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If you're confused over how to comply with hospice regulations when it comes to patients residing in nursing homes, heed this expert advice. The question: Hospices and nursing homes often wonder whether regulations require them to have a single care plan for each patient residing in the facility who is on the Medicare hospice benefit. The answer: "While the hospice and facility need to develop a coordinated plan of care, it does not need to be in a single document," says attorney Meg Pekarske with Reinhart Boerner Van Deuren in Madison, Wis.

The Centers for Medicare & Medicaid Services "has provided guidance indicating that the plan of care can be separated into different sections -- one maintained by the facility and the other maintained by the hospice," Pekarske says. "Each party is required to update their portion of the care plan in accordance with their applicable legal requirements." The hospice and nursing home  should review and share their care plan updates with one another, Pekarske adds. "If done correctly, it should be clear to anyone reviewing the documents, such as surveyors, the role and responsibilities" of the hospice and nursing home.

Tip: Given that the hospice rules require a comprehensive assessment within five days of admission to hospice, nurse Cherry Meier instructs hospice nurses at her organization to meet with the nursing home MDS coordinator upon the patient's admission and talk about the care plan. "That way,  the hospice [and nursing facility] are on the same page from the beginning," says Meier, with VITAS Healthcare Corp. in Flat Rock, N.C.