Hospice Services

Physician Certification: The attending physician must certify that a client is terminally ill, defined under Texas Medicaid hospice regulations as having a medical prognosis of 6 months or less to live if the illness runs its normal course. 

The certification statement should include information from record review or consultation with the referring physician. The attending hospice physician or the client’s primary care provider may give orders for client care, including medications and other palliative therapies.

1. Percentage of clients with an attending physician’s certification of terminal illness in the client’s primary record. 

2. Percentage of clients with documentation of physician orders for initiation of care.

Health Assessment: Staff must complete a comprehensive health assessment for each client within 48 hours of admission that identifies the client’s needs for medical, nursing, social, emotional, and spiritual care. 

3. Percentage of clients with a comprehensive health assessment completed within 48 hours of admission.

Care Planning: Agencies must complete a care plan based on the provider’s orders for each client within 7 calendar days of admission and must review plans monthly, at a minimum.

The hospice provider must maintain a complete medication list for all clients, including both scheduled and as-needed medications. Providers may prescribe HIV medications if discontinuance would result in adverse physical or psychological effects.

4. Percentage of clients with a care plan completed within 7 calendar days of admission.

5. Percentage of clients with documentation of monthly care plan reviews.

6. Percentage of clients with a complete medication list in the client’s primary record.

Bereavement Counseling: Hospice providers must have an organized program for the provision of bereavement services, under the supervision of a qualified professional with experience or education in grief or loss counseling. Agencies must make bereavement services available to the client’s family and loved ones and these services should reflect the needs of the bereaved. Hospice staff should develop a bereavement plan of care that notes the kind of bereavement services to be offered to the client’s loved ones and the frequency of service delivery.

7. Percentage of clients with documentation of bereavement counseling offered to the family upon admission to hospice services. 

Dietary Counseling: Agencies should provide dietary education and interventions as needed, which may include counseling for clients and family members regarding appropriate nutritional intake as the client’s condition progresses. A dietician or registered nurse must perform dietary counseling.

8. Percentage of clients with documentation of dietary counseling provided, when a need is identified in the care plan

Spiritual Counseling: Hospice service providers must offer spiritual counseling that meets the client’s needs for spiritual support. Spiritual counseling staff should: :

• Advise the client of the availability of spiritual counseling services
• Assess the client's spiritual needs
• Make all reasonable efforts to facilitate visits by local clergy, a pastoral counselor, or other persons who can support a client's spiritual needs.

9. Percentage of clients with documentation that spiritual counseling was offered.

Mental Health Counseling: Agencies must offer mental health counseling for clients who demonstrate a need or who request these services. Care should be solution-focused, outcomes-oriented, and have a time-limited set of activities for the purpose of achieving goals identified in the client’s individual treatment plan. A licensed mental health professional should provide mental health counseling services (see Mental Health Service Standard and Universal Standards for qualifications).

10. Percentage of clients with documentation that mental health counseling was offered, as medically indicated.

Discharge: A client is no longer in need of hospice services if one or more of these criteria is met: 

• Client dies
• Client’s medical condition improves, and hospice care is no longer necessary
  • A referral to Medical Case Management or Outpatient/Ambulatory Health Services must be completed 
• Client elects to be discharged
• Client is discharged for cause
• Client is transferred out of the provider’s facility

11. Percentage of clients with documentation of discharge status, as applicable..