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 the accreditation of hospice programs.
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.
Code of Maryland Regulations
- 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 10.07.21.07 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.