does not directly affect the safety of clients, the department may issue a temporary or provisional license that is valid for a reasonable period of time, as determined by the department.
(c) A license under 18.18.005 - 18.18.390 shall be issued in the name of the person, agency, or other entity specified in the application and is not transferable or assignable without the written approval of the department.
(d) The department shall, by regulation, establish the application fee, license fee, length of time that a license is valid, and the standards for license renewal. A license is not renewable during the time it has been suspended or revoked under 18.18.005 - 18.18.390.
(a) The department shall issue a license to a volunteer hospice program that complies with this section and with AS 18.18.010 - 18.18.040 and 18.18.100(a), (b), (c)(1) - (3) and (5), (d), (g), and (j) - (l).
(b) A direct service volunteer must
(1) submit a written application;
(2) undergo a screening interview and an interview after training;
(3) attend an 18-hour standard training program;
(4) submit a confidentiality statement in which the volunteer agrees to follow the program's policy regarding confidentiality required by (a) of this section and AS 18.18.100 (k); and
(5) if the volunteer will transport individuals, have proof of auto insurance and a valid driver's license.
(c) Volunteer hospice programs shall develop and maintain policies and procedures that address the following with respect to volunteers in the program:
(1) recruitment, retention, and dismissal;
(2) screening;
(3) orientation;
(4) scope of function;
(5) supervision;
(6) ongoing training and support;
(7) team conferencing;
(8) records of volunteer activities; and
(9) bereavement services.
(d) Volunteer services in a volunteer hospice program must be directed by a coordinator of volunteer services who shall
(1) implement a direct service volunteer program;
(2) coordinate the orientation, education, support, and supervision of direct service volunteers; and
(3) coordinate the use of direct service volunteers with other hospice staff and community resources.
Article 03. GENERAL PROVISIONS
(a) The department may deny, change to a provisional license, or revoke a home health agency application or license if the department finds that the agency
(1) has endangered or would endanger the health, safety, or welfare of a patient;
(2) has a history of deficiencies in quality of care;
(3) has had a license to operate a home health agency revoked in any licensing jurisdiction;
(4) has been convicted of operating a home health agency without a license in any licensing jurisdiction;
(5) lacks a sufficient number of personnel who have the training, experience, or judgment to provide adequate patient care;
(6) has committed fraud, deceit, misrepresentation, or dishonesty associated with the application for or operation of a home health agency in any licensing jurisdiction; or
(7) has violated regulations adopted under AS 18.18.410 - 18.18.490.
(b) The department may, without a hearing, summarily suspend a home health agency license if it finds that the actions or deficiencies of the agency cause an immediate and serious threat to the public health, safety, or welfare. A summary suspension remains in effect until the department finds that the actions or deficiencies are corrected or the license is revoked.
(c) The department may, without a hearing, change a home health agency license to a provisional license for a period of time established by the department if the department finds that an agency is temporarily unable to comply with AS 18.18.410 - 18.18.490 or is in the Medicare decertification process, but is taking the appropriate steps necessary to bring the agency into compliance. An agency holding a provisional license may not accept new patients. If the agency fails to correct its deficiencies within the provisional license period, the department shall revoke that agency's license.
(d) Application denial and revocation actions by the department shall be conducted under AS 44.62 (Administrative Procedure Act).
(1) 'bereavement services' means emotional support services related to the death of a family member, which may include counseling, provision of written material, social reorientation, and group support for up to one year following the death of the client who was terminally ill;
(2) 'care plan' means a written service delivery plan that the interdisciplinary team, in conjunction with the client, shall develop to reflect the changing care needs of the client;
(3) 'client' means the person who is receiving the hospice services;
(4) 'department' means the Department of Health and Social Services;
(5) 'direct service provider' means employees or volunteers who provide hospice services directly to a client under a hospice program;
(6) 'family' means a spouse, primary caregiver, biological relatives, and individuals with close personal ties to the client;
(7) 'governing body' means the entity that establishes policy and is legally responsible for the overall operation of a hospice program;
(8) 'hospice philosophy' means a philosophy that is life affirming, recognizes dying as a normal process of living, focuses on maintaining the quality of remaining life, neither hastens nor postpones death, strengthens the client's role in making informed decisions about care, and stresses the delivery of services in the least restrictive setting possible and with the least amount of technology necessary by volunteers and professionals who are trained to help clients with the physical, social, psychological, spiritual, and emotional issues related to terminal illness so that the clients can feel better prepared for the death that is to come;
(9) 'hospice program' means a program that provides hospice services;
(10) 'hospice services' means a range of interdisciplinary palliative and supportive services provided in a home or at an inpatient facility to persons who are terminally ill and those persons' families in order to meet their physical, psychological, social, emotional, and spiritual needs;
(11) 'interdisciplinary team,' for a hospice program providing comprehensive services, means a group comprised of at least a primary health care provider, a licensed registered nurse, a social worker, a pastoral or other counselor, and a volunteer coordinator or representative;
(12) 'medical director' means a licensed physician who oversees the medical components of hospice services and the interdisciplinary team;
(13) 'nurse supervisor' means a licensed registered nurse with education, experience, and training in hospice nursing care who is designated by the program director to oversee nursing services for the hospice program;
(14) 'primary health care provider' means the physician or advanced nurse practitioner identified by the client or by the person authorized to make decisions for the client under a durable health care power of attorney;
(15) 'program director' means the person designated by the governing body of a hospice program as responsible for the day-to-day operations of the program;
(16) 'terminally ill' means that a person has a life expectancy of less than one year, in the opinion of the person's primary physician or the medical director, and is no longer receiving curative treatment;
(17) 'volunteer' means a trained individual who works for a hospice program without compensation;
(18) 'volunteer hospice program' means a hospice program that provides all direct patient care at no charge.
Article 04. HOME HEALTH AGENCIES
(a) The department may deny a license, reduce a license to a provisional license, or revoke a license if the department finds that the applicant or licensee, as appropriate, or the program director or medical director of the applicant or licensee, as applicable, has
(1) endangered the health, safety, or welfare of a client;
(2) a history of deficiencies in quality of care;
(3) had a license to operate a hospice program suspended or revoked in another licensing jurisdiction for a reason other than failure to pay a licensing fee;
(4) been convicted of operating a hospice program without a license in any jurisdiction;
(5) an insufficient number of staff with the training, experience, or judgment to provide adequate hospice care;
(6) committed fraud, deceit, misrepresentation, or an offense involving dishonesty associated with the license application or with the operation of a hospice program in any jurisdiction; or
(7) violated 18.18.005 - 18.18.390 or a regulation adopted under 18.18.005 - 18.18.390.
(b) The department may, without a hearing, summarily suspend a license of a hospice program if it finds that the actions or deficiencies of the program have caused, or present an immediate threat of causing, serious injury to a hospice program client. A licensee is entitled to a hearing conducted by the office of administrative hearings (AS 44.64.010) to appeal the summary suspension within seven days after the order of suspension is issued. A licensee may appeal an adverse decision of the department on an appeal of a summary suspension to the superior court. A summary suspension remains in effect until the department finds that the actions or deficiencies are corrected, the license is revoked, or the licensee is successful in appealing the suspension.
(c) The department may, without a hearing, reduce a hospice license to a provisional license for a period of time established by the department if the department finds that the licensee is temporarily unable to comply with 18.18.005 - 18.18.390 or is in the process of becoming decertified under the Medicare program but is taking appropriate steps to bring the program into compliance with 18.18.005 - 18.18.390 or Medicare certification requirements. A licensee is entitled to a hearing conducted by the office of administrative hearings to appeal a reduction to a provisional license under this subsection within seven days after the order to reduce the license is issued. A licensee may appeal an adverse decision of the department on an appeal of the order reducing the license to a provisional license to the superior court. A program with a provisional license under this subsection may not accept new clients. If the program fails to correct its deficiencies and does not successfully appeal the order reducing the license to provisional status within the period stipulated in the provisional license, the department shall revoke the license.
(a) Except as provided in AS 18.18.200 for volunteer hospice programs, a hospice program shall meet the requirements of this section. If a hospice program meets the requirements of this section and AS 18.18.010 - 18.18.040, the department shall issue a license for the program.
(b) A hospice program shall have a clear mission statement that is consistent with hospice philosophy.
(c) A hospice program shall have at least the following features:
(1) a governing body;
(2) an established set of admission criteria for determining appropriate clients;
(3) a program director;
(4) an interdisciplinary team;
(5) volunteers; and
(6) a medical director.
(d) A hospice program may only provide services to a person if the person
(1) consents to receive those services; and
(2) fits the admissions criteria of the hospice program.
(e) Hospice services shall be delivered in accordance with a care plan approved by the interdisciplinary team regardless of whether the hospice services are provided by hospice program staff or by contractors. The care plan must be reviewed periodically by the interdisciplinary team and revised as needed. The client, and the client's family if the client desires, must be given the opportunity to participate in the development of the care plan and must be informed of the opportunity to attend interdisciplinary team meetings. The interdisciplinary team must consider the need for at least the following services when developing the care plan:
(1) social services;
(2) nursing care;
(3) counseling;
(4) pastoral care;
(5) volunteer visits to provide comfort, companionship, and respite;
(6) bereavement services for at least one year after the death of the person who is terminally ill; and
(7) medical services.
(f) Nursing services provided by a hospice program shall be provided in accordance with a care plan and must be under the direction and supervision of a nurse supervisor. The nurse supervisor shall
(1) develop nursing objectives, policies, and procedures consistent with hospice philosophy;
(2) develop job descriptions for nursing personnel consistent with hospice philosophy;
(3) establish staffing and on-call schedules for nursing staff to ensure the availability of nursing services 24 hours a day, seven days a week; and
(4) develop and implement orientation and training programs for nursing staff.
(g) Before providing a hospice service in a hospice program, a direct service provider shall receive an orientation of at least four hours specific to hospice service. The policy and procedures of the hospice program define the agenda of the hospice orientation program. The hospice program shall document in personnel files that staff members have completed the four-hour orientation. Indirect service volunteers shall be oriented according to program policies. The hospice orientation program must include the following subjects:
(1) hospice philosophy;
(2) personal death awareness;
(3) communication skills;
(4) personnel issues;
(5) identification of hospice resource people;
(6) stress management;
(7) ethics;
(8) stages of dying; and
(9) funeral arrangements.
(h) A hospice program shall provide an educational program that offers a comprehensive overview of hospice philosophy and hospice care. A minimum of 18 hours of education, received within a one-year period, including four hours of orientation, is required for all direct service providers delivering hospice care. Documentation of completion of this program is transferable from one hospice program to another. The educational program must include the following subjects:
(1) hospice philosophy;
(2) family dynamics;
(3) pain and symptom management;
(4) grief, loss, and transition;
(5) psychological perspectives on death and dying;
(6) spirituality;
(7) communication skills;
(8) volunteer roles; and
(9) multidisciplinary management.
(i) Direct service providers in a hospice program shall complete a minimum of eight hours of continuing education or in-service training each year after the first year, based on date of hire.
(j) A hospice program shall maintain, at a minimum, the following records:
(1) a record for each client that includes copies of the client's care plan, progress notes, assessments, and a description of services provided to the client and the client's family;
(2) minutes of governing body meetings;
(3) all receipts and expenditures; and
(4) training provided to paid staff and volunteers.
(k) A hospice program shall have and follow written policies and procedures governing its operation, including policies relating to confidentiality, training, and admissions.
(l) A person who enters a hospice program shall be given information regarding living wills and durable health care powers of attorney.
(m) The hospice program shall have a functional quality assurance or improvement plan in place that
(1) continually monitors and evaluates the care provided;
(2) identifies issues and potential issues;
(3) proposes and implements improvements; and
(4) reevaluates the care provided to determine if further improvement is possible or needed.
(n) A hospice program may not use a direct service provider whose name is listed on an abuse registry maintained by the Department of Commerce, Community, and Economic Development, division of occupational licensing. A hospice program shall contact the division for a determination of whether a prospective direct service provider's name is on an abuse registry maintained by the division and may not allow the person to provide hospice services until the division has responded to the inquiry. The Department of Commerce, Community, and Economic Development may adopt regulations to implement this subsection.
Article 02. LICENSING OF VOLUNTEER HOSPICE PROGRAMS
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