This Oklahoma regulation (OAC 310:661) establishes minimum licensing standards for hospice programs operating in the state, including application procedures, fees, organizational requirements, medical records, clinical records, confidentiality, continuing education for administrators, admission and discharge criteria, and patient assessment requirements. Operators must obtain a license from the Oklahoma State Department of Health before establishing or maintaining a hospice, and must comply with all operational, staffing, and documentation standards set forth in the chapter. The regulation also covers hospice inpatient facilities operated as part of a licensed hospice program.
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CHAPTER 661. HOSPICE
[Authority: 63 O.S., §§ 1-103a.1, 1-104, 1-860.1 et seq., and 1-862]
[Source: Codified 6-11-92]
SUBCHAPTER 1. GENERAL PROVISIONS
310:661-1-1. Purpose
This Chapter establishes the minimum criteria for the issuance and renewal of a hospice license and
the procedure for enforcement of the Act.
[Source: Added at 9 Ok Reg 1985, eff 6-11-92]
0}661-1-2. Definitions
The’ f6llgvyang words and terms, when used in this Chapter, shall have the following meaning, unless the
conte “oho y indicates otherwise.
"means the Oklahoma Hospice Licensing Act, 63 O.S. 1991, §§ 1-860.1 et seq.
"Alte e Administrative Office" means an approved location from which the hospice provides
the same full r f hospice care and services that is required of the hospice issued, stores supplies,
and/or is used for on entation and meets the requirements of 310:661-2-1(f)(2). Each location shall
meet all of the appli oe s of Chapter 661. Hospice.
"Attending ph octor of medicine or osteopathy, identified by the patient or
representative at the time nt orr entative elects to receive hospice care, as having the most
significant role in the determif f the patient's medical care.
"Bereavement counseli eans ts psychosocial, and spiritual support and services
provided before and after the sath patch sist with issues related to grief, loss, and adjustment.
"Clinical note" means a notati6n o Oy, the patient and/or the family that is written and
dated by any person providing services a: + dese Rea and symptoms, treatments and medications
administered, including the patient's reacti r responsg, and any changes in physical, emotional,
psychosocial or spiritual condition during a giv od of
"Comprehensive assessment" means Option 0) atient's physical, psychosocial,
emotional and spiritual status related to the termina’ wit) and ee conditions. This includes an
evaluation of the caregiver's and family's willingness bilt re for the patient.
"Continuous care" means nursing care that is “he byas ey or a qualified hospice
aide for as much as 24-hours a day during periods of medicaLcrisis as ne ry to maintain a hospice
patient at their place of residence.
"Department" means the Oklahoma State Department o th.
"Dietary counseling" means education and interventions pr6vi o the patient and family
regarding nutritional intake as the patient's condition changes. Dietary 1@) ing is provided by qualified
individuals, which may include a registered nurse or dietitian, when identi my patient's plan of care.
"Employed" means contracting with a person for services, regardle fem ensation. This term
also includes volunteers.
"Employee" means a person who: (1) Works for the hospice and for who
to issue a W-2 form on his or her behalf; (2) if the hospice is a subdivision of an agen anization, an
employee of the agency or organization who is assigned to the hospice; or (3) is a volun r the
jurisdiction of the hospice.
"Fast-track" The process where advance approval may be secured for construction s
design details are completed.
"First-year license" means a license issued for the initial twelve (12) month license period.
"Follow-up inspection" means the inspection by representatives of the Department that shall occur
after a hospice has provided hospice services for at least six (6) months.
"Governing body" means a person, persons, or legal entity that is legally responsible for the
conduct of the facility as an institution and carries out the functions, ownership, and governance in
accordance with these regulations and the laws of this state.
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"Initial assessment" means an evaluation of the patient's physical, psychosocial and emotional
status related to the terminal illness and related conditions to determine the patient's immediate care and
support needs.
"License" means a first-year or permanent hospice license issued pursuant to the Act and these
tules.
"Licensed independent practitioner" means any individual permitted by law and by the licensed
hospice to provide care and services, without direct supervision, within the scope of the individual's license
and consistent with clinical privileges individually granted by the licensed hospice. Licensed independent
practitioners may include advanced practice nurses with prescriptive authority, physician assistants,
dentists, podiatrists, optometrists, chiropractors, and psychologists.
"Medical Crisis" means an event or situation in which a registered nurse, through direct
ent of the hospice patient, determines that the patient has entered into a period of crisis which
req a physician's intervention and continuous nursing care to achieve palliation or management of
rae al symptoms. Peaceful symptom controlled death is an expected patient outcome and is not
ac We medical crisis. A medical crisis would include, but not be limited to the following:
uncontrolled tegminal agitation as demonstrated by hallucinations, confusion, and combativeness;
uncontrolled fais ncontrolled respiratory distress; uncontrolled nausea and vomiting; hemorrhaging;
uncontrolled ids mily distress as a result of ongoing symptom management for the patient requiring
administration of ions to dig the patient's comfort; and, any uncontrolled symptom that
requires the administr fmedi with ongoing assessment of the effectiveness and adjustment of
the medication regimen lieve c f symptoms.
"Palliative care" me atient mily-centered care that optimizes quality of life by
anticipating, preventing, and t suffe liative care throughout the continuum of illness involves
addressing physical, intellectual, nal, s ay spiritual needs and to facilitate patient autonomy,
access to information, and choice.
"Permanent license" means Uphow a hospice program after the first-year license
period has been completed and the requir fo ow-up ecbion Pos been conducted.
"Physician designee" means a Oe: icine sions designated by the hospice who
assumes the same responsibilities and obligatio e medic On when the medical advisor is not
available.
"Registered nurse" means a person who is Oy S, eQriovpractice registered nursing in the
State of Oklahoma. Ax Sy
"Representative" or "Court appointed guardia (Gans a who is authorized in
accordance with State law to execute or revoke an election fof haspice cafe r terminate medical care on
behalf of the terminally ill individual. O
"Skilled nurse" means a person who is currently licensed fo practice registered nursing or practical
nursing in the State of Oklahoma.
"Social worker" means a person who has a degree from a scho oe. ited or approved by the
Council on Social Work Education and conforms to the requirements of th jcensure Laws of
Oklahoma for Social Workers.
[Source: Added at 9 Ok Reg 1985, eff 6-11-92; Amended at 14 Ok Reg 2106, eff 4-7-97 (emergency); Amended O. g 2269, eff 6-12-97;
Amended at 19 Ok Reg 2094, eff 6-27-02; Amended at 21 Ok Reg 1303, eff 5-27-04; Amended at 23 Ok Reg 2412, efK6- Amended at 26 Ok
Reg 2042, eff 6-25-09; Amended at 40 Ok Reg 1582, eff 9-11-23]
310:661-1-3. Applicability 5)
No public or private agency or person shall establish, conduct or maintain a hospice or hold itself
out to the public as a hospice without first obtaining a license from the State Department of Health.
[Source: Added at 10 Ok Reg 77, eff 10-5-92 (emergency); Added at 10 Ok Reg 1705, eff 6-1-93; Amended at 14 Ok Reg 2106, eff 4-7-97
(emergency); Amended at 14 Ok Reg 2269, eff 6-12-97]
SUBCHAPTER 2. LICENSES
310:661-2-1. Licensure
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(a) Applicant. Any public or private agency or person desiring to establish a hospice in Oklahoma shall
apply for and obtain a license from the Department.
(b) Application. An application for a hospice license shall be filed on a form prescribed by the Department
and shall be accompanied by the information required by the Act.
(c) Plan of delivery. The initial application shall be accompanied by a plan of delivery of home and
inpatient hospice services to patients and their families. The plan shall include, but not be limited to, those
items listed in the Act.
(d) Expiration/renewal.
(1) First-year license.
(A) The first-year license shall expire one (1) year from the date of issuance unless
suspended or revoked. A hospice holding a first-year license is required to successfully
complete an initial inspection by representatives of the Department prior to the provision of
services and shall be subject to a follow-up inspection after providing hospice services for
Yy, at least six (6) months. The Department may require any hospice to renew the first-year
license for one additional year. A hospice shall not hold a first-year license for more than
enty-four (24) months.
A follow-up survey that demonstrates compliance with the Act and these rules shall be
r prior to a hospice program being issued a permanent license.
(2) Pera ene The anent license shall expire one (1) year from the date of issuance,
unless suspen revoked. Awpfapplication for renewal shall be submitted according to the Act.
Only hospice ne in co pifapce with the Act and these rules shall be issued a permanent
hospice shall be supervised
(f) Eligibility for license.
(1) A hospice making appropriate Quy: ation fas, een determined to be compliant with this
Chapter and the Act is eligible for a
(2) A hospice may operate ble for 2 eth ive oO" one (1) license as long as the
following requirements are met:
(A) The alternate administrative office Ib be Set the same administration
and governing body as an extension sit Zarices main hospice. These offices
shall operate under the same name(s) as th (ord
(B) An application for license, or renewal th estatlgh or operate each hospice
alternate administrative office of an agency a a} the State of Oklahoma shall be
accompanied by a nonrefundable licensing fee of ffvefundred dollars ($500.00) and
application at least thirty (30) days before beginning op c
(g) Compliance with Federal, State and local laws and regulations. ice and its staff shall
operate and furnish services that comply with all applicable Federal, State, laws and rules. The
hospice shall ensure that staff comply with applicable State practice acts and rul mes. e provision of
hospice services.
license.
(ec) Base of operation. everniO e pro pice services shall operate from a place of business
which is accessible to the ag I ted i in Oklahoma. Staff providing services from the
(h) Hospice inpatient facility.
(1) Each licensed hospice program may operate one (1) hospice inpatient nme Venice (12)
or fewer inpatient beds as long as the facility complies with hospice inpatient faci ice
requirements at OAC 310:661-6 and hospice inpatient facility physical plant tek OAC
310:661-8.
(2) A hospice inpatient facility may not be independently licensed as a hospice unless the hospice
provides a full continuum of hospice program services to patients in their homes and temporary
places of residence including the inpatient hospice facility.
[Source: Amended at 40 Ok Reg 1582, eff 9-11-23; Amended at 39 Ok Reg 1375, eff 9-11-22; Amended at 26 Ok Reg 2042, eff 6-25-09; Amended at
23 Ok Reg 2412, eff 6-25-06; Amended at 21 Ok Reg 1303, eff 5-27-04; Amended and renumbered from 310:661-3-1 at 14 Ok Reg 2269, eff 6-12-97;
Amended and renumbered from 310:661-3-1 at 14 Ok Reg 2106, eff 4-7-97 (emergency)]
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310:661-2-2. Deadlines for applications
The license application must be filed in accordance with the following deadlines:
(1) A first-year hospice license is filed at least thirty (30) days before beginning operations.
(2) License application following a transfer of ownership or operation, is filed at least thirty (30)
days prior to the transfer. If the Department finds that an emergency exists which threatens the
welfare of patients, the thirty (30) day advance filing notice may be waived.
(3) Renewal of an existing licensed hospice is filed at least sixty (60) days prior to the expiration
date of the license.
(4) If relocation is considered, the hospice must file an amended application with the address
change at least thirty (30) days prior to the intended relocation. No fee for processing the license
address change will be required.
(5) Incomplete first-year license applications received by the Department will be summarily
dismissed after thirty (30) days of applicant notification of an incomplete application. Thereafter, a
application and initial fee will be required.
[Source: nding van 2106, eff 4-7-97 (emergency); Added at 14 Ok Reg 2269, eff 6-12-97; Amended at 23 Ok Reg 2412, eff 6-25-06;
Amended at 39 OK BAI eff 9-11-22]
310:661-2-3. Wh Gey ile
The applicatio on oer pe must be submitted to the Department. The effective date will be
the date a complete appli n and Hycenee. All fees are non-refundable.
[Source: Added at 14 Ok Reg 2106, eff 4-7. Koyaes, 14 Ok Reg 2269, eff 6-12-97; Amended at 39 Ok Reg 1375, eff 9-11-22]
310:661-2-4. Transfer of owners Sie ticenS ic
(a) The license of a hospice shall not t to s pojement or other transfer, voluntary or
involuntary.
(b) If an entity is considering acquiring a Qe hospice, enit Z ss must submit to the Department 30 days
before the effective date of the quiring a Nee
(1) an application [See OAC 310:661-2-5]; G,
(2) a non-refundable two thousand dollars ( Sy fee [ Ayes 310:661-2-6];
(3) a copy of the executed sales agreement; an
(4) an additional five hundred dollars ($500) for eeyemaiCha istrative office operated by
the agency, if applicable.
(c) The following actions will not be considered a transfer of ows ip or change in control requiring this
subsection to apply:
(1) Change of a corporate or limited liability company licensee'yfagre through amendments of the
articles of incorporation or membership agreement.
(2) Sale of stock of a corporation.
(3) Sale or merger of a corporation that owns the hospice operating chtity7,
(4) Sale of membership interest of a limited liability company. OF
[Source: Added at 14 Ok Reg 2106, eff 4-7-97 (emergency); Added at 14 Ok Reg 2269, eff 6-12-97; Amended at 21 CA eff 5-27-04;
Amended at 23 Ok Reg 2412, eff 6-25-06; Amended at 26 Ok Reg 2042, eff 6-25-09; Amended at 39 Ok Reg 1375, eff 9- Xd
310:661-2-5. License application form Ss)
The applicant for a license must file the following application form: Application for License to
Operate a Hospice (ODH Form 924). This form requests: amount of fee submitted; name of hospice;
location and mailing address of hospice; name and title of chief executive officer; fiscal year ending date;
operating entity name and address; type of operating entity; board of directors; complete disclosure of
ownership including name, finding and mailing address, and percentage of ownership for every
stockholder having at least five percent (5%) ownership in the hospice; name, signature, and title of
position of persons making the application; and an affidavit attesting to the information provided.
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[Source: Added at 14 Ok Reg 2106, eff 4-7-97 (emergency); Added at 14 Ok Reg 2269, eff 6-12-97; Amended at 23 Ok Reg 2412, eff 6-25-06;
Amended at 39 Ok Reg 1375, eff 9-11-22]
310:661-2-6. Licensure fees
(a) There is a non-refundable $500 fee for an application for a first-year license to establish or operate a
hospice and a non-refundable $1,500 fee for a first-year license.
(b) There is a non-refundable $2,000 fee for a renewal application for an existing permanent hospice
license.
(c) A late renewal fee of $50 will be charged for any hospice submitting an application for renewal within
30 days after the expiration date of the license.
rodeo at 39 Ok Reg 1375, eff 9-11-22; Amended at 24 Ok Reg 2004, eff 6-25-07; Amended at 23 Ok Reg 2412, eff 6-25-06; Amended at
21 303, eff 5-27-04; Added at 16 Ok Reg 2518, eff 6-25-99]
310: Plan review fees
(a) Each ice inpatient facility construction project will be charged a review fee based on the cost of the
design and c ction of the building project as follows:
(1) Pro ty less than $10,000.00: $250.00 Fee
(2) Projec QA: 10.000.00 to $50,000.00: $500.00 Fee
(3) Project c 0,000.00 46 $250,000.00: $1000.00 Fee
(4) Project cost 00.0 000,000.00: $1500.00 Fee
(5) Project Cost g ween $1%090,000.00: $2000.00 Fee
(b) The review fee must be paid/When sta
The fee will cover the cost of revey for up t (2) stage one and two (2) stage two submittals. If a stage
one or stage two submittal is not np aftertwo\2) submissions, another review fee based on the cost
of the project will be required for th d submit t- Sm. projects will be allowed two (2) reviews
for each package submitted. If a fast- cin pac t approved after the second submittal,
another review fee based on the cost of oi(ag p Sagi ere fis with the third submittal of the package.
[Source: Added at 21 Ok Reg 1303, eff 5-27-04; Amended at ie) O AD; eff 9-1 ee
SUBCHAPTER INI ION
310:661-3-1. Licensure [AMENDED AND von eg 31G6b1-2-1|
[Source: Added at 9 Ok Reg 1985, eff 6-11-92; Amended and renumbered to 3 10:661-2¢a))4 Ok Reg 2106, eff 4-7-97 (emergency); Amended and
renumbered to 310:661-2-1 at 14 Ok Reg 2269, eff 6-12-97]
310:661-3-2. Organization O
(a) Organization and administration of services. The hospice must org nage, and administer its
resources to provide the hospice care and services to patients, caregivers an co: eS oO. for the
palliation and management of the terminal illness and related conditions.
(b) Serving the hospice patient and family. The hospice must provide 7 Q
(1) Optimizes comfort and dignity; and
(2) Is consistent with patient and family needs and goals, with patient needs and’g ép
(c) Continuation of care. A hospice cannot discontinue or reduce care provided as aD
pay for that care.
(d) Professional management responsibility. A hospice that has a written agreement with another agency,
individual, or organization to furnish any services under arrangement must retain administrative and
financial management, and oversight of staff and services for all arranged services, to ensure the provision
of quality care. Arranged services must be supported by written agreements that require that all services be:
(1) Authorized by the hospice;
(2) Furnished in a safe and effective manner by qualified personnel; and
(3) Delivered in accordance with the patient's plan of care.
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(ce) Narrative program. Each Hospice must provide a narrative program with its application which
describes the functions, staffing, services available to the patient and other basic information relating to the
fulfillment of the facility's objectives.
(f) Governing body. A hospice must have a governing body that assumes full legal responsibility for
determining, implementing and monitoring policies governing the total operations of the hospice. The
governing body will designate an individual who is responsible for the day-to-day management of the
hospice program. The governing body must also ensure that all services provided are consistent with
accepted standards of practice.
(g) Hospice team. A hospice team must be developed and function according to the Act. The hospice team
is responsible for all of the following:
(1) Participation in the establishment of the plan of care.
(2) Provision or supervision of hospice care and services.
(3) Periodic review and updating of the plan of care for each individual receiving hospice care.
Caaynplementaton of policies governing the day-to-day provisions of hospice care and services.
(h) Me dvisor. The medical advisor must be a medical doctor or osteopathic physician and is
responsibl@fordhe medical component of the patient care program for the hospice. The physician must also
serve as medé€aladvisor to the hospice, possess a license free of sanctions, and be a doctor of medicine or
osteopathy who & g ployee, or under contract with the hospice. When the medical advisor is not
available, a nse a by tbe hospice assumes the same responsibilities and obligations as the
medical advisor.
(1) KS advikowe contra n contracting for medical advisor services, the contract must
specify the physician assu Mie advisor responsibilities and obligations. A hospice
may contract with eit
(A) A self-emplo ee 3
(B) A physician emp by a Yon fonal entity or physician's group.
(2) Initial certification of termhin ess: dical advisor or physician designee reviews the
clinical information for each hospice patient and provgdes written certification that it is anticipated
that the patient's life expectancy is o year or legs ifthe illness runs its normal course. The
physician must consider the following king*thj ee
(A) The primary terminal condition;
(B) Related diagnosis(es), if any;
(C) Current subjective and objective m Gindin
(D) Current medication and treatment ord Ln
we
(E) Information about the medical manage ny of Op s conditions unrelated
to the terminal illness.
(3) Medical advisor responsibility. The medical advisor A Psician designee has responsibility
for the medical component of the hospice's patient care progra:
(1) Patient care coordinator. A registered nurse must be appointed and afproyed by the hospice governing
body and employed by the hospice as patient care coordinator to supervise dinate the palliative
and supportive care for patients and families provided by a hospice team.
(j) Medical social services. Medical social services must be provided by a social cmployed by the
hospice.
(k) Support services. Support services must be available to both the individual and — . These
services include bereavement support provided before the patient's death, spiritual suppo y other
support or service needed by the patient or family. These services may be provided by moi at
interdisciplinary group as well as other qualified professionals as determined by the hospice.
(1) Training. A hospice must:
(1) provide orientation about the hospice philosophy to all employees and contracted staff who
have patient and family contact;
(2) provide an initial orientation for each employee that addresses the employee's specific job
duties.
(3) assess the skills and competence of all individuals furnishing care, including volunteers
furnishing services, and, as necessary, provide in-service training and education programs where
required. The hospice shall have written policies and procedures describing its method(s) of
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assessment of competency and maintain a written description of the in-service training provided
during the previous twelve (12) months.
(m) Volunteers. Volunteers must be used in defined roles and under the supervision of a designated
hospice employee. The hospice must provide appropriate orientation and training.
(1) Training. The hospice will maintain, document, and provide volunteer orientation and training.
(2) Role. Volunteers will be used in day-to-day administrative and/or direct patient care roles.
(3) Recruiting and retaining. The hospice will document and demonstrate viable and ongoing
efforts to recruit and retain volunteers.
(4) Utilization. The hospice must document
(A) The identification of each position that is occupied by a volunteer.
(B) The work time spent by volunteers occupying those positions.
( iminal background checks.
(1) The hospice must obtain a criminal background check on all hospice employees who have
iP patient contact or access to patient records. Hospice contracts must require that all contracted
OO: obtain criminal background checks on contracted employees who have direct patient
contactor access to patient records
(2) eh ch criminal background check must meet the criteria established for certified nurse
aides as ided for in Title 63 O.S. Section 1-1950.1 and be obtained in accordance with State
ren
Amended at 26 Ok Reg 2042, eff 6-25-09; nded at 3 g 1375, eff 9-11-22]
[Source: Added at 9 Ok Reg 1985, EMi-9 ess Reg 2106, eff 4-7-97 (emergency); Amended at 14 Ok Reg 2269, eff 6-12-97;
310:661-3-3. Medical records
(a) The hospice must establish and es a 7 pn for each individual receiving care and
services. The record must be completefti tely documented, and readily accessible.
(b) The medical record must contain suffiien mt to,justify the diagnosis and warrant the
treatment and services provided. Entries are og and eno bythe person providing the services. The
record must include all care and services wheth ished’
oy or under arrangements by the hospice.
Each record must contain at least the following: Pe
(1) Identification data; DD: QQ
(2) Initial and subsequent assessments; “MR %
(3) Plan of care;
(4) Consent, authorization and election forms; %
(5) Medical history; and
(6) Complete documentation of all care, services and cet" evaluations, treatments,
progress notes, laboratory and x-ray reports, and discharge sum
(c) The hospice must safeguard the medical record against loss, destruc 6 untthoried use.
(d) Current records must be completed promptly. A plan of care must be 6 within forty-eight (48)
hours following admission. Records of discharged patients must be completed w, irty (30) days
following discharge. “os
(e) Medical records must be retained at least five (5) years beyond the date the patiterwa SQ seen or at
least three (3) years beyond the date of the patient's death.
(f) A hospice may microfilm medical records in order to conserve space. Records reconst
microfilm will be considered the same as the original and retention of the microfilmed “ae tutes
compliance with preservation laws. oy
(g) The hospice must advise the Department in writing at the time of cessation of operation as to where
hospice records will be archived and how these records can be accessed.
[Source: Added at 9 Ok Reg 1985, eff 6-11-92; Amended at 14 Ok Reg 2106, eff 4-7-97 (emergency); Amended at 14 Ok Reg 2269, eff 6-12-97;
Amended at 39 Ok Reg 1375, eff 9-11-22]
310:661-3-3.1. Clinical records
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(a) General. A clinical record containing past and current findings is maintained for each hospice patient.
The clinical record contains accurate clinical information that is available to the patient's attending
physician and hospice staff. The clinical record may be maintained electronically.
(b) Content. Each patient's record must include the following:
(1) The initial plan of care, updated plans of care, initial assessment, comprehensive assessment,
updated comprehensive assessments, and clinical notes;
(2) Signed copies of the notice of patient rights;
(3) Responses to medications, symptom management, treatments, and services;
(4) Outcome measure data elements, as described in 310:661-5-3.1;
(5) Physician certification of terminal illness;
(6) Any advance directives; and
(7) Physician orders.
(c) entication. All entries must be legible, clear, complete, and appropriately authenticated and dated
in ac ce with hospice policy.
(d) ree of information. The clinical record, its contents and the information contained therein must
be safegu ainst loss or unauthorized use. Additionally, the hospice is subject to all Federal and State
privacy re)
(ec) Discharge o Ce r of care.
(1) If the c patient is tygnsferred to another licensed hospice, the hospice will forward to the
receiving hos tei in ty Gy our (24) hours, a copy of:
(A) The lesb 1ce disc ummary; and
(B) The patient linical d, as requested.
(2) If a patient revoke ection ice care, or is discharged from hospice, the hospice will
forward to the patient's a ing physi nd twenty-four (24) hours, a copy of:
(A) The hospice disché@rge summ.
(B) The patient's clinic me “a d, a a
(3) The hospice discharge summa a tag uiré ust include:
(A) A summary of the paonore cluding 3a treatments, symptoms and pain management;
(B) The patient's current entry oft
(C) The patient's current physician ofders; ane
(D) Any other documentation that wae tein ni en continuity of care or that is
requested by the attending nn oy: or ing
(f) Retrieval of clinical records. The clinical record, whe ard ig electronic form, must be
made readily available on request. ‘ y
[Source: Added at 26 Ok Reg 2042, eff 6-25-09; Amended at 39 Ok Reg 1375, eff 9-11 Y%
310:661-3-4. Confidentiality —
(a) Medical records must be kept confidential. Only authorized personnel ht ores ss to the record.
Written consent of the patient, patient representative, the court appointed guardighy court order will be
accepted as authority for release of medical information.
(b) An individual who is, or has been, a patient of a physician, hospital, or other meat@al” Facility, except
psychiatric, is entitled to access information contained in the individual's own medica Ca upon
request. A request for minors may be made by parents or legal guardian. The hospice mu a copy
of the medical record upon payment for the charge of such copy. —
[Source: Added at 9 Ok Reg 1985, eff 6-11-92; Amended at 14 Ok Reg 2106, eff 4-7-97 (emergency); Amended at 14 Ok Reg 2269, eff 6-12-97;
Amended at 39 Ok Reg 1375, eff 9-11-22]
310:661-3-5. Continuing education
The section implements the provisions of Title 63 O.S. 1-862 concerning hospice administrator
continuing education.
[Source: Added at 36 Ok Reg 1728, eff 9-13-19]
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310:661-3-5.1. Number of continuing education hours required
(a) All hospice administrators operating a hospice program in this state are required to complete eight (8)
hours of continuing education each calendar year.
(b) Hours of continuing education may be completed in person or online.
(c) Membership in a statewide organization relating to hospice care will be considered as completion of
one (1) hour of ethics credit each year.
[Source: Added at 36 Ok Reg 1728, eff 9-13-19; Amended at 39 Ok Reg 1375, eff 9-11-22]
310:661-3-5.2. Acceptable continuing education
(a) Continuing education curriculum content is acceptable when it includes at least one of the following
c ents:
(1) Administrative skills, duties, and responsibilities;
Administrative procedures and strategic planning;
mmunity relations and public information;
(4y¥Fiscal and information data management;
(5) relations;
(6) Ethi
(7) State a
(b) Continuing educa
workshop, conference, o
competency. This excludes 1
are offered as a public service
(c) An acceptable instructor or e
(1) Experience in hospice ad: ee
(2) Expertise in teaching and i ilo day, uitable to the subject presented; or
(3) Academic qualifications and ekpey Kesha fo be
[Source: Added at 36 Ok Reg 1728, eff 9-13-19; Amended at 39 “ay eff Amended at 39 Ok Reg 1375, eff 9-11-22]
310:661-3-5.3. Documentation of ener
(a) A hospice administrator must maintain in their perso ay Vv tion of course attendance,
completion, or membership documents. Acceptable docu eGinclude owing
(1) A continuing education validation form locus presen
(2) A certificate or letter of attendance or completion wi enda o or content outline; or
(3) An official college transcript showing courses completed with credit issued or audit credit.
(b) The presenting organization must be identified in the verification cog s through documentation
ca taught, total number of
identifying the sponsoring entity, the name of the program, location, dat
hours, participant's name and presenter's name and credentials.
(c) Presentation of fraudulent continuing education documentation is a Vion Chapter and
applicable to the hospice license. OL
urs ma fered through a graduate or undergraduate course, seminar,
fession ciation meeting for the purpose of enhancing professional
ps ey i and informal meetings that are informational in nature and
ral pair applicable to Hospice service delivery.
g of continuing education.
(ae education courses must have:
[Source: Added at 36 Ok Reg 1728, eff 9-13-19; Amended at 39 Ok Reg 1375, eff 9-11-22] < O
310:661-3-5.4. Penalty for failure to fulfill continuing education
Failure to meet the continuing education requirements is a violation of Title 63, SectionN..662 and
this Chapter and therefore, subject to a written notice of violation.
[Source: Added at 36 Ok Reg 1728, eff 9-13-19]
SUBCHAPTER 5. MINIMUM STANDARDS
310:661-5-1. Admission
(a) Admission to a hospice will be in accord with the Act.
(b) Hospice services will be available twenty-four (24) hours a day, seven (7) days a week.
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(c) A hospice program will not impose the dictates of any value or belief system on its patients and their
families.
(d) A hospice will coordinate its service with those of the patient's primary or attending physician, all
hospice caregivers, and nursing facility staff if a patient resides in a nursing facility.
(e) The hospice team will be responsible for coordination and continuity between inpatient and home care
aspects of care.
[Source: Added at 9 Ok Reg 1985, eff 6-11-92; Amended at 14 Ok Reg 2106, eff 4-7-97 (emergency); Amended at 14 Ok Reg 2269, eff 6-12-97;
Amended at 39 Ok Reg 1375, eff 9-11-22]
310:661-5-1.1. Admission to hospice care
hospice admits a patient only on the recommendation of the medical advisor in consultation with,
or input from, the patient's attending physician (if any).
ing a decision to certify that the patient is terminally ill, the hospice medical advisor must
consid ast the following information:
BBrae osis of the terminal condition of the patient;
(2) Q iy conditions, whether related or unrelated to the terminal condition; and
(3) Curr cally relevant information supporting all diagnoses.
[Source: Added at 26 Ok Reg Ye 6-25-09; ony at 39 Ok Reg 1375, eff 9-11-22]
310:661-5-1.2. Discharge roihosnced
(a) Reasons for discharge. A oy nash a patient if:
(1) The patient moves o eae TA area or transfers to another hospice;
(2) The hospice determines't e patie onger terminally ill; or
(3) The hospice determines, urfder Coren no e hospice for the purpose of addressing
discharge for cause that meets ihelegd remen patagraphs (a)(3)(A) through (a)(3) (D) of this
section, that the patient's (or other pe in the hep home) behavior is disruptive, abusive, or
uncooperative to the extent that delive ent or the ability of the hospice to
operate effectively is seriously impaired. Sen titio S, Tellowang before it seeks to
discharge a patient for cause:
(A) Advise the patient that a discharge se 1S (a ne
(B) Document efforts to resolve the ces he patient's behavior or
situation;
(C) Ascertain that the patient's proposed discharfe 7 7? to the patient's use of
necessary hospice services; and
(D) Document the problem(s) and efforts made to aa roblem(s)and enter this
documentation into its medical records. Os
(b) Discharge order. Prior to discharging a patient for any reason listed in h (a) of this section, the
hospice must obtain a written physician's discharge order from the hospice medi See: visor. Any attending
physician involved in the patient's care must be consulted before discharge and ae and
decision included in the discharge note.
(c) Discharge planning.
(1) The hospice must have a discharge planning process that takes into account DH ct that a
patient's condition might stabilize or otherwise change such that the patient cannot cant to be
certified as terminally ill.
(2) The discharge planning process will include planning for any necessary family counseling,
patient education, or other services before the patient is discharged because he or she is no longer
terminally ill.
[Source: Added at 26 Ok Reg 2042, eff 6-25-09; Amended at 39 Ok Reg 1375, eff 9-11-22]
310:661-5-1.3. Initial and comprehensive assessment of the patient
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(a) General. The hospice must conduct and document in writing a patient-specific comprehensive
assessment that identifies the patient's need for hospice care and services, and the patient's need for
physical, psychosocial, emotional, and spiritual care. This assessment includes all areas of hospice care
related to the palliation and management of the terminal illness and related conditions.
(b) Initial assessment. The hospice registered nurse must complete an initial assessment within forty-eight
(48) hours after the physician's order for hospice care is received (unless the physician, patient, or
representative requests that the initial assessment be completed in less than 48 hours.)
(c) Timeframe for completion of the comprehensive assessment. The hospice interdisciplinary group, in
consultation with the individual's attending physician (if any), must complete the comprehensive
assessment no later than five (5) calendar days after the election of hospice care .
(d) Content of the comprehensive assessment. The comprehensive assessment must identify the physical,
p social, emotional, and spiritual needs related to the terminal illness that will be addressed in order to
promoge the hospice patient's well-being, comfort, and dignity throughout the dying process. The
con kei ive assessment must take into consideration the following:
e nature and condition causing admission (including the presence or lack of objective data
and subjective complaints);
jcations and risk factors that affect care planning;
(3) Functfio atus, including the patient's ability to understand and participate in his or her own
care;
(4) Imminenek ge ath;
(5) Severity of syinptoms; “)
(6) A review of all of HR atient' Ciatioet and over-the-counter drugs, herbal remedies and
other alternative treat hat co st drug therapy. This includes, but is not limited to,
identification of the follo
(A) Effectiveness o therapy) Ad
(B) Drug side effects; 7,
(C) Actual or potential inkdracti /
(D) Duplicate drug therapy; L
(E) Drug therapy currently asso ith ory monitoring.
(7) An initial bereavement assessment of thg needs of BSSecents family and other individuals
focusing on the social, spiritual, and cultural fi sthat m act their ability to cope with the
patient's death. Information gathered from the iffifab6Oereav ssessment is incorporated into
the plan of care and considered in the bereavemen Ny of car
(8) The need for referrals and further evaluation by appr professionals.
(e) Update of the comprehensive assessment. The update of ithe rehensive assessment must:
(1) be accomplished by the hospice interdisciplinary groupipkollaboration with the individual's
attending physician, if any);
(2) consider changes that have taken place since the initial asses cut)
u ome, s well as a
(3) include information on the patient's progress toward desired o
reassessment of the patient's response to care; and
(4) be accomplished as frequently as the condition of the patient requires, Kooress frequently
than every fifteen(15) days.
(f) Patient outcome measures. Q2)
(1) The comprehensive assessment must include data elements that allow for mea’ t of
outcomes. The hospice must measure and document data in the same way for all pa e data
elements must take into consideration aspects of care related to hospice and palliation. oh
(2) The data elements must be:
(A) an integral part of the comprehensive assessment;
(B) documented in a systematic and retrievable way for each patient;
(C) used in individual patient care planning and in the coordination of services; and
(D) used in the aggregate for the hospice's quality assessment and performance
improvement program.
[Source: Added at 26 Ok Reg 2042, eff 6-25-09; Amended at 39 Ok Reg 1375, eff 9-11-22]
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310:661-5-2. Plan of care
(a) A written plan of care must be established and maintained for each patient admitted to a hospice
program and the care provided to an individual is in accordance with the plan.
(b) The plan must be established by the attending physician, the medical advisor, and the interdisciplinary
group.
(c) The plan of care must be reviewed and updated by the hospice team at intervals specified in the plan
and documented by the team members.
(d) The content of the plan must include an assessment of the patient's needs and identify the services
provided. The plan must state in detail the scope and frequency of services needed to meet the patient's and
family's needs.
(e) Continuous care must be provided under a plan of care that is developed specifically to resolve the
p 's medical crisis. These plans must include:
(1) Caregiver education;
‘Anticipated duration of the continuous care;
ecessity of continuous care;
(4)Antegyentions required;
(5) ation of interdisciplinary team members developing the plan; and,
(6) Physiti ers for continuous care.
[Source: Added at 9 Ok Reg 19 om eps 19 Ok Reg 2094, eff 6-27-02; Amended at 26 Ok Reg 2042, eff 6-25-09; Amended at 39
Ok Reg 1375, eff 9-11-22] J)
310:661-5-2.1. Interdisciplitafy, oup, ee and coordination of services
(a) General. The hospice must te ani Uriae group or groups which, in consultation with
the patient's attending physician, w
pare a “plan of care for each patient. The plan of care will
specify the hospice care and services wa i atient and family-specific needs identified in
the comprehensive assessment as such neé is plate to inal illness and related conditions.
(b) Approach to service delivery. -
(1) The hospice must designate in wa terdt
ary group or groups composed of
individuals who work together to meet the sical, ma psychosocial, emotional, and spiritual
needs of the hospice patients and families Benge vote 2 1 sand bereavement.
Interdisciplinary group members must provide Nye e on Ge S offered by the hospice, and the
group, in its entirety, must supervise the care and Oe Thelood e will designate a registered
nurse that is a member of the interdisciplinary group vide céogdination of care and to ensure
continuous assessment of each patient's and family's necks) implementation of the
interdisciplinary plan of care. The interdisciplinary group include individuals who are
qualified and competent to practice in the following professions ee
(A) A doctor of medicine or osteopathy (who is an empl
ici i ove Ounder contract with the
hospice); A
(B) A registered nurse; 70
(C) A social worker; and
(D) A pastoral or other counselor.
(2) If the hospice has more than one interdisciplinary group, it must identify my a
designated interdisciplinary group to establish policies governing the day-to- in Oot
hospice care and services.
(c) Plan of care. All hospice care and services furnished to patients and their families must follgvyjan
individualized written plan of care established by the hospice interdisciplinary group in collaboration with
the attending physician (if any), the patient or representative, and the primary caregiver in accordance with
the patient's needs. The hospice will ensure that each patient and the primary care giver(s) receive
education and training provided by the hospice as appropriate to their responsibilities for the care and
services identified in the plan of care.
(d) Content of the plan of care. The hospice must develop an individualized written plan of care for each
patient. The plan of care will reflect patient and family goals and interventions based on the problems
identified in the initial, comprehensive, and updated comprehensive assessments. The plan of care must
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include all services necessary for the palliation and management of the terminal illness and related
conditions, including at least the following:
(1) Interventions to manage pain and symptoms;
(2) A detailed statement of the scope and frequency of services necessary to meet the specific
patient and family needs;
(3) Measurable outcomes anticipated from implementing and coordinating the plan of care;
(4) Drugs and treatment necessary to meet the needs of the patient;
(5) Medical supplies and appliances necessary to meet the needs of the patient; and
(6) The interdisciplinary group's documentation of the patient's or representative's level of
understanding, involvement, and agreement with the plan of care, in accordance with the hospice's
own policies, in the clinical record.
( iew of the plan of care. The hospice interdisciplinary group (in collaboration with the individual's
atte g physician, if any) must review, revise and document the individualized plan as frequently as the
patchy, dition requires, but no less frequently than every fifteen (15) calendar days. A revised plan of
care m re information from the patient's updated comprehensive assessment and note the patient's
progress ard outcomes and goals specified in the plan of care.
(f) von f services. The hospice must develop and maintain a system of communication and
integration, in a e with the hospice! s own policies and procedures, to:
(1) Ensure e interdisci
supervising th’ and se
(2) Ensure that t re and s
ary group maintains responsibility for directing, coordinating, and
rovided;
are provided in accordance with the plan of care;
(3) Ensure that the ca d servi en are based on all assessments of the patient and
family needs;
(4) Provide for and ensu neo g of information between all disciplines providing
care and services in all settings, whether ote" and services are provided directly or under
arrangement; and
(5) Provide for an ongoing sharinosh nforma other non-hospice healthcare providers
furnishing services unrelated to the t arse ‘Ines 4 lated conditions.
[Source: Added at 26 Ok Reg 2042, eff 6-25-09; Amended at "Y Ok Re Ky eff 9- Ay
310:661-5-2.2. Core Services Oy
(a) General. A hospice must provide substantially all core ces ay hospice trained and oriented
employees. These services include nursing services, medical $o On" and bereavement and spiritual
counseling. The hospice may contract for physician services.
(b) Physician services. The hospice medical advisor, physician enhirees and contracted physician(s) of
the hospice, in conjunction with the patient's attending physician, are re shox sible for the palliation and
management of the terminal illness and conditions related to the terminaffllng
(1) All physician employees and those under contract, must functio® pre he supervision of the
hospice medical advisor.
(2) All physician employees and those under contract must meet this reais by either
providing the services directly or through coordinating patient care with the eridjn g physician
(3) If the attending physician is unavailable, the medical advisor, contracted p CD: and/or
hospice physician employee is responsible for meeting the medical needs of the p
(c) Nursing services.
(1) The hospice must provide nursing care by licensed nurses under the supervision of istered
nurse. Nursing services must ensure that the nursing needs of the patient are met as identified in the
patient's initial assessment, comprehensive assessment, and updated assessments.
(2) If State law permits registered nurses to see, treat, and write orders for patients, then registered
nurses may provide services to patients receiving hospice care.
(3) Highly specialized nursing services that are provided so infrequently that the provision of such
services by direct hospice employees would be impracticable and prohibitively expensive, may be
provided under contract.
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(d) Medical social services. Medical social services must be provided by a qualified social worker, under
the direction of a physician. Social work services must be based on the patient's psychosocial assessment
and the patient's and family's needs and acceptance of these services.
(e) Counseling services. Counseling services must be available to the patient and family to assist the
patient and family in minimizing the stress and problems that arise from the terminal illness, related
conditions, and the dying process. Counseling services will include, but are not limited to, the following:
(1) Bereavement counseling. The hospice must:
(A) Have an organized program for the provision of bereavement services furnished under
the supervision of a qualified professional with experience or education in grief or loss
counseling;
(B) Make bereavement services available to the family and other individuals in the
bereavement plan of care up to one (1) year following the death of the patient. Bereavement
¢ counseling also extends to residents of a care facility when appropriate and identified in the
4p bereavement plan of care;
Q (C) Ensure that bereavement services reflect the needs of the bereaved; and
) Develop a bereavement plan of care that notes the kind of bereavement services to be
Ve: red and the frequency of service delivery.
(2) Diet seling. Dietary counseling, when identified in the plan of care, must be performed
by a qualift ividual, whigh include dietitians as well as nurses and other individuals who are
able to addres ssure tlfat thé dietary needs of the patient are met.
(3) Spiritual coulasfin . Th ice must:
(A) Provide afbiesn he patient's and family's spiritual needs;
(B) Provide spffi conse these needs in accordance with the patient's and
family's accepta is se Ce nd in a manner consistent with patient and family
beliefs and desires; °
(C) Make all reasonablé e to fatuifate,visits by local clergy, pastoral counselors, or
other individuals who can rt the papfent's spiritual needs to the best of its ability; and
rfose
(D) Advise the patient and fanrifyfof_this se
[Source: Added at 26 Ok Reg 2042, eff 6-25-09; Amended at 39 Ok Reg 1375, eff MY,
¢ 5
310:661-5-2.3. Physical therapy, occupational eric e pathology
Physical therapy services, occupational therapy se 63. and s nguage pathology services
must be available.
[Source: Added at 26 Ok Reg 2042, eff 6-25-09; Amended at 39 Ok Reg 1375, eff sam)
310:661-5-2.4. Licensed Professional Services
(a) Licensed professional services provided directly or under arrangement uthorized, delivered,
and supervised only by health care professionals who meet the appropriate qualiffcatrens specified by the
State and who practice under the hospice's policies and procedures. Oj
(b) Licensed professionals must actively participate in the coordination of all aspectOf thy patient's
hospice care, in accordance with current professional standards and practice, including*pa ating in
ongoing interdisciplinary comprehensive assessments, developing and evaluating the pla care, and
contributing to patient and family counseling and education.
(c) Licensed professionals must participate in the hospice's quality assessment and performanc
improvement program and hospice sponsored in-service training.
[Source: Added at 26 Ok Reg 2042, eff 6-25-09; Amended at 39 Ok Reg 1375, eff 9-11-22]
310:661-5-3. Quality assurance
(a) The hospice must develop, maintain, and conduct a comprehensive quality assurance program that
includes an evaluation of services, quarterly clinical record audits, and organizational review.
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(b) The hospice must ensure that appropriate and quality care is provided to include inpatient care, home
care, and care provided under arrangements.
(c) The quality assurance program must be reviewed at least once a year. Policies and procedures will be
revised as needed, reviewed, and approved annually. Goals will be established and problems identified
with documented results.
[Source: Added at 9 Ok Reg 1985, eff 6-11-92; Amended at 14 Ok Reg 2106, eff 4-7-97 (emergency); Amended at 14 Ok Reg 2269, eff 6-12-97;
Amended at 39 Ok Reg 1375, eff 9-11-22]
310:661-5-3.1. Quality Assessment/Performance Improvement
(a) The hospice must develop, implement, and maintain an effective, ongoing, hospice-wide data-driven
assessment and performance improvement program. The hospice's governing body must ensure that
the ram: Reflects the complexity of its organization and services; involves all hospice services
(inclidyfgfhose services furnished under contract or arrangement); focuses on indicators related to
liative outcomes; and takes actions to demonstrate improvement in hospice performance. The
aintain documentary evidence of its quality assessment and performance improvement
to improved palhative outcofnesaand hospice services.
(2) The hospice measures yze, and track quality indicators, including adverse patient
events, and other aspeptof perf ce that enable the hospice to assess processes of care,
hospice services, and of gasons. 4 .
(c) Program data. V4
(1) The program must use ‘fot indica Cy including patient care, and other relevant data, in
the design of its program.
(2) The hospice must use the data Gites oe pnt
(1) The pro ust at least ¢ capable of showing measurable improvement in indicators related
(A) Monitor the effectivenes safety of sérvices and quality of care; and
(B) Identify opportunities and p for
ement.
(3) The frequency and detail of the data coll€¢tion mak deapproved by the hospice's governing
body. >
(d) Program activities. Sx
QD °
(1) The hospice's performance improvement activi us O
(A) Focus on high risk, high volume, or problfém-prone ar€ag¥
(B) Consider incidence, prevalence, and severit problems in those areas; and
(C) Affect palliative outcomes, patient safety, and qtaltty of care.
(2) Performance improvement activities must track adverse pati gf vents, analyze their causes,
and implement preventive actions and mechanisms that include fe€dbagk and learning throughout
the hospice.
(3) The hospice must take actions aimed at performance improvement and after implementing
those actions, the hospice shall measure its success and track performances re that
improvements are sustained. I
(ec) Performance improvement projects. Hospices must develop, implement, and evalua rformance
improvement projects.
(1) The number and scope of distinct performance improvement projects conducted , based
on the needs of the hospice's population and internal organizational needs, must reflect th@scope,
complexity, and past performance of the hospice's services and operations.
(2) The hospice must document what performance improvement projects are being conducted, the
reasons for conducting these projects, and the measurable progress achieved on these projects.
(f) Executive responsibilities. The hospice's governing body is responsible for ensuring the following:
(1) An ongoing program for quality improvement and patient safety is defined, implemented, and
maintained, and is evaluated annually;
(2) The hospice-wide quality assessment and performance improvement efforts address priorities
for improved quality of care and patient safety, and that all improvement actions are evaluated for
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effectiveness; and
(3) One or more individual(s) who are responsible for operating the quality assessment and
performance improvement program are designated.
[Source: Added at 26 Ok Reg 2042, eff 6-25-09; Amended at 39 Ok Reg 1375, eff 9-11-22]
310:661-5-4. Rights and responsibilities
(a) Every hospice must provide, before or at the time of admission, a written statement of rights and
responsibilities to each patient, or patient representative, or available family member. The hospice shall
ensure that all staff members are familiar with and observe the rights and responsibilities enumerated in the
statement.
( statement must inform the patient that he/she has a right to:
(1) A listing of available services, charges, billing process, and services that may be covered by
Gi Wate payment, private insurance, or state or federal medical care payment programs, including
aid or Medicare;
(2yAdyance notice of any change in fees or billing as soon as possible but no later than thirty (30)
cale ys before the effective date of the change;
(3) Rece ation explaining the Medicare, Medicaid and insurance benefits which are no
longer avai the patientgwhile the patient receives hospice care, any applicable benefit
periods, lengt ine of cert period, and the process of revoking and transferring from
one hospice to i 4 ifthe Patéent desires;
(4) Be informed of iN to pafté€fpate in the planning of care, the right to be advised in advance
of any changes in the pia, care, iplines that shall furnish care, the proposed frequency of
care, the title of the pers rvisin atient's care and the manner in which that person may
be contacted; y »)
¢
(5) Revoke the hospice benefit; wishOut coefgren from the hospice;
(6) Expect that the hospice shall e ber) rthétA L. life and affairs than is required to meet
the goals of the hospice care plan;
(7) A grievance procedure that includes t to fegi a grievance with the hospice regarding
treatment or care received or lack of treatment or care t reprisal or discrimination from the
hospice; and Ay . °
(8) File a complaint with the Oklahoma State Péptinen ) at its current mailing address.
(c) The statement must include the following hospice resp ilities:
(1) Accepting patients for service only if they meet hdspige,admissigh criteria and have been
determined to be terminally ill by a licensed medical do osteopathic physician;
(2) Providing services regardless of payment; 7)
(3) Providing services if the patient is a nursing facility resident indicating that care will be
provided according to the hospice plan of care and that the nurs1 ity will be provided with
the plan of care and all subsequent changes to ensure care is coordi ;
(4) Informing the patient representative or family of the patient's conditigh ; ad what future changes
may occur in the patient's condition and encouraging the patient or paenggplsctatv to express
feelings and emotions without fear of reprisal; )
(5) Providing caregivers who are non-judgmental and conduct themselves in a Cae
manner;
(6) Making and accepting referrals solely in the best interest of the patient; 45s
(7) Ensuring that hospice owners, employees, and contractors do not knowingly initiat tact
with a patient currently treated by another hospice for the purpose of attempting to persuade the
patient to change hospice providers, and ensuring that a hospice which has knowledge of contacts
initiated by its employees, owners or contractors will take reasonable and necessary steps to cease
such contacts;
(8) Respecting and being sensitive to the ethnic, cultural, socioeconomic, religious and lifestyle
diversity of the patients and their families;
(9) Ascertaining and honoring the wishes, concerns, priorities and values of the patient and the
patient's family including refusal of routine care and treatment consistent with the organization's
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values as stated by hospice policy;
(10) Complying with the patient's advance directive, informing the patient of the right to revoke the
advance directive at any time, and discussing the procedures required to revoke;
(11) Providing qualified personnel to meet the patient's needs;
(12) Supporting, affirming, and empowering families as caregivers while acknowledging and
responding with sensitivity to the interruption of privacy that is necessitated by hospice care in the
patient's residence; and
(13) Ensuring that contracted providers and volunteers are qualified and properly trained and
provide care consistent with the values and philosophy of hospice.
(14) Ensuring hospice care is established to meet the patient's needs and not to supplement facility
staffing if the patient resides in an inpatient facility.
[Source nded at 39 Ok Reg 1375, eff 9-11-22; Amended at 21 Ok Reg 1303, eff 5-27-04; Amended at 19 Ok Reg 2094, eff 6-27-02; Added at 14
Ok Reg Layo Added at 14 Ok Reg 2106, eff 4-7-97 (emergency)]
310:661-3=4.1. Additional rights of the patient
(a) General tient has the right to be informed of his or her rights, and the hospice must protect and
promote the exe these rights.
(b) Notice of righ responsibilities.
(1) During th ial assessfientwisit in advance of furnishing care the hospice must provide the
patient or repres ve wit 1 and written notice of the patient's rights and responsibilities in
a language and mannepthat he ey understands.
(2) The hospice must 1 Piesvriion information to the patient concerning its policies
on advance directives, in a de ion of applicable State law.
(3) The hospice must obtai atient' Gx esentative's signature confirming that he or she has
received a copy of the notice
rightsand r sibilities.
(c) Exercise of rights and respect for orkpey an on
(1) The patient has the right: “/ L
(A) To exercise his or her rights tien Odean
(B) To have his or her property and pérson tre
ian respect;
(C) To voice grievances regarding trea t,or c t is (or fails to be) furnished and the
lack of respect for property by anyone furnis rvices on behalf of the hospice;
and
and
(D) To not be subjected to discrimination Qi for oleDsing his or her rights.
(2) If a patient has been adjudged incompetent under sta by a court of proper jurisdiction, the
rights of the patient are exercised by the person appointed AQuan to state law to act on the
patient's behalf. QQ
(3) If a state court has not adjudged a patient incompetent, any | representative designated by
the patient in accordance with state law may exercise the patient's fi the extent allowed by
state law. 7,
(4) The hospice must:
(A) Ensure that all alleged violations involving mistreatment, negls@ror" bal, mental,
sexual, and physical abuse, including injuries of unknown source, and opriation of
patient property by anyone furnishing services on behalf of the hospice, ee, ed
immediately by hospice employees and contracted staff to the hospice admi
(B) Immediately investigate all alleged violations involving anyone furnishing ices on
behalf of the hospice and immediately take action to prevent further potential violations
while the alleged violation is being verified. Investigations and/or documentation of all
alleged violations shall be conducted in accordance with established procedures;
(C) Take appropriate corrective action in accordance with state law if the alleged violation
is verified by the hospice administration or an outside body having jurisdiction, such as the
State survey agency or local law enforcement agency; and
(D) Ensure that verified violations are reported to State and local bodies having jurisdiction
(including to the State survey and certification agency) within 5 working days of becoming
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aware of the violation.
(d) Rights of the patient. The patient has a right to the following:
(1) Receive effective pain management and symptom control from the hospice for conditions
related to the terminal illness;
(2) Be involved in developing his or her hospice plan of care;
(3) Refuse care or treatment;
(4) Choose his or her attending physician;
(5) Have a confidential clinical record. Access to or release of patient information and clinical
records 1s permitted in accordance with State and Federal law.
(6) Be free from mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including
injuries of unknown source, and misappropriation of patient property;
(7) Receive information about the services covered under the hospice benefit; and
(8) Receive information about the scope of services that the hospice will provide and specific
Cr tations on those services.
[Source: Added SY, @ Reg 2042, eff 6-25-09; Amended at 39 Ok Reg 1375, eff 9-11-22]
hospice patient and fa e pro¥isioff of continuous care must meet the following requirements:
(1) A skilled nur: ovides a 51% of the care in a 24-hour period, and a qualified home
health aide must rove h
(2) A registered nurse
of interventions and the
thereafter of the uncontrolled rhedi isis! Yy
[Source: Added at 19 Ok Reg 2094, eff 6-27-02; Amended at wh 1375, cfr
310:661-5-6. Infection Control ©,
(a) General. The hospice must maintain and docume fective R¥grtion control program that protects
patients, families, visitors, and hospice personnel by prevepth an oA lling infections and
communicable diseases.
(b) Prevention. The hospice must follow accepted standards of oo Levent the transmission of
infections and communicable diseases, including the use of stan ecautions.
(c) Control. The hospice must maintain a coordinated agency-wid gram for the surveillance,
identification, prevention, control, and investigation of infectious and c icable diseases that:
(1) Is an integral part of the hospice's quality assessment and pe ce improvement program;
and
(2) Includes the following:
(A) A method of identifying infectious and communicable disease Grob
s; and
(B) A plan for implementing the appropriate actions that are rere a ult in
improvement and disease prevention. Q
(d) Education. The hospice must provide infection control education to employees, cont oviders,
patients, and family members and other caregivers.
[Source: Added at 26 Ok Reg 2042, eff 6-25-09; Amended at 39 Ok Reg 1375, eff 9-11-22]
310:661-5-7. Supervision of hospice aides
(a) A registered nurse must make an on-site visit to the patient's home:
(1) No less frequently than every fourteen (14) calendar days to assess the quality of care and
services provided by the hospice aide and to ensure that services ordered by the hospice
interdisciplinary group meet the patient's needs. The hospice aide does not have to be present
during this visit.
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(2) If an area of concern is noted by the supervising nurse, then the hospice must make an on-site
visit to the location where the patient is receiving care in order to observe and assess the aide while
he or she is performing care.
(3) If an area of concern is verified by the hospice during the on-site visit, then the hospice must
conduct, and the hospice aide must complete a competency evaluation.
(b) A registered nurse must make an annual on-site visit to the location where a patient is receiving care in
order to observe and assess each aide while he or she is performing care.
(c) The supervising nurse must assess an aide's ability to demonstrate initial and continued satisfactory
performance in meeting outcome criteria that include, but is not limited to:
(1) Following the patient's plan of care for completion of tasks assigned to the hospice aide by the
registered nurse;
(2) Creating successful interpersonal relationships with the patient and family;
(3) Demonstrating competency with assigned tasks;
omplying with infection control policies and procedures; and
porting changes in the patient's condition.
[Source: Added at 26 Oo Reg 2042, eff 6-25-09; Amended at 39 Ok Reg 1375, eff 9-11-22]
(a) General. Medical ies and ces; durable medical equipment; and drugs and biologicals
related to the palliation a' anage s) the terminal illness and related conditions, as identified in the
hospice plan of care, must be sie ER ngspice while the patient is under hospice care.
(b) Managing drugs and bio
(1) The hospice must ere wee co ciplinary group confers with an individual with
310:661-5-8. ia 4/, ps and ois Supplies, Durable Medical Equipment
education and training in d nagem defined in hospice policies and procedures and State
law, who is an employee of or fin na e hospice to ensure that drugs and biologicals
meet each patient's needs.
(2) A hospice that provides inpatient edfe ctly hoe facility must provide pharmacy
services under the direction of a qualified a sed cist who is an employee of or under
contract with the hospice. The provided phafmacist se a include evaluation of a patient's
response to medication therapy, identification pr drug reactions, and
recommended appropriate corrective action. %
(c) Ordering of drugs.
(1) Only a licensed independent practitioner with preScriptiye aut y, in accordance with the plan
of care and State law, may order drugs for the patient. o)}
(2) If the drug order is verbal or given by or through electrénj¢ transmission:
(A) It must be given only to a licensed health care practiffoners within their scope of
practice under state law and authorized by hospice policy ive verbal orders; and
(B) The individual receiving the order must record and signNt infin it set A oions and have the
prescribing person sign it in accordance with State and Federal r. ons.
(d) Dispensing of drugs and biologicals. The hospice must obtain drugs and ps from community
or institutional pharmacists or stock drugs and biologicals itself. )
(ec) Administration of drugs and biologicals. The interdisciplinary group, as part of t w of the plan
of care, must determine the ability of the patient and/or family to safely self-administer d a
biologicals to the patient in his or her home.
(f) Labeling, disposing, and storing of drugs and biologicals.
(1) Labeling. Drugs and biologicals must be labeled in accordance with currently accepted
professional practice and include appropriate usage and cautionary instructions, as well as an
expiration date (if applicable).
(2) Disposing. The hospice must have written policies and procedures for the management and
disposal of controlled drugs in the patient's home. At the time when controlled drugs are first
ordered the hospice must:
(A) Provide a copy of the hospice written policies and procedures on the management and
disposal of controlled drugs to the patient or patient representative and family;
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(B) Discuss the hospice policies and procedures for managing the safe use and disposal of
controlled drugs with the patient or representative and the family in a language and manner
that they understand to ensure that these parties are educated regarding the safe use and
disposal of controlled drugs; and
(C) Document in the patient's clinical record that the written policies and procedures for
managing controlled drugs was provided and discussed.
(g) Use and maintenance of equipment and supplies.
(1) The hospice must ensure that manufacturer recommendations for performing routine and
preventive maintenance on durable medical equipment are followed. The equipment must be safe
and work as intended for use in the patient's environment. Where a manufacturer recommendation
for a piece of equipment does not exist, the hospice must ensure that repair and routine
maintenance policies are developed. The hospice may use persons under contract to ensure the
maintenance and repair of durable medical equipment.
Co hospice must ensure that the patient, where appropriate, as well as the family and/or other
CQrero) receive instruction in the safe use of durable medical equipment and supplies. The
hoSpicggmay use persons under contract to ensure patient and family instruction. The patient,
tamil oh or caregiver must be able to demonstrate the appropriate use of durable medical
equipmefit satisfaction of the hospice staff.
[Source: Added at 26 Ok Reg oa Cy at 39 Ok Reg 1375, eff 9-11-22]
310:661-5-9. Short-term ingaene car Q
(a) Inpatient care must be avai or pai symptom management, and respite purposes.
(b) If the hospice has an arrange ith an cility to provide for short-term inpatient care, the
arrangement is described in a writte ement, €oordinated by the hospice, and at a minimum specifies
that:
inpatient services to be furnished;
(2) the inpatient provider has establish tca i¢les consistent with those of the hospice
and agrees to abide by the palliative care pr@tocols an f care established by the hospice for
its patients; S ° Q +
(3) the hospice patient's inpatient clinical recor ule des are f all inpatient services furnished
and events regarding care that occurred at the faciltt#/\that a co e discharge summary be
provided to the hospice at the time of discharge; and that aecopy of Me inpatient clinical record is
available to the hospice at the time of discharge;
(4) the inpatient facility has identified an individual within fp acility who is responsible for the
implementation of the provisions of the agreement; and
(5) the hospice retains responsibility for ensuring that the trainin SEprsonnel who will be
providing the patient's care in the inpatient facility has been provi at a description of the
training and the names of those giving the training are documented. O
tn
(1) the hospice supplies the <a pas patient's plan of care and specifies the
€ P,
[Source: Added at 26 Ok Reg 2042, eff 6-25-09; Amended at 39 Ok Reg 1375, eff 9-11-22]
SUBCHAPTER 6. HOSPICE INPATIENT SERVICE REQUIRE
310:661-6-1. General
(a) Each hospice program that operates a hospice inpatient facility must comply with service requiétements
specified in this subchapter.
(b) Patients are allowed to receive visitors at any hour, including small children and house pets.
(c) Smoking or possessing a lighted tobacco product is prohibited in a hospice inpatient facility and within
fifteen (15) feet of each entrance to a facility and of any air intakes; provided however, the facility may
provide a smoking room for use by patients and their visitors. The walkway to the main entrance must also
be smoke free. Ashtrays cannot be located closer than fifteen (15) feet to an entrance, except in an indoor
smoking room. An indoor smoking room may be provided if:
(1) It is completely enclosed;
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(2) It is exhausted directly to the outside and maintained under negative pressure sufficient to
prevent any tobacco smoke from entering non-smoking areas of the building;
(3) It allows for visual observation of the patients from outside of the smoking room; and
(4) The plans are reviewed and approved by the Department.
[Source: Added at 21 Ok Reg 1303, eff 5-27-04; Amended at 39 Ok Reg 1375, eff 9-11-22]
310:661-6-2. Compliance with health and safety requirements
(a) Each hospice inpatient facility must comply with all Federal, State, and local laws, regulations, codes
and ordinances as required.
he facility must have written policies and procedures relating to advance directives with respect to all
receiving care. These policies and procedures will comply with existing Federal and State laws.
[Source: yea Ok Reg 1303, eff 5-27-04; Amended at 39 Ok Reg 1375, eff 9-11-22]
310:661 Sain services
(a) The faci t provide twenty-four (24) hour nursing services sufficient to meet the needs of the
hospice inpatien
(b) Each patient m ive treatmegtts, medications, and diet as prescribed, and kept comfortable, clean,
well-groomed, and pr om Rigi injury, and infection.
(c) Each shift must includgfit least one egistered nurse to supervise the facility and provide direct
patient care.
(d) There must be adequate neh of oth mp nurses and support staff to provide services
established in the patient's plan o while tle ent is in the facility.
[Source: Added at 21 Ok Reg 1303, eff 5-27-04; “aneeCy* ey 11-22]
310:661-6-4. Dietary services }
may be provided on a contract basis as long as dietaty needs o ts are met.
(a) The facility must provide dietary service adeq fic) o meet ESionts needs of the patients. Services
(b) Each facility must serve at least three (3) meals or tr neal h day at regular times, with not
more than fourteen (14) hours between a substantial eve eal an kfast.
(c) Menus must be planned and followed to balance patien Aiice wit ional needs of patients, in
|
accordance with physicians' orders and to the extent medically p ible, in a@cordance with the Dietary
Reference Intakes (DRIs) of the Food and Nutrition Board of th my of Medicine, National Academy
of Sciences.
compliance with Chapter 257 of this Title.
(e) Nourishments are available for all patients at anytime in accordance with appr yas diet orders.
(f) There must be adequate trained staff available to manage and provide dietar om A
(d) The facility must procure, store, prepare, distribute, and serve ? foo yA Os. sanitary conditions in
licensed/registered dietitian must be available to provide consultation on patients' woe supervise
services, and ensure medically prescribed special diets are provided as ordered.
(g) The system to be used for dishwashing must be approved by the Department and o oO
accordance with approved procedures and requirements of Chapter 257 of this Title. OF
(h) Garbage and refuse must be kept in durable, easily cleanable, insect-proof and rodent-pr iners
that do not leak and do not absorb liquids. Adequate carriers and containers will be provided fo
collection and transportation, in a sanitary manner, of garbage and refuse from food service areas of the
hospice to the place of disposal in accordance with the requirements of Chapter 257 of this Title.
[Source: Added at 21 Ok Reg 1303, eff 5-27-04; Amended at 24 Ok Reg 2004, eff 6-25-07; Amended at 39 Ok Reg 1375, eff 9-11-22]
310:661-6-5. Pharmaceutical services
(a) The hospice inpatient facility must provide appropriate methods and procedures for dispensing and
administering drugs and biologicals. Whether drugs and biologicals are obtained from community or
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institutional pharmacies or maintained and stocked by the facility, the facility is responsible for the
pharmaceutical services and ensure services are provided in accordance with accepted professional
standards of practice in compliance with Federal, State, and local laws.
(b) Each facility must employ or contract with a licensed pharmacist to supervise services and ensure drugs
and biologicals are obtained, stored, administered and disposed of as required by Federal and State law.
(c) A physician or licensed independent practitioner must order all medications for each patient. If the
physician or practitioner's order is verbal, the physician or practitioner must give the order to a licensed
nurse or other individual authorized by State law to receive the order. The individual receiving the order
must record and sign the order immediately and have the prescribing physician or practitioner sign as soon
as possible in a manner consistent with good medical practice. Another covering or attending physician or
practitioner may sign another physician or practitioner's verbal order if the facility allows this practice and
S procedures are approved by the governing body to permit the practice. If a covering or attending
phygicyan or practitioner authenticates the ordering physician or practitioner's verbal order, such an
authény€ation indicates that the covering or attending physician or practitioner assumes responsibility for
his or hér@ofleague's order and verifies the order is complete, accurate, appropriate, and final.
(d) Drugs nd biologicals must be administered only by a physician, licensed nurse, an individual
authorized b, law to administer, or the patient if his or her attending physician has approved.
(e) The pharmac of ervice must have procedures for control and accountability of all drugs and
biologicals in the i Ds are comes in compliance with Federal and State law. Records of
receipt and dispositio ontroffed drugs are maintained in sufficient detail to enable an accurate
reconciliation. The pha: st must
controlled drugs is maintaineg Ad reco
(f) The labeling of drugs and bfol@gicals i oe currently accepted professional principles in
compliance with State law, and 1 the a iate accessory and cautionary instructions, as well as
the expiration date and lot number w. sppliote) °
(g) All drugs and biologicals must be stor Jockey artments under proper temperature controls.
Only authorized personnel must have acc eparateé Piboek d compartments must be provided for storage
of Schedule I controlled drugs. All stores 0 dule II cn individually dispensed to a patient must
aS
the drug records are in order and that an account of all
be accounted for at regular intervals to ensure t are hotdaverted.
(h) If the facility only maintains drugs and biolog by indi
medication kit approved by the Medical advisor must be main
(1) Controlled drugs no longer needed by the patient m VesBispos
State requirements. The pharmacist and a facility register Ase or t
document disposal and maintain a record. O
atient prescription, an emergency
compliance with Federal and
acility registered nurses must
EDITOR'S NOTE: !When published in the Register, these permanent amendments to this Section 6-5) were incorrectly numbered as
amendments to 310:661-6-7. This error was editorially corrected, and the amendments were codifié#’as_ amgndments to the correct number (310:661-
. 7,
310:661-6-6. Disaster preparedness OQ
The hospice inpatient facility must have an acceptable written plan, period Hy A earsed with
staff, with procedures to be followed in the event of an internal or external disaster an O care of
casualties arising from such disasters. 5
[Source: Amended at 26 Ok Reg 2042, eff 6-25-09; Amended at 39 Ok Reg 1375, eff 9-1 Rar at 21 Ok Reg 1303, eff 5-27-04]
[Source: Added at 21 Ok Reg 1303, eff 5-27-04; Amended at 39 Ok Reg 1375, eff 9-11-22]
310:661-6-7. Infection control
310:661-6-7.! Infection control
Each hospice inpatient facility must establish an infection control program to provide a sanitary
environment and avoid sources and transmission of infections. The program must include written policies
and procedures for identifying, reporting, evaluating and maintaining records of infections among patients
and personnel, for ongoing review and evaluation of all aseptic, isolation and sanitation techniques
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employed in the facility, and development and coordination of training programs in infection control for all
facility personnel.
[Source: Added at 21 Ok Reg 1303, eff 5-27-04; Amended at 39 Ok Reg 1375, eff 9-11-22]
EDITOR'S NOTE: 'In 2009, permanent amendments were incorrectly promulgated as amendments to this section number (310:661-6-7) instead of
310:661-6-5, as intended [see 26 Ok Reg 2042, effective 6-25-09]. This error was editorially corrected, and the amendments were codified as
amendments to the correct number (310:661-6-5).
SUBCHAPTER 7. INFRACTIONS
310:661-7-1. Inspections
Any duly authorized representative of the Department has the right to conduct such inspections as
ne ry in order to determine compliance with the provisions of the Act and this Chapter. The right of
ifis os also extends to any hospice the Department has a reason to believe is advertising or operating a
e
ice without a license.
[Source: Adde Ok Reg 1985, eff 6-11-92; Amended at 21 Ok Reg 1303, eff 5-27-04; Amended at 39 Ok Reg 1375, eff 9-11-22]
310:661-7-2. nts and investigations
(a) A complaint m’ registered by any person who believes a hospice is operating contrary to the Act or
is posing a serious thr€atto the hala welfare of a patient in its care. The complaint may be registered
verbally or in writing to (he Depart investigation will be conducted by the Department to
determine the validity of the sas instigate necessary action thereto. The Department must
notify the complainant in writt the fi if a name and address is furnished.
(b) If the Department determine are re le grounds to believe that a hospice is operating in
violation of the Act or the rules, tiADappren ust follow the notice and hearing procedure established
by the Act and the Procedures of the Dépa nt, r 2 of this Title.
[Source: Added at 9 Ok Reg 1985, eff 6-11-92; Amended at g 2106, eff 447-97 (emergency); Amended at 14 Ok Reg 2269, eff 6-12-97;
Amended at 21 Ok Reg 1303, eff 5-27-04; Amended at 39 Ok Reg as” 1-
310:661-7-3. Penalties > 7 >
After notice and hearing pursuant to the Act, t tme use any and all of the remedies
provided by the Act and by the general statutory authority YO Com er of Health.
[Source: Added at 9 Ok Reg 1985, eff 6-11-92]
310:661-7-4. Appeals é Q
Final orders of the Department may be appealed to the Supreme ‘Appeals must be in
accordance with 63 O.S. § 1-860.11. TA
[Source: Added at 9 Ok Reg 1985, eff 6-11-92; Amended at 14 Ok Reg 2106, eff 4-7-97 (emergency); Amenfe Ok Reg 2269, eff 6-12-97;
Amended at 39 Ok Reg 1375, eff 9-11-22]
SUBCHAPTER 8. HOSPICE INPATIENT FACILITY PHYSICA
310:661-8-1. General ~~
(a) These requirements are intended as minimum standards for constructing and equipping a roy
inpatient facility of twelve beds (12) beds or less. Inpatient hospice facilities containing three (3) beds or
less shall only be required to comply with the physical plant requirements contained in Section 310:661-8-
14 of this subchapter. Insofar as practical, these rules relate to desired performance or results or both.
Details of construction and engineering are assumed to be part of good design practice and local building
regulations. Design and construction shall conform to the requirements of these rules. Requirements set
forth in these rules shall be considered as minimum. For aspects of design and construction not included,
local governing building codes shall apply. Where there is no local governing building code, the prevailing
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model code used within the geographic area is hereby specified for all requirements not otherwise specified
in these rules.
(b) These rules are not intended to restrict innovations and improvements in design or construction
techniques. Accordingly, the Department may approve plans and specifications which contain deviations if
it is determined that the respective intent or objective has been met.
(c) All facilities shall comply, insofar as practical, with applicable sections of these standards and with
appropriate parts of NFPA 101, 2000 edition, covering Health Care Occupancies which is incorporated by
reference. Where major structural elements make total compliance impractical or impossible, exceptions
may be considered by the Department. This does not guarantee that an exception shall be granted, but does
attempt to minimize restrictions on those improvements where total compliance would not substantially
improve safety, but would create an unreasonable hardship. This subchapter shall not be construed as
p iting a single phase of improvement. However, they are not intended as an encouragement to ignore
defi€igncies when resources are available to correct life-threatening problems.
hen construction is complete, the facility shall satisfy functional requirements for a hospice
jent facility in an environment that shall provide acceptable care and safety to all occupants.
(2yAn r ukeiyy atte projects and those making additions to existing facilities, only that portion of the
tota affected by the project shall comply with applicable sections of these standards and
with os parts of NFPA 101, 2000 edition, covering New Health Care Occupancies.
(3) Those Shoos portions ofphe facility which are not included in the renovation but which are
essential to th igning complete facility, as well as existing building areas that receive
less than substan mounts work shall, at a minimum, comply with that section of NFPA
101, 2000 edition, forsting Care Occupancies.
(4) Conversion to oth opriat replacement shall be considered when cost prohibits
compliance with a tA
(5) When a building is conv from neat: to another, it shall comply with the new
occupancy requirements. For purpose of lif a conversion from a hospital or nursing facility
to a hospice inpatient facility or vee} rsa is wer: pdcred a change in occupancy.
(6) When parts of an existing facility. tial ° co ovis overall facility operation cannot
comply with particular standards, those &t eg by the Commissioner of Health if
patient care and safety are not jeopardized.
(7) Renovations, including new additions, sha Ursin
the start of the work; however, excess of aS re for ne
(d) Design standards for the disabled. The Americans isabiliti
comprehensive civil rights protection to individuals with disabilit
Standards" (UFAS) also provides criteria for the disabled. Also le for use in providing quality
design for the disabled is the International Codes Council (ICC)/A can National Standards Institute
(ANSI) A117.1 "American National Standard for Accessible and UsablyByiidings and Facilities."
(ICC/ANSI A117.1)
(1) State and local standards for accessibility and usability may be ore gent than ADA,
UFAS, or ICC/ANSI A117.1. Designers and owners, therefore, shall ass vf esponsibility for
verification of all applicable requirements and comply with the most string yrs. ndards.
(ce) N onconforming conditions. It is not always financially feasible to renovate theertar tire existing
structure in accordance with these standards. In such cases, the Department may grant | to renovate
portions of the structure if facility operation and patient safety in the renovated areas are eOpardized by
the existing features of facility sections retained without complete corrective measures. In nfajor.
modernization projects and additions to existing facilities, those unrenovated areas that do not yy with
NFPA 101 requirements for existing buildings shall be separated from sections to be modernized by fire
barriers rated not less than two (2) hour fire resistance and by labeled fire doors of class "B" one and one
half (1-1/2) hour construction.
[Source: Added at 21 Ok Reg 1303, eff 5-27-04]
310:661-8-2. Location
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(a) Access. The site of any hospice inpatient facility shall be convenient to the public and to service
vehicles, including fire protection apparatus, etc.
(b) Environment. Quietness and sanitary features of the immediate environment shall be considered in
locating a hospice inpatient facility.
(c) The site for a hospice inpatient facility shall conform to all local zoning regulations in cities where
zoning ordinances are in effect.
(d) Security. A hospice inpatient facility shall have security measures for patients, personnel, and the
public consistent with the conditions and risks inherent in the location of the facility. These measures shall
include a program designed to protect human and capital resources.
(e) Availability of utilities. The facility shall be located to provide reliable utilities (water, gas, sewer,
electricity). The water supply shall have the capacity to provide normal usage plus fire-fighting
r ments. The electricity shall be of stable voltage and frequency.
( s. Paved or all weather surface roads shall be provided within the property for access to all
entra d to loading and unloading docks for delivery trucks. Vehicular or pedestrian traffic shall not
contracts to the emergency transport station. In addition, access to emergency transport services
shall be lo€atedgto incur minimal damage from floods and other natural disasters. Paved walkways shall be
provided roe rian traffic.
(g) Parking. Ea ice inpatient facility shall provide not less than one (1) space for each day shift staff
member plus one e for reaGrapy patient bed. At least two (2) handicap accessible parking
spaces, but not less th t,is reqdired*by the ICC/ANSI A117.1 Standard, shall be provided. This ratio
may be increased in area public transportation system or to public parking facilities if
proper justification is included com with applicable local codes or zoning standards is achieved.
Space shall be provided for e Ie an vehicles.
[Source: Added at 21 Ok Reg 1303, eff 5-27-04] Me oe,
310:661-8-3. Submission of plans and sy Depew ec ion.
(a) Before construction is begun, plans and s cations covering the construction of new buildings or
major alterations to existing buildings shall re d to TYacneck for review and approval.
(b) Each construction project submission shall be a ompanie I Yrchock for the appropriate review fee
based on the cost of design and construction of the projg as specified at 3 10:661-2-7.
(c) All construction project submittals shall be review cnn 45 ca >" of receipt by the
Department.
(d) Preparation of plans and specifications.
(1) Stage one. Preliminary plans and outline _ Il ? submitted and include
sufficient information to establish the following: scope of Sys roject location; required fire-
safety and exiting criteria; building-construction type, compan showing fire and smoke
barriers, bed count and services; the assignment of all spaces, ar: rooms for each floor level,
including the basement.
(2) Stage two. A proposed construction document shall be submitted th PAs. final drawings
and specifications adequate for proposed contract purposes. All final planfané and specifications shall
be appropriately sealed and signed by an architect registered by the State o oni ma. All
construction modifications of approved documents are subject to review and a To, and shall be
submitted timely.
(ec) Special submittals.
(1) Fast-track projects. Fast-track projects shall have prior approval and be submitted info more
than four (4) separate packages.
(A) Site work, foundation, structural, under slab mechanical, electrical, plumbing work, and
related specifications.
(B) Complete architectural plans and specifications.
(C) All mechanical, electrical, and plumbing plans andspecifications.
(D) Equipment and furnishings.
(2) Automatic sprinkler-systems. At least two (2) sets of sprinkler-system shop drawings,
specifications, and calculations (if applicable), prepared by the installer, shall be submitted to the
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Office of the State Fire Marshal for review and approval prior to installation of the proposed
system in the project.
(f) Construction other than minor alterations shall not be commenced until Stage Two plan-review
deficiencies have been satisfactorily resolved.
(g) Prior to commencing construction, the hospice shall submit a construction schedule, which includes, as
a minimum, the start date, dates that the heating-ventilation air-conditioning (HVAC), plumbing, and
medical gas installation (if applicable) shall commence, and projected date of completion.
(h) The completed construction shall comply with the approved drawings and specifications, including all
addenda or modifications approved for the project.
(1) A fifty percent (50%) completion inspection and a final construction inspection of the facility shall be
conducted by the Department. for the purpose of verifying compliance with this subchapter and the
and phased to minimize disruptions of retained, existing functions and shall not disrupt or
interfere lent care. Access, exits, and fire protection shall be maintained so that the occupants'
safety shall Gr during construction.
[Source: Added at 21 Ok “ps -27-04] gY
310:661-8-4. Space occ ot gities
(a) Areas within the same na as a Fesnan facility that are leased to, or occupied by, a
separate entity and comply wi ancy requirements as specified by NFPA 101, 2000
edition, shall be separated from t {Ce by demising partitions that are rated not less than one
(1) hour fire resistance. Lease areas with Health Care Occupancy requirements as
specified by NFPA 101, 2000 edition, the licensed hospice by demising partitions
that are rated not less than two (2) hour fi stance:
(b) Lease areas shall have signage that lee 1eS tenght are from the hospice inpatient facility
area.
(c) The lease between the hospice and the tenant enfity shall Mpecta the tenant area shall be:
(1) Maintained to comply with NFPA 101 for Sei Care ncies;
(2) Included in the hospice's sprinkler systems and fire drills; and
(3) Accessible to representatives of the Departmen (eer liance with these standards.
(d) A copy of the executed lease agreement for leased areas s to the Department for
review as part of the plan approval application process and a cu py shall be available for review by
Department staff upon request.
[Source: Added at 21 Ok Reg 1303, eff 5-27-04] O )
310:661-8-5. Nursing unit “O.,
(a) Patient rooms. Each room shall meet the following requirements.
(1) Maximum room capacity shall be one (1) patient. eo
(2) Minimum room area exclusive of toilet rooms, lockers, wardrobes, alcoves} ules shall
be one hundred twenty (120) square feet. There shall be a minimum of three NA, earance
between beds and obstructions, such as walls. This minimum dimension shall not ap e head
of the bed.
(3) Each room shall be located on an exterior wall and be provided with a window to the exterior.
The maximum sill height for the window shall be three (3) feet above finished floor and also be
located above exterior lot grade. Windows shall be provided with window coverings to ensure
privacy.
(4) Each patient bed shall be served by a nurse's call system and provided with an individual call
device immediately accessible to patient, which shall register at the nurse's station. A nurse's call
emergency device shall be provided for each patient toilet room, shower, and bathing room. The
nurse's call system installed shall be one of the following types.
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(A) Conventional UL 1069 hardwired system; or,
(B) Wireless system with individual call pendants or bracelets. These appliances shall
activate notification devices at the nurse's station and individual pagers that are carried by
staff at all times.
(5) One (1) lavatory or disinfectant wash shall be provided for each patient room.
(6) Each patient shall have access to a toilet room complying with accessibility requirements as
determined by the ICC/ANSI A117.1. One (1) toilet room shall contain, at a minimum, a water
closet and a lavatory.
(A) Each patient room shall have access to a toilet room without entering or crossing the
general corridor.
(B) Toilet rooms shall be equipped with bedpan washing apparatus with flushing
1 contain a lavatory and soap and disposable towel dispensers. Each isolation room shall have
s to an accessible toilet room without entering the general corridor.
(8)Each patient shall have a wardrobe, locker, or closet with minimum clear dimensions of one
foot hes (1'-10") by one foot eight inches (1'-8"). A clothes rod and shelf shall be provided.
(9) Patiefit shall have general lighting and night lighting. A reading light shall be provided
d at least ope (1) light fixture for night lighting shall be switched at the entrance
&
attachment and vacuum breaker.
ay There shall be a minimum of one (1) isolation rooms per hospice inpatient facility. Each room
_ All elgttrig@l switches shall be of the quiet operating type.
(10) Each patien 1 be pr with a bed complete with springs and a mattress (not rollaway),
a chair suitable for tngfbphen a edside table. Cots, sofas, rollaway or similar type beds shall
not be used for patient: ay b family members. A bedside table and over-bed table
shall be available for eac idden . Arecliner suitable for sleeping shall be provided for
each patient in each patient'r . Guest used for family member(s) shall be permitted, but
shall not be used as patient roofs prtte et,the requirements for patient rooms.
(11) No television surveillance sven d a the interior of patient rooms or
baths.
(b) Service areas.
(1) The size and disposition of each service Area shall aa upon the number and types of beds to
be served. Although identifiable spaces are reqhesio be i
functions, consideration will be given to design ae WwW ould accommodate some
functions without specific designation of areas or ch proposals shall be
submitted for prior approval. Each service area may Be arganged angMocated to serve more than one
(1) nursing unit, but at least one (1) such service area ppv on each nursing floor. The
service areas noted below shall be located in or readily ava e to each nursing unit:
(A) Nurse's stations with space for nurses' charting, phy: charting, and storage for
administrative supplies. The distance from the nursing s “n d the most distant resident
room shall not exceed one hundred fifty (150) feet and this ‘di shall not be interrupted
by physical barriers, such as closed fire doors.
(B) A private physician's office shall be provided in each facility.
(C) Lounge and toilet room(s) for nursing staff. A
(D) Clean workroom and clean holding room. These may be combined ean
workroom shall contain a work counter, hand washing station, and storag iffties. The
clean holding room shall be part of a system for storage and distribution of a sterile
supply materials and shall be similar to the clean workroom except that the wet unter
and hand washing station may be omitted.
(E) Clean linen storage area. This may be provided by a separate closet or fully enclosed
area within the clean workroom.
(F) Soiled workroom or soiled holding room. The soiled workroom shall contain a clinical
sink or equivalent flushing rim fixture, sink equipped for hand washing, work counter,
waste receptacle, and linen receptacle.
(G) Nourishment station. This shall contain a sink equipped for hand washing, equipment
for serving nourishment between scheduled meals, refrigerator, and storage cabinets. Ice for
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patients' service and treatment shall be located in the nourishment station on each floor and
in the kitchen/dining area.
(H) A family room shall be provided by the facility equipped with two (2) compartment
sinks, cabinets, microwaves, soap and paper towel dispensers.
(I) One (1) medical equipment storage room shall be provided on each floor.
(J) Parking for stretchers and wheelchairs shall be located out of path or normal traffic.
(K) Patients' bathing facilities. Bathtubs or showers shall be provided at the rate of one for
each six (6) beds, which are not otherwise served by bathing facilities within patients’
rooms. At least one (1) bathtub shall be provided in each nursing unit or floor. Whirlpool
units, which are suitable for bathing purposes, shall be included in satisfying the
requirement. Each tub or shower shall be in an individual room or enclosure, which
provides space for private use, drying and dressing, and for a wheelchair and an attendant.
All fixtures shall be accessible for the handicapped.
Yy, (L) Janitor's closet containing a floor receptor or service sink and storage space for
Q housekeeping equipment and supplies.
(c) Sterilizing Bacilities. The hospice inpatient facility shall make provisions for the sterilization of
equipment we) lies and shall have available for all staff and visitors, approved OSHA, NIOSH
certified dust, mba umes (DMF) respirators or respirators affording greater protection. This is required
for all entry into ro cupied by kjrown or suspected infectious tuberculosis patients and others. There
shall be minimum of red (00) fairs of gloves and DMF respirators in the facility at all times.
(d) Personal Care Unit. arate ro y be provided for hair care and grooming needs of the patients.
[Source: Added at 21 Ok Reg 1303, eff 5- 27-0. © OK.
310:661-8-6. Dietary facilities ) _%
(a) The following facilities shall be pr “OC Wy required to implement the type of food service
system selected:
(1) Control station for receiving food L
(2) Storage space including cold storag 1”
r
ligs.
(3) Food preparation as required by the program. Coma oua food preparation systems require
space and equipment for preparing, cooking, agGvskins. CORY emlence food service systems such
as frozen prepared meals, bulk packaged entree Spt ed portions, or systems using
contractual commissary services require space an ment ing, portioning, cooking,
and/or baking.
(4) Hand washing facilities in the food preparation area en ed with wrist, knee, or foot controls.
Disposable towels shall be provided.
(5) Patient meal service space including facilities for tray nog distribution.
(6) Dishwashing shall be in a room or alcove separate from foo ation and serving areas. The
dishwashing equipment shall be of a commercial-type with a separ lance system.
(7) Space for receiving, scraping, sorting, and stacking soiled tableware my, transferring clean
tableware to the using areas. A lavatory shall be conveniently available wit knee, or foot
controls.
(8) Pot washing facilities with a three (3) compartment sink.
(9) Sanitizing facilities and storage areas for cans, carts, and mobile tray conveye
(10) Garbage storage facilities in a separate area, which is easily accessible to the aa direct
pickup or disposal.
(11) Toilet for dietary staff with hand washing facility immediately available.
(12) Janitors' closet for the dietary department shall be located in or adjacent to the department. It
shall contain a floor receptor or service sink and storage space for housekeeping equipment and
supplies used exclusively for the dietary department.
[Source: Added at 21 Ok Reg 1303, eff 5-27-04]
310:661-8-7. Administrative and public areas
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The following areas shall be provided:
(1) Public lobby area including:
(A) Reception and information counter or desk.
(B) Waiting spaces.(C)Public toilet facilities (handicapped accessible).
(D) Public telephone(s).
(E) Drinking fountain(s).
(2) General or individual offices shall be provided for business transactions, medical and financial
records, and administrative functions.
(3) A quiet room for counseling\reflection is required and shall have a minimum of one hundred
(100) square feet.
[Sour, ded at 21 Ok Reg 1303, eff 5-27-04]
310 ae Linen service
(a) If li to be processed on the site, the following shall be provided:
(1/*Lauadry processing room with hand washing facilities and commercial-type equipment, which
can seven (7) days' needs within a regularly scheduled workweek.
(2) oie yen, noieing. and sorting room with hand washing facilities.
(3) Storage ndry ay
(4) Clean line , Iss A> holding room separate from the soiled linen storage,
processing and h
(5) Janitors’ closet eB eer a ceptor or service sink and storage space for housekeeping.
(6) Sanitizing facilities%’a peyote ;,carts, unless a disposable bagging system is used.
(b) If linen is processed off the s wo iar ay be provided:
(1) Soiled linen holding roo
(2) Sanitizing facilities and stofag OU
(c) Whether linen is processed on or off t t ny all be physically separated into clean and
soiled sections with each section having os If, lege exhaust returns to prevent cross-
contamination. The hospice shall certify that th e launhd tisfies this regulation.
[Source: Added at 21 Ok Reg 1303, eff 5-27-04]
310:661-8-9. Engineering service and equipment he %
(a) Central Stores. General storage room(s) shall have a total are I, less’than five (5) square feet per
bed and should be generally concentrated in one (1) area.
(b) Room(s) or separate building(s) for boilers, mechanical a) nd electrical equipment shall not
be used for storage. i
(c) Waste Processing Services. Storage and Disposal. Space and facilitie ae Provided for the sanitary
storage and disposal of waste by incineration, mechanical destruction, ado Jn
removal or by a combination of these techniques.
[Source: Added at 21 Ok Reg 1303, eff 5-27-04] Sis
310:661-8-10. Details and Finishes 2
(a) A high degree of safety for the patients shall be provided to minimize the incidence of ac ith
special consideration for patients who will be ambulatory, to assist them in self-care. (b) Hazard ch as
sharp corners shall be avoided. All details and finishes for modernization projects as well as for new
construction shall comply with the following requirements:
(1) All rooms containing bathtubs, sitz baths, showers, and water closets, subject to occupancy by
patients, shall be equipped with doors and hardware which will permit access from the outside in
any emergency. When such rooms have only one (1) opening or are small, the door shall be capable
of opening outwards or be otherwise designed to be opened without need to push against a patient
who may have collapsed within the room.
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(2) The minimum width of all doors to rooms needing access for beds or stretchers shall be three
feet eight inches (3' 8"). Doors to patient toilet rooms and other rooms needing access for
wheelchairs shall have a minimum clear width of 32 inches.
(3) Windows and outer doors shall not be left in an open position unless provided with insect
screens.
(4) Windows and/or screening devices shall be designed to prevent accidental falls when open.
(5) Door(s) shall not swing into corridors in a manner that might obstruct traffic flow or reduce the
required corridor width. All door handles shall be approved lever type.
(6) Grab bars shall be provided at all patients’ toilets, showers, tubs, and sitz baths.
(7) Recessed soap dishes shall be provided in showers and bathrooms, or soap dispensers may be
substituted.
(8) Lavatories and hand washing facilities shall be securely anchored to withstand an applied
vertical load of not less than two hundred fifty (250) pounds on the front of the fixture.
Mirrors shall be arranged for convenient use by patients in wheelchairs as well as by patients in
One position. All lavatories shall have mirrors except those in kitchens.
el wat towel and soap dispensers and waste receptacles shall be provided at all hand washing
facilj public, staff locations and patient areas.
(11) Ceil ights shall be as follows:
(A rooms shallhave ceiling clearances not less than two feet six inches (2' 6")
Se OS 1 si iat and connecting piping.
(B) Roonkesnaiiny Pye -mounted equipment shall have height required to
accommodate equip soe
(C) All rooms ot ha n mn eight foot (8' 0") ceilings except that corridors,
storage rooms, to TGR snd rooms may be not less than seven feet eight
inches (7' 8"). Suspe € pe nd pipes located in the path of normal traffic shall
not be less than six feef ei pry s") above the floor.
(D) Kitchens shall have a m el oop(8' 0") ceiling height and be air-conditioned.
(12) Spaces where impact noises — erated on be located directly over or adjacent to
patient bed areas unless special provisi inimize such noise to a Noise Isolation
Class (NIC) of not less than forty-five (45). GS,
(13) Rooms containing heat producing cra such Le Sipe heater rooms, and laundries)
shall be insulated and ventilated to prevent any ne Se Onn exceeding a temperature
of 10°F. (60C.) above the ambient room temperat ic)
(14) Indicators shall be placed on all doors leading t Oo” OF such as knurled knobs or
signs.
(15) The hospice shall eliminate fire and smoke hazards. Ti Pospice shall not use pillows,
mattresses, pads, padded furniture, carpeting, or other furnishings’ hich contain urethane foams,
which are not fire retardant.
(c) Hospice Finish Requirements
(1) Floor materials shall be easily cleanable and have wear resistance appt) priate for the location
involved. Floors in areas used for food preparation or food assembly shall Geiger resistant and
grease proof. Points in tile and similar material in such areas shall be resista’ d acids. In all
areas frequently subject to wet cleaning methods, floor materials shall not be LoL affected by
germicidal and cleaning solutions. Floors that are subject to traffic while wet (su wer and
bath areas, kitchens, and similar work areas) shall have a no slip surface.
(2) Wall bases in kitchens, soiled workrooms, and other areas which are frequently subjec#to wet
cleaning methods shall be made integral and covered with the floor, tightly sealed with the wall,
and constructed without voids that can harbor insects.
(3) Wall finishes shall be washable and, in the immediate area of plumbing fixtures, shall be
smooth and moisture resistant. Finish, trim, and wall and floor constructions in dietary and food
preparation areas shall be free from spaces that can harbor rodents and insects.
(4) Floor and wall penetrations by pipes, ducts, and conduits shall be tightly sealed to minimize
entry of rodents and insects. Joints of structural elements shall be similarly sealed.
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(5) Ceilings throughout shall be easily cleanable. Ceilings in the dietary and food preparation areas
shall have a finished washable ceiling covering all overhead piping and ductwork; a smooth surface
drywall or plaster type ceiling shall be required. Finished ceilings may be omitted in mechanical
and equipment spaces, shops, general storage areas, and similar spaces, unless required for fire-
resistive purposes.
(6) All buildings that have patients’ facilities (such as bedrooms, dining rooms, or recreation areas)
or critical services (such as diagnostic or therapy) located on other than the main entrance floor
shall have electric or electro hydraulic elevators.
(A) At least one (1) hospital type elevator shall be installed where patients are located on
any floor other than the main entrance floor.
(B) Cars and platforms. Cars of hospital type elevators shall have inside dimensions that
will accommodate a patient bed and attendants, and shall be at least five feet (5' 0") wide by
seven feet six inches (7' 6") deep. The car door shall have a clear opening of not less than
Yy, three feet eight inches (3' 8").
(C) Leveling. Elevators shall be equipped with an automatic leveling device of the two-way
utomatic maintaining type with an accuracy of one-half (1/2) inch.
otsebeved Elevators, except freight elevators, shall be equipped with a two-way special
yed switch to permit cars to bypass all landing button calls and be dispatched
dir he any floor.
(E) El C irl agen buttons, controls, and telephones shall be accessible to
wheelchee Ge it a
(F) Elevator c pABiton a and door safety stops shall be of a type that will not be
activated by reg mek,
(G) At least one ator a be on the emergency power system of the hospice.
(H) Elevator door c Oo. SY O, be timed to accommodate the needs of the
residents served.
(1) Field Inspection and ne) specti ndtests shall be made and the owner shall be
furnished written certificatio the a5 pe meets the requirements set forth in this
Section and all applicable reef tions”a des.
[Source: Added at 21 Ok Reg 1303, eff 5-27-04]
5,8
310:661-8-11. Temperature and ventilating systems
(a) An indoor design temperature of 75°F. (24°C.) (winter desig Op be provided for all
occupied areas. oO
(b) All air supply and air-exhaust systems shall be mechanically opkepled. All fans serving exhaust systems
shall be located at the discharge end of the system. The ventilating syst hall comply with the
requirements of the appropriate edition of the International Mechanical
(c) Outdoor air intakes shall be located not less than ten feet (10' 0") from aie ae of ventilating
systems, combustion equipment stacks, plumbing vent stacks, or from areas whi collect vehicular
exhaust and other noxious fumes. The bottom of outdoor air intakes serving centr Daw shall be
located as high as practical but not less than three feet (3' 0") above ground level, OTE installed above the
roof, one foot (1' 0") above roof level. Q
(d) Corridors shall not be used to supply air to or exhaust air from any room, except that corridors
may be used to ventilate bathrooms, toilet rooms, and janitors' closets.
(e) All central ventilating or air conditioning systems shall be equipped with filters. The filter bed#&hall be
located upstream of the air conditioning equipment, unless a prefilter is employed. In this case, the prefilter
shall be upstream of the equipment and the main filter bed may be located further downstream.
(f) All filter efficiencies shall be average atmospheric dust spot efficiencies tested in accordance with
ASHRAE Standard 52-68. A manometer shall be installed across each filter bed serving central air
systems. The filter efficiencies for central ventilation and air conditioning system should follow the table
shown on Appendix A.
(g) Exhaust hoods in food preparation centers shall be in compliance with NFPA 96 and the International
Mechanical Code (IMC).
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(h) Boiler rooms shall be provided with sufficient outdoor air to maintain combustion rates of equipment
and to limit temperatures in working stations to 97°F. (36°C.), Effective Temperatures (ET) as defined by
ASHRAE "Handbook of Fundamentals", without creating negative air pressure in any room housing fire
equipment.
(i) Where individual mechanical exhaust systems are used to exhaust patient toilets or bathrooms, the
individual ventilation fan shall run continuously. All mechanical ventilating equipment including under
window and exhaust systems shall operate continuously.
(j) Wall or baseboard electrical heaters shall not be used.
(k) Detectors in central ventilating systems shall be in accordance with NFPA 90A.
(1) All ducts shall be in concealed spaces.
(m) All smoke dampers on any one air conditioning system shall be controlled by unit mounted return air
a ply air smoke detectors, which will act to close all of the smoke dampers on that system and stop
the fane Smoke dampers shall also close and the fan shall stop when the fire alarm system is activated
and. prinkler system is energized.
(n) All 1 Gn rooms shall have all air directly exhausted to the exterior without recirculation. There shall
be a negattf¥e pressure relationship between the patient room and adjacent areas. The differential pressure
shall be a mj
prevent nuisancda
(o) Ventilation for
of 0.01" water gage (2.5 Pa). If alarms are installed, allowances shall be made to
of monitoring devices.
ation cre provide for a minimum twelve (12) air changes per hour
including two (2) air sper h outside air. Patient sleeping rooms shall provide a minimum of
two (2) air changes per hi ith at a i (2) of these air changes being outside air. Soiled holding and
workroom areas shall have a AGnum (10) air changes per hour. All other rooms shall comply with
the ventilation requirements o io ai chanical Code as adopted by the State of Oklahoma.
[Source: Added at 21 Ok Reg 1303, eff 5-27-04] Z “ey
310:661-8-12. Plumbing and other pipi te Y
(a) All plumbing systems shall be designed a: Stalled in fsordance with the requirements of the
appropriate edition of the International Plumbi . )
(b) Plumbing Fixtures.
(1) The material used for plumbing fixtures nee non,
(2) The water supply spout for lavatories and si uired i
so that its discharge point is a minimum distance o (1) ine e the rim of the fixture. All
fixtures shall be trimmed with valve, which can be operated witho e use of hands. Where blade
handles are used for this purpose, they shall not exceed d one-half (4’2) inches in length,
except that handles on clinical sinks shall be not less than Lf) inches long.
(3) Clinical sinks shall have an integral trap in which the upper erpon of a visible trap seal
provides a water surface.
(4) Shower bases and tubs shall provide no slip surfaces for standin’ patie Toe All towel bars shall
be of the handicapped type meeting the two hundred fifty pound (250 |b load requirement.
Shower curtain rods shall be of rigid metal and anchored to insure a two eis) fifty pound (250
pption and acid-resistant material.
ient care areas shall be mounted
Ib.) dead load is met.
(5) Floor and wall penetrations by pipes, ducts, and conduits shall be tightly se Neyo inimize
entry of rodents and insects. Joints of structural elements shall be similarly NO-
(c) Water Supply Systems.
(1) Before the facility is used the water supply system shall be approved by the health rtment.
(2) Backflow preventers (vacuum breakers) shall be installed in hose bibs, janitors' sinks, bedpan
flushing attachments, and on all other fixtures on which hoses or tubing can be attached. Two (2)
approved reduced pressure backflow preventers in parallel on the domestic water supply are
required for sprinkler systems.
(3) Water distribution systems shall be arranged to provide hot water at each hot water outlet at all
times. Hot water at shower, bathing, and hand washing facilities shall not be less than 105°F. nor
exceed 115°F. A low temperature-mixing valve shall be required with an anti-scald device
(solenoid valve) down stream from mixing valve.
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(d) Water Heaters and Tanks.
(1) The water heating equipment shall have sufficient capacity to supply water at the temperatures
and amounts indicated above. Water temperatures shall be tested monthly and the results monitored
at hot water point of use or inlet to processing equipment.
(2) The anti-scald device shall be arranged to shut off hot water system two degrees (2°) higher
than maximum temperature allowed.
(3) Heater and storage tanks shall be fabricated of corrosion-resistant metal or lined with no
corrosive material.
(e) Drainage Systems.
(1) Drainage piping shall not be installed within the ceiling nor installed in an exposed location in
food preparation centers, food serving facilities, and food storage areas unless special precautions
are taken to protect these areas from possible leakage or condensation.
(2) Building sewers shall discharge into an approved sewerage system.
[Source: whey Ok Reg 1303, eff 5-27-04]
310:661-8-19(Eh trical requirements
(a) All electrical ifements shall comply with National Electrical Code (NEC) as adopted.
(b) Receptacles ( i
nce Outlet
(1) Patient ro ch patient rg6m shall have duplex grounding type receptacles as follows: one
(1) located near theMead_of eich/Hed; one (1) for television if used; and at least one (1) on each
wall.
(2) Corridors. Duplex hep cles (e) l use shall be installed approximately fifty feet (50' 0")
apart in all corridors and twent feet (25' 0") of ends of corridors.
(c) All receptacles and switches on t ereen{p) r shall be distinctly marked.
(d) All electrical receptacles in wet areas (gh as: Hagncare rooms, bathrooms, kitchens, laundries,
physical therapy areas, janitor closets) my) on grovhd@ fault interrupter circuits within six feet (6' 0") of
any lavatory and all outside plugs.
(ce) Emergency Electric Service. 0)
(1) To provide electricity during an interrupfion of the ipial electric supply, the hospice shall be
equipped with an emergency power source as ired by Sl NFPA 101, and NEC (NFPA
70) on the premises. It shall have fuel supply wy opane resel to operate the generator for a
minimum of twenty-four (24) hours at rated full lo YQ
(2) The emergency power source shall be automatically Sat required load within a
period of ten (10) seconds after the interruption of the n: ower source. This time delay shall
be adjustable.
(3) The load for which emergency power shall be supplied are ag
(A) Illumination for means of egress as required in NFPA Sta
than one (1) foot-candle of light measured at floor level in the e€ of the corridors.
(B) Illumination of exit signs and exit directional signs. 4
(C) Duplex receptacle located at head of patient bed. OF
(D) Nurse call systems.
(E) Power for maintaining telephone communication.
(F) Sump pumps and other equipment required to operate for the safety oftafajdrjapparatus
including alarms. wen
(G) General illumination and convenience receptacles in the area of the emergeacy power
source.
(H) Paging and speaker systems used for communications during emergency.
(I) Alarm systems including the fire alarm system, water flow alarm devices for sprinklers,
fire and smoke detecting facilities, and alarm monitors for non-flammable medical gas
systems, except systems which have trickle-charged battery (DC) power.
(J) Illumination lighting in the mechanical rooms serving essential heating, ventilating,
plumbing, vacuum, and other essential needs.
(K) Security facilities such as door monitoring.
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(L) At least one (1) elevator shall be on the emergency power system of the hospice.
(M) Night lights in patient bathrooms, toilets and patient rooms.
(N) All receptacles and switches served by emergency power shall be color coded (red).
(O) The operation of the emergency electric system shall be demonstrated prior to placing
the facility in operation.
[Source: Added at 21 Ok Reg 1303, eff 5-27-04]
310:661-8-14. Physical plant requirements for facilities with three (3) beds or less
(a) This section shall be applicable to small homes serving three (3) or less residents. Homes qualifying
under this section shall be exempt from other sections of this subchapter except as may be specifically
feretaced in this section.
g requirements of 310:661-8-1 are applicable except as follows:
hese requirements are intended as minimum standards for constructing and equipping a
Gee inpatient facility projects containing, at a maximum, three (3) beds.
(2 w and renovation projects shall comply with the applicable sections of International
Resi Code as required for residential construction.
(c) The location ements of 310:661-8-2 are applicable except as follows:
(1) Parking¢ treet Cs. be provided in adequate numbers to prevent overflow to
adjacent prop
(d) Plan submission and truction Ayetion requirements of 310:661-8-3 are applicable to all hospice
facilities containing three (3) yi or les
)
(e) The requirements for spac Cr NS BiGenie in 310:661-8-4 are applicable to all hospice
facilities containing three (3) be oo t,
r
(f) All physical plant requirements g to me€hahjéal plumbing and electrical systems shall comply
with the applicable requirements for rési o> con: 7
[Source: Added at 21 Ok Reg 1303, eff 5-27-04]
APPENDIX A. Filter Efficiencies for Central Vi eB air on Systems in Hospices
Figure 1
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Number
Filter Beds Filter Bed Filter bed
Area Designation No. 1 No.2
All areas for 2 25 80
inpatient care,
treatment, and
diagnosis, and
those areas
providing direct
service or clean
supplies such
as sterile and
clean processing,
etc.
Food Preparation Areas 1 25 ---
and Laundries
inistrative, bulk
Merage, soiled holding
AS, food preparation
eas, and laundries
A tional roughing or pre-filters should be considered to
intenance required for filters with efficiency higher
The fi efficiency ratings are based on average dust spot
efficiel ic ASHRAE 52.1-1992.
G
%
%Qy:
[Source: Added at 21 Ok Reg 1303, eff 5-27-04] ff S
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