DEPARTMENT OF CONSUMER AND INDUSTRY SERVICES

                             DIRECTOR'S OFFICE

                      HOSPICE AND HOSPICE RESIDENCES

(By authority conferred on the department of consumer and  industry  services 
by Section 21419 of 1978 PA 368 and Executive Orders Nos. 1996-1 and  1996-2, 
MCL 333.21419, 330.3101, and 445.2001)


                        PART 1. GENERAL PROVISIONS

R 325.13101    Definitions.
  Rule 101.(1) As used in these rules:
  (a) "Applicant" means a person applying to the  department  for  a  hospice 
license.
  (b) "Bereavement services" means those services provided to the  family  to 
assist them in coping with the death of the patient.
  (c) "Change of ownership," for purposes of section 20142(3)  of  the  code, 
means a transfer of the property of a hospice  from  one  owner  to  another, 
where the new owner will use the transferred property as a  hospice  operated 
by the new owner subsequent to the transfer.
  (d) "Code" means 1978 PA 368, MCL 333.1101 et seq.
  (e) "Department" means the department of consumer and industry services.
  (f) "Distinct hospice administration" means an identifiable  administrative 
group which has a distinct organizational structure and which is  accountable 
to a governing body, either directly or through the  governing  body's  chief 
executive officer, for all aspects of the hospice.
  (g) "Governing body" means any of the following:
  (i) The policy?making body of a hospice, which is a government agency.
  (ii)  The  board  of  directors  or  trustees  of  a  hospice  which  is  a 
not?for?profit corporation.
  (iii) The board of directors of a hospice which is a business corporation.
  (iv) The proprietor or owners of a hospice which is a solely owned business 
or partnership.
  (h) "Hospice" means a program  which  provides  palliative  and  supportive 
services to meet physical, psychological,  social,  and  spiritual  needs  of 
patients and their families in the home, health  care  facilities,  or  other 
residential settings.
  (i) "Hospice administrator" means  a  person  who  is  responsible  to  the 
governing body,  either  directly  or  through  the  governing  body's  chief 
executive officer, for the administrative operation of a hospice.
  (j) "Hospice patient" or "patient" means  an  individual  in  the  terminal 
stage of illness who has an anticipated life expectancy of 6 months  or  less 
and who, alone or in  conjunction  with  a  family  member  or  members,  has 
voluntarily requested admission and been accepted into a hospice.
  (k) "Hospice  patient's  family"  means  the  hospice  patient's  immediate 
relations, including  a  spouse,  brother,  sister,  child,  or  parent.   In 
addition, other relations and individuals with significant personal  ties  to 
the hospice patient may be designated as members  of  the  hospice  patient's 
family by mutual agreement between  the  hospice  patient,  the  relation  or 
individual, and the hospice organization.  The patient?family unit  shall  be 
considered the unit of care throughout these rules.
  (l) "Hospice  patient?family  record"  means  written  medical  and  health 
information pertaining to services rendered  the  patient?family  unit  by  a 
hospice.
  (m) "Hospice residence" means a hospice residence  as  defined  by  section 
21401(1)(B) of the code.
  (n) "Hospice staff"  means  the  individuals  who  work,  with  or  without 
remuneration, for the hospice.
  (o) "Interdisciplinary care team"  means  a  group  composed  of  qualified 
individuals who collectively have expertise in assessing the special needs of 
the hospice patient?family unit.
  (p) "Licensee" means a program or  residence  that  possesses  a  currently 
valid hospice license.
  (q) "Ownership interest" means the ownership or control of 5%  or  more  of 
the equity in the capital or stock, or interest in the profits, of a hospice.
  (r) "Physician" means a physician licensed under part 170  or  175  of  the 
code.
  (s) "Sale of a hospice" means a change in ownership by sale.
  (2) The definitions and principles of construction in articles 1 and 17 and 
part 214 of 1978 PA 368,  MCL  333.1101  et  seq.,  333.20101  et  seq.,  and 
333.21401 et seq. apply to these rules.

  History:  1984 AACS; 2003 AACS.


R 325.13102    State, federal, and local laws, rules, codes, and  ordinances; 
compliance.
  Rule 102. A hospice and its hospice  residence,  if  applicable,  which  is 
licensed or certified shall comply with applicable state and federal laws and 
rules and shall furnish evidence  as  the  department  may  require  to  show 
compliance with the laws and rules and applicable  local  rules,  codes,  and 
ordinances.

  History:  1984 AACS; 2003 AACS.


R 325.13104    Patient?family  unit;  rights  and  responsibilities   policy; 
adoption of written procedure required.
  Rule 104. (1) A hospice and its hospice  residence,  if  applicable,  shall 
adopt  written  policies  and  procedures  to  implement   the   rights   and 
responsibilities of the patient?family unit as provided by  section  20201(1) 
and  (2)  of  the  code.  Before  and  following  the  patient?family  unit's 
admission, the policy and procedures shall be available upon request.
  (2)  The  procedures  shall  include  a  mechanism  for   the   initiation, 
investigation, and resolution of complaints, subject to department  approval, 
and, at a minimum, all of the following:
  (a) A statement that a patient?family unit may  complain  to  the  hospice, 
hospice residence, or the department about any condition, event, or procedure 
in the hospice and its hospice residence, if  applicable,  without  citing  a 
specific violation of the code or these rules.
  (b) A procedure for submitting written complaints to the  hospice  and  its 
hospice  residence,  if  applicable,  including  a  procedure  to  assist   a 
complainant in reducing an oral complaint to writing, when the oral complaint 
is not resolved to the satisfaction of the complainant.
  (c) The name, title, location, and telephone number of  the  individual  in 
the hospice and its hospice residence, if applicable, who is responsible  for 
receiving complaints and conducting complaint investigations and a  procedure 
for communicating with that individual.
  (d) A requirement that all complaints be investigated within 5 working days 
following receipt of a complaint by the hospice and its hospice residence, if 
applicable, and a requirement that, within 15 working days following  receipt 
of the complaint, the hospice and its hospice residence, if applicable, shall 
deliver  to  the  complainant  a  written  report  of  the  results  of   the 
investigation.
  (e) A mechanism for appealing  the  matter  to  the  administrator  of  the 
hospice and its hospice residence, if applicable, if the complainant  is  not 
satisfied with the investigation or resolution of the complaint.
  (3) A hospice and its hospice  residence,  if  applicable,  shall  maintain 
written complaints filed under its  complaint  procedure  and  all  complaint 
investigation reports delivered to each complainant for 3 years. The  records 
shall be available to the department upon request.

  History:  1984 AACS; 2003 AACS.


R 325.13105    Complaints to the department.
  Rule 105. (1) When a person files a written complaint against, and requests 
investigation of,  a  hospice  and  its  hospice  residence,  if  applicable, 
pursuant to  section  20176  of  the  code,  the  complaint,  if  alleging  a 
nonrecurring violation, shall be made within 12 months of  the  discovery  of 
the violation or, if the complaint has been initially filed with the  hospice 
and its hospice residence, if applicable, within 12 months following a  final 
determination in the matter by the hospice  and  its  hospice  residence,  if 
applicable.  A complaint, if alleging a recurring violation,  shall  be  made 
within 12 months of the last alleged occurrence cited  in  the  complaint  or 
within 12 months following a final determination in the matter by the hospice 
and its hospice residence, if applicable.
  (2) If a complaint is not filed within the  12?month  period  specified  in 
subrule (1) of this rule, the department may  consider  the  complaint  based 
upon information supplied by the  complainant  as  to  the  reasons  for  the 
failure to file within the 12?month period.
  (3) Complaints shall be in writing, shall be signed by the complainant, and 
shall indicate the name and address of the hospice and its hospice residence, 
if applicable, the nature of  the  complaint,  and  the  complainant's  name, 
address, and telephone number. If a complaint is oral, the  department  shall 
have the option  of  determining  what,  if  any,  action  it  will  take  in 
investigating the complaint.
  (4) Anonymous complaints shall be received and evaluated.   The  department 
may investigate anonymous complaints.
  (5) A complainant who is dissatisfied with  the  written  determination  or 
investigation by the department may appeal as provided by section 20176(2) of 
the code.

  History:  1984 AACS; 2003 AACS.


R 325.13106    Governing body; duties and responsibilities.
  Rule 106.  (1) A hospice and its hospice residence,  if  applicable,  shall 
have a clearly defined, organized governing  body  which  shall  assume  full 
legal responsibility for the overall conduct and operation of the hospice and 
its hospice residence, if applicable, including quality of care and services.
  (2) The governing body  shall  be  responsible  for  the  establishment  of 
policies and procedures for the management, operation, and evaluation of  the 
hospice and its hospice residence, if applicable.
  (3) The governing body shall meet at sufficient intervals to carry out  its 
legal obligations and shall keep a written record of its actions.
  (4) The governing body shall not enter  into  any  agreement  limiting  its 
responsibility.
  (5) The governing body shall appoint  a  hospice  administrator  and  shall 
delegate to the administrator the authority  for  operating  the  hospice  in 
accordance with policies established by the governing body.
  (6) The governing body shall provide for medical direction of  the  hospice 
and its hospice residence, if applicable, through a  physician  or  group  of 
physicians who are currently licensed under part 170 or 175 of  the  code  to 
practice in the state of Michigan.
  (7) If the hospice organization and its hospice residence,  if  applicable, 
discontinues operation of the hospice for  any  reason,  the  governing  body 
shall   comply   with   the   appropriate   provisions   set   forth   in   R 
325.13109(1)(t)(vi).

  History:  1984 AACS; 2003 AACS.


R 325.13107    Hospice administrators; duties.
  Rule 107. (1) The hospice administrator shall direct the  hospice  and  its 
hospice residence, if applicable, and ensure implementation of  policies  and 
procedures regarding all activities and  patient?family  unit  care  services 
provided in the hospice and its hospice  residence,  if  applicable,  whether 
provided through staff employed directly  by  the  hospice  and  its  hospice 
residence, if applicable, by volunteers, or through contract arrangement.
  (2) The hospice administrator shall designate, in writing, an alternate  to 
act in his or her absence.
  (3) The hospice administrator shall implement administrative  policies  and 
procedures which include personnel policies and which are applicable  to  all 
hospice and its hospice residence, if applicable, staff.
  (4) The  hospice  administrator  shall  implement  financial  policies  and 
procedures, approved by the  governing  body,  according  to  sound  business 
practice, including, but not limited to, all of the following:
  (a) Payroll.
  (b) Budget.
  (c) Accepting and accounting for gifts and donations.
  (d) Keeping and submitting such reports and  records  as  required  by  the 
department and other authorized agencies.

  History:  1984 AACS; 2003 AACS.


R 325.13108    Services generally.
  Rule 108. As the needs  of  the  hospice  and  its  hospice  residence,  if 
applicable,  and   its   patient?family   units  dictate,  the  services   of 
qualified personnel, who  need  not  be  salaried employees,  shall  be  made 
available in all of the following disciplines:
  (a) Medical care.
  (b) Nursing care.
  (c) Social work.
  (d) Spiritual care.

  History:  1984 AACS; 2003 AACS.


R 325.13109    Development of policies and procedures for home  or  inpatient 
care and services program provided by a hospice and its hospice residence, if 
applicable.
  Rule 109. (1)  Written  policies  and  procedures  shall  be  developed  to 
coordinate a program for home or inpatient care and services  provided  by  a 
hospice and its hospice residence, if applicable. The  written  policies  and 
procedures shall include all of the following:
  (a) Philosophy and objectives.
  (b) Patient?family unit rights and responsibilities.
  (c) Medical direction.
  (d) Admissions, transfers, and discharges of the patient?family unit.
  (e) Types of services provided and  the  coordination  of  those  services, 
including inpatient care and follow?up.
  (f) Quality assurance programs.
  (g) Determining the number and types of staff and volunteers needed.
  (h) Position descriptions for each  category  of  employed,  volunteer,  or 
contracted personnel.
  (i)  Orientation  and  staff  development  to  all   personnel,   including 
volunteers.
  (j) Functions of interdisciplinary care team.
  (k) Medical services.
  (l) Nursing services.
  (m) Nutrition services.
  (n) Pharmaceutical services.
  (o) Bereavement services.
  (p) Social work services.
  (q) Volunteer services.
  (r) Informed consent.
  (s) Availability of a staff member, 24 hours a day, 7 days  a  week,  to  a 
patient?family unit.
  (t) A hospice patient?family unit record relating to all of the following:
  (i) Documentation by staff of services rendered to patient?family units.
  (ii) Confidentiality of medical information.
  (iii) Release of information or the provision of copies of the  information 
to patient?family units or authorized persons upon  written  consent  of  the 
patient or guardian.
  (iv)  Transfer  of  medical  information  to  another  hospice  program  or 
inpatient unit.
  (v) Records retention for a period of not less than 5 years following death 
or discharge or, in the case of a minor, 3 years after the  individual  comes 
of age under state law, whichever is longer.
  (vi) Notification to the department regarding storage  of  records  if  the 
hospice ceases to operate.
  (2) All policies and procedures shall be reviewed and shall be revised,  if 
necessary, annually.
  (3) All policies and procedures shall be immediately available for  on?site 
inspection by the department.

  History:  1984 AACS; 2003 AACS.


R 325.13110    Patient rights and  responsibilities  policy;  transmittal  of 
information  to  patient?family   unit;  provision  of  hospice  and  hospice 
residence rules and regulations to patient?family unit required.
  Rule 110. (1) A hospice and its hospice  residence,  if  applicable,  shall 
develop, adopt, post in a public place, distribute, and implement a policy on 
the rights and responsibilities of hospice patient?family units in accordance 
with the requirements of sections 20201, 20202, and 20203 of the code.
  (2) A hospice and its hospice residence, if applicable, shall  assure  that 
information transmitted to a patient?family unit will be  communicated  in  a 
manner that will reasonably ensure that the information is understood by  the 
patient?family unit.
  (3) The hospice and its hospice residence, if applicable, shall assure that 
a patient?family unit is provided with information about  the  hospice  rules 
and regulations affecting patient care  and  conduct.  The  hospice  and  its 
hospice residence, if applicable, shall provide a written copy of the hospice 
and its hospice residence,  if  applicable,  rules  and  regulations  to  the 
patient?family unit  upon  request  or  admission  and  when  the  rules  and 
regulations are changed.

  History:  1984 AACS; 2003 AACS.


R 325.13111    Quality assurance program.
  Rule 111. (1) The hospice and its hospice residence, if  applicable,  shall 
develop and implement, through an  interdisciplinary  committee,  an  ongoing 
quality assurance program which will monitor activities and identify problems.
  (2) The committee shall adopt or develop professional standards which, at a 
minimum, shall address all of the following:
  (a) Interdisciplinary team services.
  (b) Patient and family as the unit of care.
  (c) Symptom control.
  (d) Continuity of care.
  (e) Home care services.
  (f) Inpatient services.
  (3) The committee shall do all of the following:
  (a) Collect and analyze data.
  (b) Recommend change when necessary.
  (c) Recommend reevaluation when necessary.

  History:  1984 AACS; 2003 AACS.


                             PART 2. LICENSURE


R 325.13201    Hospice and hospice residence; establishing,  maintaining,  or 
operating without license prohibited.
  Rule 201. A person shall not establish, maintain, or operate a hospice  and 
its hospice residence, if applicable, unless licensed by  the  department  in 
accordance with section 21411 of the code and these rules.

  History:  1984 AACS; 2003 AACS.


R 325.13202    Time of application.
  Rule 202. An application  for  initial  licensure  shall  be  made  to  the 
department not less than  90  days  before  the  hospice's  and  its  hospice 
residence's, if applicable, anticipated  opening  date.  An  application  for 
renewed licensure shall be submitted to the department not less than 90  days 
before the expiration of the current license.

  History:  1984 AACS; 2003 AACS.


R 325.13203    Content of application.
  Rule 203. (1) An application for an initial or renewed license shall  be
made on a form authorized and provided by  the  department  and  shall  be
completed  in  full  in  accordance  with  department  instructions.   The
application form shall be accompanied by the attachments, additional data,
and information required by the department.
  (2) A complete application shall include,  at  a  minimum,  all  of  the
following:
  (a) A completed application form, including the assurances described  in
section 20152 of the code.
  (b) Identification of  owners  and  financially  interested  persons  as
required.
  (c) The applicable license fee.
  (d) Evidence of a currently valid certificate of need if applicable.
  (e) Additional information specified in departmental instructions.

  History:  1984 AACS.


R 325.13204    Processing the application.
  Rule 204. (1) The department shall review all applications to  determine
whether they are complete and  shall  promptly  notify  the  applicant  in
writing if additional information is required to complete the  application
or determine compliance with the code  and  these  rules.  The  department
shall investigate and consider each completed application.
  (2) By applying for or accepting a license or a permit, an applicant  or
licensee authorizes the department and its representatives to conduct  the
surveys, inspections, and investigations necessary to determine compliance
with applicable licensing standards.

  History:  1984 AACS.


R 325.13205    Surveys and investigations.
  Rule 205. (1) The department shall conduct a survey and investigation of  a 
hospice for initial licensure within the 3?month period following receipt  of 
the application.  An initial hospice license shall  only  be  issued  if  the 
department, after completing a survey and investigation, finds the hospice to 
be in substantial compliance with the requirements  of  the  code  and  these 
rules.  An initial hospice residence license  may  be  issued  subject  to  a 
survey and investigation following its opening.
  (2) The department may make additional visits, inspections, and
investigations for the purpose of survey, evaluation, consultation,
complaint investigation, or enforcement of these rules and the code.
  (3) Surveys and investigations by the department pursuant to this part  may 
include all of the following:
  (a) Inspections of applicable programs and their operation.
  (b) Inspection and copying of books, records, patient?family  unit  medical 
records, and other documents  maintained  by  the  hospice  and  its  hospice 
residence, if applicable.
  (c) The acquisition of other information from any other person who may have 
information bearing on the applicant's or licensee's compliance or ability to 
comply with the applicable requirements for licensure.
  (4) When making a survey or investigation, the department representative or 
representatives shall, upon request, present proper identification. For  this 
purpose, "proper identification"  means  a  card  issued  by  the  department 
certifying that the holder is an employee of the department.

  History:  1984 AACS; 2003 AACS.


R 325.13206    Disclosure of ownership interests.
  Rule 206. (1) An applicant or licensee shall include all of  the  following 
information with its application for an initial or renewed license:
  (a) The name, address, principal occupation, and official position  of  all 
persons who have an  ownership  interest  in  the  hospice  and  its  hospice 
residence, if applicable.
  (b) The name, address, principal occupation, and official position of  each 
trustee for a voluntary nonprofit corporation.
  (c) If a hospice is located on or in leased real estate, the  name  of  the 
lessor and any direct or indirect interest of the applicant or licensee.
  (2) The department may accept ownership interest  reports  filed  with  the 
securities and exchange commission in place of the  information  required  in 
subrule (1) of this rule, if  the  department  determines  that  the  reports 
contain the information required.

  History:  1984 AACS; 2003 AACS.


R 325.13207    Administrator; responsibilities as  hospice  and  its  hospice 
residence, if applicable, agent.
  Rule 207. An application for an initial or renewed license or certification 
shall  be  signed  by  the  owner  or  hospice  administrator.   The  hospice 
administrator shall act as agent for the owner  or  owners  with  respect  to 
doing any of the following:
  (a) Submitting the application and making amendments thereto.
  (b)  Providing  the  department  with  all  information  necessary  for   a 
determination with respect to the application.
  (c) Entering  into  agreements  with  the  department  in  connection  with 
licensure or certification.
  (d) Receiving notice and service of process on behalf of the  applicant  in 
matters relating to licensure or certification.

  History:  1984 AACS; 2003 AACS.


R 325.13208    Action on applications for licensure.
  Rule 208. (1) With respect to any application for licensure, on  the  basis 
of the information  supplied  by  the  applicant  or  any  other  information 
available to it, including hospice and its hospice residence, if  applicable, 
surveys and investigations, the department shall  take  1  of  the  following 
actions:
  (a) Issue the license.
  (b) Issue a temporary unrenewable permit.
  (c) Deny an initial or renewed license.
  (d) Take other action consistent with the purposes of the code.
  (2) Action by the department pursuant to subrule (1)(b) or (c) of this rule 
shall be preceded by a notice of intent and an opportunity for a hearing.  In 
all other cases, the determination of the department is final.

  History:  1984 AACS; 2003 AACS.


R 325.13209    Rescinded.

  History:  1984 AACS; 2003 AACS.



R 325.13210    Temporary permits.
  Rule 210. (1)  The  department  may  issue  a  temporary  permit  to  an
applicant  pursuant  to  section  20162(2)  of  the  code  when,  in   the
department's discretion, additional time is needed  for  the  department's
survey, inspection, or investigation of the applicant or  additional  time
is  needed  for  the  applicant,  including  the  initial  applicant   and
applicants applying because of changes in ownership, to undertake remedial
action as described in section 20162(2) of the code.
  (2) A temporary permit shall expire on the date set forth on  its  face,
but not more than 6 months after the date of its  issuance,  whichever  is
sooner. The holder of a temporary permit shall reapply for a  license  not
less than 90 days before the expiration date of the  temporary  permit.  A
temporary permit is not renewable.

  History:  1984 AACS.


R 325.13211    Notice  to  department  of  change  in  information  required; 
transfer of license; posting.
  Rule 211. (1) An applicant or licensee shall give  written  notice  to  the 
department within 5 business days of any change in information  submitted  as 
part of an application for initial or renewed licensure.
  (2) A license is not transferable.
  (3) The current license shall be posted in a conspicuous  public  place  in 
the hospice and its hospice residence, if applicable, office. For purposes of 
this rule, the term "license" includes  a  limited  license  or  a  temporary 
permit.

  History:  1984 AACS; 2003 AACS.


R 325.13212    Prohibited terms.
  Rule 212. In addition to the terms limited by the  code,  the  use  of  the 
words "state approved" or words having a similar meaning is prohibited unless 
the hospice and its hospice residence, if applicable,  is  operated  under  a 
current license.

  History:  1984 AACS; 2003 AACS.


R 325.13213    Public inspection of license records.
  Rule 213. (1) Unless otherwise  provided  by  law,  records  pertaining  to 
licensure and certification are available for public inspection  and  copying 
during business hours on the days when the department is open for business.
  (2) The department shall delete from licensing  and  certification  records 
made available for inspection any matters or items of information exempt from 
disclosure under law. Fees related to requests for inspection  or  copies  of 
licensing and certification records shall  be  assessed  in  accordance  with 
applicable law and department procedure.
  (3)  Arrangements  for  the  inspection  or  copying   of   licensing   and 
certification records shall be made with the department.

  History:  1984 AACS; 2003 AACS.


                             PART 3. SERVICES


R 325.13301    Contractual services.
  Rule 301. (1) A hospice and  its  hospice  residence,  if  applicable,  may 
contract with other health care providers  or  appropriate  parties  for  the 
provision of care and services when the hospice and/or its hospice residence, 
if applicable, does not have sufficient qualified staff or available adequate 
equipment to render such services directly.  Contracts  for  shared  services 
shall be written and shall clearly delineate the authority and responsibility 
of the contracting parties.  Contracts  with  providers  shall  maintain  the 
responsibility of the hospice and its hospice residence, if  applicable,  for 
coordinating and administering the hospice  and  its  hospice  residence,  if 
applicable, program.
  (2)  The  hospice   administrator   shall   maintain   responsibility   for 
coordinating and administering the hospice program.
  (3) Any  and  all  personnel  provided  to  the  hospice  and  its  hospice 
residence, if applicable, under the terms of  contracted  services  shall  be 
licensed or credentialed as required by law.
  (4)  All  contracts  shall  include  financial  arrangements  and  charges, 
including donated services.
  (5) All contracts shall state the availability of service.
  (6) A contracted service shall not absolve the hospice from  responsibility 
for the quality, availability,  documentation,  or  overall  coordination  of 
patient?family unit care or responsibility for compliance with  any  federal, 
state, or local law or rules and regulations.
  (7) All contracts shall be reviewed annually and revised if necessary.
  (8) All contracts shall be signed and dated by the  administrator  and  the 
duly authorized official of the agency providing the contractual service.
  (9) All contracts shall state that the contractor will provide services  to 
the patient in accordance with the patient care plan developed by the hospice.
  (10) Employees of an agency providing a contractual service shall not  seek 
or accept reimbursement in addition to that due the  agency  for  the  actual 
service delivered.
  (11) All contracts shall prohibit the sharing of fees between  a  referring 
agency or individual and the hospice and its hospice residence, if applicable.

  History:  1984 AACS; 2003 AACS.


R 325.13302    Medical services.
  Rule 302. (1) At the time of admission  to  the  hospice  program  and  its 
hospice residence, if applicable, and thereafter, a patient  shall  be  under 
the care of a physician who shall be responsible for providing  or  arranging 
for medical care.  This physician may be the attending physician.
  (2) The physician  providing  the  medical  care  to  a  patient  shall  be 
responsible for the direction and quality of medical care  rendered  to  that 
patient.
  (3) The physician shall review the patient's medical history  and  physical 
assessment within 48 hours before or following the patient's admission to the 
program. 
  (4) The physician shall do both of the following:
  (a) Validate the prognosis and life expectancy of the patient.
  (b) Assist in developing the care plan of the patient.
  (5) Medical care shall emphasize prevention and control of pain  and  other 
distressing symptoms.
  (6) Physician?patient/family encounters shall be at least  as  frequent  as 
described in the written plan of care.
  (7) All physician orders and the services rendered shall be entered in  the 
patient and family record.
  (8) The hospice and its hospice residence,  if  applicable,  shall  arrange 
with a physician or group  of  physicians  to  provide  the  development  and 
coordination of the medical care to ensure the adequacy  and  appropriateness 
of the medical services.
  (9) The hospice and its hospice residence, if applicable, shall arrange for 
the availability of medical services 24 hours a day, 7 days a week.

  History:  1984 AACS; 2003 AACS.


R 325.13303    Physicians' assistants services.
  Rule 303. (1) A physician's assistant working under the  supervision  of  a 
licensed approved physician, as set forth in part 170 or 175 of the code, may 
carry out appropriate delegated  functions  in  a  hospice  and  its  hospice 
residence, if applicable, in accordance with written policies of the  hospice 
and its hospice residence, if applicable, which are formally adopted  by  the 
governing body, owner, or operator.
  (2) The written policies  governing  the  functioning  of  the  physician's 
assistant within the hospice and its hospice residence, if applicable,  shall 
be consistent with law and rules applicable to the hospice  and  its  hospice 
residence, if applicable, the  physician's  assistant,  and  the  supervising 
physician.
  (3) The  physician's  assistant  shall  not  substitute  for  the  licensed 
physician insofar as the overall  responsibility  for  a  patient's  care  is 
concerned.
  (4) The attending physician supervising a physician's  assistant  shall  do 
all of the following:
  (a) Visit the patient at intervals prescribed in R 325.13302(6).
  (b) Check, renew, or  amend  physician  assistant's  orders  at  prescribed 
intervals.
  (c) Review and  participate  in  the  development  of  patient  care  plans 
following admission and at prescribed intervals.
  (d) Review, approve, and countersign all physician assistant entries in the 
patient?family unit record. Orders written by the physician's assistant shall 
be countersigned by the attending supervising physician within 48 hours.

  History:  1984 AACS; 2003 AACS.


R 325.13304    Nursing services.
  Rule 304. (1) Nursing services in a hospice and its hospice  residence,  if 
applicable, shall be available directly or by  written  agreement  7  days  a 
week, 24 hours per day and shall be under the supervision of  a  director  of 
nursing who is registered and licensed in the state of Michigan.
  (2) Written policies and procedures for nursing services shall be developed 
by the director of  nursing  and  implemented  incorporating  objectives  and 
maintaining standards of nursing practice.
  (3) The development of a comprehensive patient care plan for  each  hospice 
and its hospice residence, if applicable, patient?family unit shall  commence 
within 24 hours of admission.
  (4) The patient care plan shall be  established  by  the  hospice  and  its 
hospice residence, if  applicable,  designated  interdisciplinary  care  team 
composed of, at a minimum, all of the following:
  (a) Physician.
  (b) Registered nurse.
  (c) Social worker.
  (d) A spiritual advisor, if selected by the patient?family unit.
  (5) A staff member, as designated  in  the  patient  care  plan,  shall  be 
responsible for the coordination, implementation, and ongoing review of  each 
plan. The plan shall be recorded in ink and shall be maintained  as  part  of 
the patient?family unit record.
  (6) The patient care plan shall give direction to the care given in meeting 
the physiological, psychological, sociological, and spiritual  needs  of  the 
patient?family unit. The  plan  shall  specifically  address  maintenance  of 
patient independence and pain control.
  (7) Resource materials relating to the administration and untoward  effects 
of medications and treatments used in  pain  and  symptom  control  shall  be 
readily available to hospice and hospice residence personnel.

  History:  1984 AACS; 2003 AACS.


R 325.13305    Bereavement and spiritual services.
  Rule 305.  (1) The hospice and its hospice residence, if applicable,  shall 
provide,  either  directly  or  by  arrangement,  bereavement  and  spiritual 
services to the patient and family before and following the patient's death.
  (2) Bereavement and spiritual services shall be  available,  if  needed,  7 
days a week and shall be available to the family for not less than 13  months 
following the death of the patient.
  (3) Bereavement and spiritual services shall provide support to  enable  an 
individual to adjust to experiences associated with death.
  (4) A spiritual advisor, if selected  by  the  patient?family  unit,  shall 
participate as a member of the interdisciplinary care team.
  (5) Bereavement and spiritual services shall be delivered  consistent  with 
the patient care plan.

  History:  1984 AACS; 2003 AACS.


R 325.13306    Volunteer services.
  Rule 306. (1) The hospice and its hospice  residence,  if  applicable,  may 
utilize lay or professional volunteer services to promote the availability of 
care, meet the broadest  range  of  patient?family  unit  needs,  and  effect 
financial economy in the operation of the hospice and its hospice  residence, 
if applicable.
  (2) A volunteer services director shall develop  and  implement  a  program 
which meets the operational needs of the program, coordinates orientation and 
education of volunteers, defines the role and responsibilities of volunteers, 
recruits volunteers, and coordinates the utilization of volunteers with other 
program directors.
  (3)  The  volunteer  services  director  shall   be   a   member   of   the 
interdisciplinary team.
  (4) Volunteer service staff shall be aware of  a  patient's  condition  and 
treatment as indicated on the written plan of care.
  (5) Services provided by volunteers shall be in  accord  with  the  written 
plan of care.

  History:  1984 AACS; 2003 AACS.


R 325.13307    Social work services.
  Rule 307.  (1) The hospice and its hospice residence, if applicable,  shall 
provide, either directly or by  arrangement,  social  work  services  to  the 
patient and family before and following the patient's death.
  (2) Social work services shall be available, if needed, 7 days a week.
  (3) Social work services shall provide support to enable an  individual  to 
adjust to experiences associated with death.
  (4) Social work services shall be delivered  consistent  with  the  patient 
care plan.

  History:  1984 AACS; 2003 AACS.


                         PART 4. HEARING PROCEDURE


R 325.13401    Rescinded.

  History:  1984 AACS; 2003 AACS.


R 325.13402    Rescinded.

  History:  1984 AACS; 2003 AACS.


R 325.13403    Rescinded.

  History:  1984 AACS; 2003 AACS.


R 325.13404    Rescinded.

  History:  1984 AACS; 2003 AACS.


R 325.13405    Rescinded.

  History:  1984 AACS; 2003 AACS.


R 325.13406    Rescinded.

  History:  1984 AACS; 2003 AACS.


R 325.13407    Rescinded.

  History:  1984 AACS; 2003 AACS.


R 325.13408    Rescinded.

  History:  1984 AACS; 2003 AACS.


R 325.13409    Rescinded.

  History:  1984 AACS; 2003 AACS.


R 325.13410    Rescinded.

  History:  1984 AACS; 2003 AACS.


R 325.13411    Rescinded.

  History:  1984 AACS; 2003 AACS.


R 325.13412    Rescinded.

  History:  1984 AACS; 2003 AACS.


R 325.13413    Rescinded.

  History:  1984 AACS; 2003 AACS.


R 325.13414    Rescinded.

  History:  1984 AACS; 2003 AACS.


R 325.13415    Rescinded.

  History:  1984 AACS; 2003 AACS.


R 325.13416    Rescinded.

  History:  1984 AACS; 2003 AACS.


R 325.13417    Rescinded.

  History:  1984 AACS; 2003 AACS.


R 325.13418    Rescinded.

  History:  1984 AACS; 2003 AACS.


    PART 5. HOSPICE RESIDENCES PROVIDING CARE ONLY AT THE HOME CARE LEVEL

R 325.13501    Applicability.
  Rule 501.  (1) Unless otherwise specified in a rule, this part shall  apply 
only to hospice residences that provide care only at the home care  level  of 
care.
  (2) Articles 1 and 17 and part 214 of 1978 PA 368, MCL  333.1101  et  seq., 
333.20101 et seq., and 333.21401 et seq. contain definitions  and  additional 
licensure requirements for both hospice residences that provide care only  at 
the home care level of care and hospice residences  which  provide  inpatient 
care.

  History: 2003 AACS.


R 325.13503    Submission of plans.  
  Rule 503. (1) Complete plans, specifications, and an operational  narrative 
for new buildings, additions,  major  building  changes,  and  conversion  of 
existing facilities to use  as  a  hospice  residence,  including  a  hospice 
residence providing inpatient care, shall  be  submitted  to  the  bureau  of 
health systems of the department for review to assure compliance with the law 
and these rules.
  (2) Plans and specifications meeting the requirements of the law and  these 
rules shall be approved by the department.
  (3) Construction of new buildings, additions, major building  changes,  and 
conversions of existing facilities to use as a hospice  residence  shall  not 
begin until the plans and specifications have been approved by the department 
and a construction permit has been issued for the construction to begin.
  (4) The plan review fee shall be calculated at 0.5% of the first $1,000,000 
and 0.85% of the amount over $1,000,000.  The maximum plan review  fee  shall 
be $30,000.

  History: 2003 AACS.


R 325.13505    Exteriors.
  Rule 505.  (1) The premises of a  home  care  hospice  residence  shall  be 
maintained in a safe and sanitary condition and in a manner  consistent  with 
the public health and welfare.
  (2) Sufficient light for  an  exterior  ramp,  step,  and  porch  shall  be 
provided for the safety of persons using the facilities.
  (3) An exterior step or ramp shall have a handrail on both sides.  A  porch 
shall have a railing to open sides.

  History: 2003 AACS.


R 325.13507    Interiors.
  Rule 507. (1) A home care hospice  residence  building  shall  be  of  safe 
construction and shall be free from hazards to hospice residents,  personnel, 
and visitors.
  (2) A stairway or ramp shall have a handrail on both sides.
  (3) A room shall be provided with a type and amount  of  ventilation  which 
will control odors and contribute to the comfort of occupants as follows:
  (a) Systems shall be capable of maintaining a temperature in the  range  of 
71 to 81 degrees Fahrenheit in patient and public areas.
  (b) Supply air systems shall be  equipped  with  air  filters  rated  at  a 
minimum efficiency of 25% per ASHRAE  standard  52.1992.  Printed  copies  of 
ASHRAE  standard  52.1--1992  are  available  a  cost  of  $15.00/member  and 
$19.00/non-member from the American Society of  Heating,  Refrigeration,  and 
Air-conditioning Engineers, Inc. (ASHRAE), 1791 Tullie Circle,  NE,  Atlanta, 
GA and WWW.ASHRAE.ORG. It is also available  for  review  at  the  Bureau  of 
Health Systems, Michigan Department of Consumer & Industry Services,  525  W. 
Ottawa, G. Mennen Williams Building, 5th floor, Lansing, MI  48933.
  (c) Net airflow shall be from clean to less clean.
  (d) Air shall not be returned from toilet/bathing rooms, janitor's closets, 
soiled holding/utility rooms, and isolation rooms.
  (e) Continuous exhaust ventilation shall be provided for  janitor  closets, 
soiled utility rooms, isolation rooms, and toilet rooms that serve more  than 
1 patient. 
  (4) A floor, wall, or ceiling shall be covered and  finished  in  a  manner 
that will permit maintenance of a sanitary environment.
  (5) All of the following areas of the hospice residence shall  be  provided 
with lighting as follows: 
  (a) General room illumination-10 footcandles measured at  30  inches  above 
the floor.
  (b) Reading locations (head of bed)-30 footcandles.
  (c) Charting/medical area-50 footcandles.
  (d) Handwash sinks and bathing areas-30 footcandles.
  (e) Food preparation areas (task level)-30 footcandles.
  (f) Storage rooms-20 footcandles.
  (g) Corridors-20 footcandles.
  (h) Laundry (general)-30 footcandles.
  (i) Examination/treatment (may be portable)-75 footcandles.
  (j) Night lighting in toilet rooms and bedrooms, sufficient to illuminate a 
footpath from the bed to the toilet room.
  (k) Light fixtures shall be equipped with lenses or shields for  protection 
of the lamps or with lamps that will not shatter.
  (6) A room used for living or sleeping purposes shall have a minimum  total 
window glass area on the outside walls equal to 10%  of  the  required  floor 
area and a clear unobstructed window view for a minimum distance of 20 feet. 
  (7) A minimum of 30 square feet of floor space per  hospice  bed  shall  be 
provided for dayroom, dining, and activity space. 
  (8) A basement or cellar shall not be used for sleeping or living quarters.
  (9) A battery or secondary power source shall be provided for all  critical 
or life support equipment, including oxygen and suction equipment, and  there 
shall be emergency lighting sufficient to light corridors and exits.
  (10) A functionally separate  living,  sleeping,  dining,  lavatory,  water 
closet, and bathing facility shall be provided for personnel and  members  of 
their families who live on the premises.
  (11) A doorway, passageway, corridor, hallway, or stairwell shall  be  kept 
free from obstructions at all times.
  (12) An elevator shall be provided if hospice beds are located on more than 
1 floor level.  An elevator shall have a minimum cab size of 5 feet by 7 feet 
6 inches.
  (13) Dedicated space shall be provided for  patient/family  visitation  and 
bereavement.  The space  may  be  omitted  where  all  private  bedrooms  are 
provided.
  (14) The facility shall provide for family overnight stay.

  History: 2003 AACS.


R 325.13509    Home care hospice residence rooms.
  Rule 509. (1) A bedroom shall have the floor  surface  at  or  above  grade 
level along exterior walls with windows.
  (2) A single bedroom shall provide not less than 100 square feet of  usable 
floor space.
  (3) A multi-bed room shall provide not less than 80 square feet  of  usable 
floor space per bed. 
  (4) Usable floor  space  shall  not  include  a  toilet  room,  closet,  or 
vestibule.
  (5) A bedroom shall be provided with a lavatory  and  toilet  room  opening 
into the room.
  (6) A wardrobe or closet shall be provided  for  the  storage  of  personal 
clothing.
  (7) A multiple bedroom shall be designed to have a 3-foot clearance at each 
side and foot of the bed.
  (8) A water closet or bathing facility  shall  have  substantially  secured 
grab bars at least 1 foot long.
  (9) A bedroom shall  permit  the  functional  placement  of  furniture  and 
equipment essential to the residents' comfort and safety.
  (10) A bedroom shall have not less than 2 duplex receptacles, at least 1 of 
which shall be near the head of each bed.
  (11) A nurse call system shall  be  provided  at  each  home  care  hospice 
resident bed, water closet,  and  bathing  fixture.   The  nurse  call  shall 
register at a staff location.   An  alternate  calling/alert  system  may  be 
approved by the department.  A hand bell or other call system  is  acceptable 
in a hospice residence that has 8 or fewer  beds  if  all  beds  are  located 
within direct observation of the staff  work  station  and  if  the  call  is 
clearly audible and identifies the patient location. 
  (12) The need for and number of airborne infection  isolation  rooms  in  a 
home care hospice residence shall be determined by an infection control  risk 
assessment.  Where provided, an isolation room shall be a single bedroom that 
has an attached lavatory, water closet, and bathing facility reserved for the 
use of the occupant of the isolation room only.   The  isolation  room  shall 
have an area for staff hand washing and gowning and for storage of clean  and 
soiled materials located directly outside or  immediately  inside  the  entry 
door to the room.  
  (13) A minimum of 10% of the bedrooms shall  be  accessible  and  meet  the 
requirements of the Michigan barrier free design criteria.
  (14) A hospice patient room shall have not more than 4 beds. 
  (15) In multiple-bedrooms, visual privacy from casual observation by  other 
residents and visitors shall be provided for each resident.  The  design  for 
privacy shall not restrict resident access to the entrance, lavatory,  toilet 
room, or wardrobe.

  History: 2003 AACS.


R 325.13511    Hospice care unit.
  Rule 511.  (1) A hospice care unit in a home care hospice  residence  shall 
have all of the following:
  (a) A dedicated area for medication storage and preparation and charting.   
The space shall be well lighted, equipped with a lavatory for hand washing, a 
refrigerator, and locked storage for medication.
  (b) A room for the storage of  clean  linen,  clean  equipment,  and  clean 
supplies.
  (c) A workroom for holding trash and soiled linens that  is  also  designed 
for reprocessing of equipment. The room shall be separate from clean  storage 
facilities.
  (d) A janitor's closet shall be provided. For home care hospice  residences 
of 8 or fewer beds, the janitor's closet may  be  combined  with  a  properly 
sized soiled workroom.	
  (2) A bathing facility shall be provided for every  20  home  care  hospice 
residence beds.
  (3) At least 1 assisted (barrier free) bathing fixture shall be provided.
  (4) A home care hospice toilet room or  bathroom  shall  not  be  used  for 
storage or housekeeping functions.

  History: 2003 AACS.


R 325.13513    Public and personnel area.
  Rule 513. (1) A public toilet room that has a  lavatory  and  water  closet 
shall be provided.
  (2) A dedicated staff break/locker space shall be provided.  A lavatory and 
water closet shall be located convenient to the  break/locker  space.  For  a 
home care hospice residence that has 8 or fewer beds,  the  staff  facilities 
and public areas may be shared.

  History: 2003 AACS.


R 325.13515    Laundry and linens.
  Rule 515. (1) The collection, storage, and transfer  of  clean  and  soiled 
linen shall be accomplished in a manner that  will  minimize  the  danger  of 
disease transmission.
  (2) A home care hospice residence that  uses  an  outside  laundry  service 
shall have a soiled linen holding room and a  separate  clean  linen/supplies 
storage room.  When justified by the operational narrative, a properly  sized 
soiled workroom may function as the soiled linen holding room.    
  (3) A home care hospice  residence  that  processes  its  own  linen  shall 
provide a well ventilated laundry room of sufficient size to allow functional 
separation of soiled linen  holding,  laundry  processing,  and  clean  linen 
folding.  The laundry shall be ventilated to provide directional airflow from 
clean to soiled areas.  A lavatory for hand washing shall be provided in  the 
laundry processing area.  A separate clean linen storage room/area  shall  be 
provided.  When justified by the operational narrative, a properly sized  and 
located soiled workroom may serve as a soiled  linen  holding  room.  Laundry 
equipment shall be rated commercial or heavy duty.

  History: 2003 AACS.


R 325.13517    Water systems.
  Rule 517.  (1) A home care hospice residence located in a area served by  a 
public water system shall connect to and use that system.
  (2) If a public water system  is  not  available,  then  the  location  and 
construction of a well and the operation of the  water  system  shall  comply 
with 1976 PA 399, MCL 325.1001 seq.
  (3) Tempered water shall be regulated in the  range  between  105  and  120 
degrees Fahrenheit.

  History: 2003 AACS.


R 325.13519    Liquid wastes.
  Rule 519. (1) Liquid wastes shall be  discharged  into  a  public  sanitary 
sewage system when a system is available.
  (2) If a public sanitary sewage system  is  not  available  and  a  private 
liquid wastewater disposal system is used, the type, size, construction,  and 
alteration of the system shall comply with all applicable laws.  A subsurface 
disposal system shall not be approved for a home care hospice residence  that 
has more than 8 beds.
  (3) The wastewater disposal system shall be maintained in a sanitary 
manner.

  History: 2003 AACS.


R 325.13521    Solid wastes.
  Rule 521. (1) The  collection,  storage,  and  disposal  of  solid  wastes, 
including garbage, refuse, and dressings, shall be accomplished in  a  manner 
which will minimize the danger of disease transmission and avoid  creating  a 
public nuisance or a breeding place for insects and rodents.
  (2) Suitable containers for garbage, refuse, medical waste, and other solid 
wastes shall be provided, emptied at frequent intervals, and maintained in  a 
clean and sanitary condition.

  History: 2003 AACS.


R 325.13523    Heating.
  Rule 523.  A room in the home care  hospice  residence  used  by  residents 
shall be maintained at a regular daytime temperature of not less  72  degrees 
Fahrenheit.  Bedroom temperatures may be less than 72 degrees  Fahrenheit  if 
justified by the hospice patient's medical condition or preference. 

  History: 2003 AACS.


R 325.13525    Kitchen and dietary area.
  Rule 525. (1) A home care  hospice  residence  shall  have  a  kitchen  and 
dietary area of adequate size to meet food service needs of the residents. It 
shall be arranged and equipped for the refrigeration,  storage,  preparation, 
and serving of food as well as for  dish  and  utensil  cleaning  and  refuse 
storage and removal. Where food service is provided from an outside  service, 
the food service shall be licensed by the Michigan department of agriculture.
  (2) The kitchen and dietary area shall be equipped with a lavatory for hand 
washing.  The lavatory shall have a gooseneck inlet and wristblade  or  other 
hands-free controls.
  (3) Food stored, prepared, and served in the hospice residence  shall  meet 
the requirements of 2000 PA 92, MCL 289.1101 et seq.
  (4) Multi-use utensils used in food  storage,  preparation,  transport,  or 
serving shall be designed, cleaned, and  sanitized  in  accordance  with  the 
requirements of 2000 PA 92, MCL 289.1101 et seq.
  (5) Food equipment and work surfaces shall meet the requirements of 2000 PA 
92, MCL 289.1101 et seq.  Heavy-duty residential food equipment, including an 
exhaust hood and work surfaces may be provided in a  hospice  residence  that 
has 8 beds or less.

  History: 2003 AACS.


R 325.13527    Insect and vermin control.
  Rule 527. (1) A home care hospice residence shall be kept free from insects 
and vermin.
  (2) Breeding places for insects and vermin shall be eliminated. 

  History: 2003 AACS.


R 325.13529    General maintenance.
  Rule 529. (1) The building, equipment, and furniture shall  be  kept  clean 
and in good repair.
  (2) Hazardous and toxic materials shall be stored in a safe manner.
  (3) A room shall be provided in the home care hospice residence or  on  the 
premises for equipment and furniture  maintenance  and  repair  and  for  the 
storage of maintenance equipment and supplies.

  History: 2003 AACS.


R 325.13531    Fire safety and disaster planning.
  Rule 531. (1) A home care hospice residence shall comply with  all  of  the 
following provisions:
  (a) Obtain fire safety approval pursuant to sections 20156 and  21413(3)(c) 
of 1978 PA 368, MCL 333.20156 and 333.21413(3)(c).
  (b) Have a disaster management plan tailored to the facility and the  types 
of residents it serves, which shall be periodically practiced on all shifts.
  (c)  Have  policies  and  procedures  to  meet  potential  emergencies  and 
disasters, which include, at a  minimum  fire,  tornado,  power  outage,  and 
severe weather.
  (2) A home care hospice residence shall have policies and procedures  which 
address all of the following:
  (a) Prompt identification and transfer  of  patients  and  records  to  the 
appropriate facility.
  (b) Arrangements with community resources.
  (c) Emergency management and family call.

  History: 2003 AACS.


R 325.13533    Pharmaceutical services.
  Rule 533. Pharmaceutical services in a home care hospice residence 
shall comply with the requirements of 42 CFR 418.100(k).  Printed  copies  of 
42 CFR, part 418.00, published in December 2001 in the federal register,  are 
available for inspection and distribution  to  the  public  from  the  United 
States Government  Printing  Office,  Superintendent  of  Documents,  PO  Box 
371954, Pittsburgh, PA 15250-7924, at a cost of $59.00 at  the  time  of  the 
adoption of this rule.  The full text of code of federal regulations are also 
available in electronic format at www.access.gpo.gov/nara  and  is  available 
for review at the Bureau of Health Systems, Michigan Department of Consumer & 
Industry Services, G. Mennen Williams Building, 525 W. Ottawa, Lansing,  MI   
48933.

  History: 2003 AACS.


R 325.13535    Infection control.
  Rule  535.  (1)  The  plan  for  infection  control,  required  by  section 
21413(3)(b) of the code, shall be approved by  the  residence  administration 
and shall contain a plan and facility policies which address, at least all of 
the following:
  (a) Provisions for isolating each patient who has an infectious disease.
  (b) Provisions for isolation rooms.
  (c) Universal precautions.
  (d) Transfer of patients to other facilities if required.
  (e) Non-admission of patients who have airborne infectious disease.
  (2) A residence shall require a new resident to  have  had  a  chest  x-ray 
within 90 days before admission.
  (3) Employee TB testing shall include the 2-step mantoux test and shall  be 
annual or as specified by the local health department.

  History: 2003 AACS.


R 325.13537    Staffing requirements.
  Rule 537. (1) A home care hospice residence shall comply with  all  of  the 
following staffing requirements: 
  (a) Provide 24-hour nursing services for each patient  in  accordance  with 
the patient's hospice care plan as required by  42  CFR  part  418.   Printed 
copies of 42 CFR, part 418.00, published in December,  2001  in  the  federal 
register, are available for inspection and distribution to  the  public  from 
the United States Government Printing Office, Superintendent of Documents, PO 
Box 371954, Pittsburgh, PA 15250-7924, at a cost of $59.00 at the time of the 
adoption of this rule.  The full text of code of federal regulations are also 
available in electronic format at www.access.gpo.gov/nara  and  is  available 
for review at the Bureau of Health Systems, Michigan Department of consumer & 
Industry Services, G. Mennen Williams Building, 525 W. Ottawa, Lansing,  MI   
48933.
  (b) Provide nursing care and services by or  under  the  supervision  of  a 
registered nurse.
  (c) Direct and staff nursing services to assure that the nursing  needs  of 
patients are met.
  (d) Specify patient care responsibilities  of  nursing  and  other  hospice 
personnel.
  (e) Provide services in accordance with recognized standards of practice.
  (f) Provide a licensed nurse for each shift.
  (2) A home care hospice residence shall maintain a nursing staff sufficient 
to provide at least 1 nurse to each 8 patients on the morning shift; 1  nurse 
to each 12 patients on the afternoon shift; and 1 nurse to each  15  patients 
on the nighttime shift.  Additional nurses and other nursing personnel  shall 
be added based upon patient or family needs.

  History: 2003 AACS.


R 325.13539    Medical waste.
  Rule 539.  A home care hospice residence shall comply with the requirements 
of 1990 PA 13, MCL 330.1147 et seq. 

  History: 2003 AACS.


R 325.13541    Dietary.
  Rule 541.  A home care hospice residence dietary service shall comply  with 
the requirements of 42 CFR 418.100(j). Printed copies of 42 CFR, part 418.00, 
published in December  2001  in  the  federal  register,  are  available  for 
inspection and distribution to the public from the United  States  Government 
Printing Office, Superintendent of Documents, PO Box 371954,  Pittsburgh,  PA 
15250-7924, at a cost of $59.00 at the time of the adoption of  this  rule.   
The full text of code of federal regulations are also available in electronic 
format at www.access.gpo.gov/nara and is available for review at  the  Bureau 
of Health Systems, Michigan Department of Consumer &  Industry  Services,  G. 
Mennen Williams Building, 525 W. Ottawa, Lansing, MI  48933.

  History: 2003 AACS.


R 325.13543    Additional requirements.
  Rule 543.  A hospice  residence  which  provides  both  home  care  and  an 
inpatient level of care shall comply with the  requirements  established  for 
hospices providing an inpatient level of care.

  History: 2003 AACS.