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 must include information from a 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 for each client based on the provider’s orders within seven calendar days of admission and review plans at least monthly.

The hospice provider must maintain a complete medication list for all clients, including 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 seven 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 providing bereavement services under the supervision of a qualified professional with experience or education in grief or loss counseling.

Agencies must offer bereavement services to the client’s family and loved ones, and these services should reflect the needs of the bereaved. Hospice staff must 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 dietary counseling provided when a need is identified in the care plan.

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 licensed 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 to 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 to achieve goals identified in the client’s treatment plan. A licensed mental health professional must 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:

• The client dies.
• The client’s medical condition improves and hospice care is no longer necessary. The agency must refer the client to Medical Case Management or Outpatient/Ambulatory Health Services as appropriate.
• The client elects to be discharged.
• The client is discharged for cause.
• The client is transferred out of the provider’s facility.

Staff must complete a discharge note for each client discharged from services, regardless of the cause.

11. Percentage of clients with discharge notes, as applicable. (Pilot Measure 2025-2026)