1. Department of Health Hospice Update 2018

2. In-Home Services Rules
The In-Home Services (IHS) licensing rules (chapter WAC) have been updated and became effective April 6, 2018.
The rules project took over two years to complete due to the complexity of the rules. Eight public rules workshops and a public hearing were held between 2016 and During this time, the hospice association and individual hospice providers provided significant input into the revised hospice rules.

3. In-Home Services Rules
The department provided a six-month time period (April 6th thru October 6th, 2018) where we increased technical assistance to acclimate providers to the various new and revised rule requirements.
Today’s update will highlight “significant” rule changes for hospice agencies.

4. Significant changes to the IHS rules
The rules have been reformatted into distinct sections for Home Care, Home Health, Hospice, and Hospice Care Centers. Agencies can essentially look at one section of rules for all of their requirements.
WAC (1) Requires applicants to complete a department-sponsored in-home services orientation class before submitting a state licensing application.

5. Significant changes to the IHS rules
2. WAC (4) and (6) Washington State Patrol background checks are required every two years for the administrator, director of clinical services and all employees who provide direct patient care.
WAC (7) Requires agencies to conduct a character, competence, and suitability determination when employee background check results reveals non-disqualifying convictions, charges, or negative actions.

6. Significant changes to the IHS rules
WAC (16) and (17) WAC (9) Adds definitions for “restraint” and “seclusion” (R&S); requires agencies to develop policies and procedures (P&Ps) around the utilization of R&S; and adds to the Bill of Rights that patients have the right to be free from the unlawful use of R&S.
WAC (12) Requires agencies to develop P&Ps for the provision of “back-up care” when services cannot be provided as scheduled. Back-up care involving patient ADLs or health services must be provided by appropriately credentialed staff.

7. Significant changes to the IHS rules
WAC (1) Requires agencies to develop and operationalize P&Ps giving patients at least 48 hours notice prior to discharge.
WAC (3) Requires agencies to develop and operationalize P&Ps to complete the initial patient assessment within seven days of accepting a practitioner referral for hospice services.

8. Significant changes to the IHS rules
WAC (14) Requires agencies to expanded P&Ps around infection control, communicable disease testing, and vaccinations. This includes conducting initial and annual Tuberculosis risk assessments for employees providing direct patient care.
WAC (3) Requires the director of clinical services to complete a minimum of ten (10) hours of training annually.

9. Significant changes to the IHS rules
WAC (14) Agencies must develop P&Ps that describe the actions the agency will take if a patient has a signed physician order for life-sustaining treatment (POLST) form.

10. Significant changes to the IHS rules
Hospice Care Center rules (WAC thru 768)
No new requirements.
The licensing and construction standards sections have been reformatted for ease of reading.
Added a new section which outlines the department’s construction review services plan review process.
All building code references have been updated.

11. In-Home Services Rules
The department primarily communicates with stakeholders through the In-Home Services GovDelivery service.
The link to GovDelivery is labeled “Subscribe” on the bottom of the department’s Hospice Agencies webpage.
Please subscribe to receive important updates about the new rules and other department communications.

12. John Hilger is the program manager for In-Home Services
John Hilger is the program manager for In-Home Services. He can be reached at

13. Updates from the Survey Team
Sarah Benson – In-Home Services Surveyor
Suzanne Kinchen – In-Home Services Surveyor
Robin Bucknell, In-Home Services Survey Manager

14. Federal Hospice L-Tags Citations

15. Frequent Hospice WAC Citations (L798)
WAC Delivery of Services – Mandatory Reporting:
No documentation of abuse/neglect training for staff.
Incorrect policy instructing staff to contact their supervisor or social worker or policy states to contact appropriate state agency, however when staff interviewed, they say they report to their supervisor or someone in the agency who will then report to the appropriate state agency.
WAC Personnel, Contractor, and Volunteer Policies – Annual performance evaluations of all personnel and volunteers providing direct patient or client care, including on-site observation of care and skills specific to the care needs of patient’s.
No documentation of annual evaluations or evaluations are late.
No on-site observation of care and skills documented.

16. Most cited Emergency Preparedness E-Tags

17. Emergency Preparedness checklist

18. Most cited HCC LSC Fire Marshal K-Tags

19. Medicare Helpful Tips
Please review the Hospice Compare site to verify your information is correct. Updates to Hospice Provider demographic information do not happen in real-time and take approximately 6-months to appear on Hospice Compare.
Notify your Medicare Administrative Contractor of all demographic and organizational changes.
Be prepared for the implementation of the Emergency Preparedness Rules that go into effect November You can watch a video at
When is your revalidation due? You can go to to check when your agency will be due. But the MAC should send you a notice 2-3 months prior. Revalidations are always due on last day of the month

20. Questions & Thank you!