Hospice IDG/IDT protocols/rules

Specialties Hospice


Hello - I'm looking for the Medicare Regulations regarding the actual IDG/IDT meetings and not who is required, at a minimum to be ON the team. (Doc, RN, SW, Chaplain).

Example: If you have an urgent situation and need to have a team meeting with simply the Doc, RN, and SW and the patient has refused Spiritual Care so the Chaplain isn't part of that Care Plan, does a chaplain still have to be there in order for the meeting to be considered within regs?

Does your entire team stay for the entire report about all the patients? Example: The meetings I've been to in larger hospices only have the volunteer who is assigned to the patient you are reporting on and leaves when the next patient info comes up.

We have weekly scheduled meetings. What are the regs about how often the Doc or anyone have to be at a meeting in a month?

I've searched for these details in the regs and can't find them.


Specializes in Hospice.

Good questions! I'd be interested to know more about the regulations themselves.

I know that IDT/IDG review and update of each patient's care plan must occur a minimum of every 15 days per Medicare guidelines.

If you haven't already looked at the NHPCO website, they have a lot of good resources for regulations and interpretive guidelines.

The hospice I previously worked for the entire hospice team (nurses, manager, spiritual care, social work, medical director etc) all attended the entire meeting for all the patients on the entire service. Volunteer input was submitted to the volunteer coordinator who presented it on behalf of the volunteers. This hospice had patients who used their own physicians (not the medical director) in most cases, communication was faxed to them for review/ signature. We survived a Medicare audit with no issues that I recall regarding IDT.

I currently work inpatient hospice, all patients are under the care of one of our hospice physicians. The physician, social worker, manager and spiritual care sit through the entire meeting and the nurse case managers rotate in just for their patients. In this case, the primary nurse case managers are the day nurses. This agency is pilot site for Medicare Choices Program, I'm guessing that Medicare only uses sites with strong histories of quality and compliance for pilot sites. This agency also has a strong quality/ regulatory department and provides frequent education.

Specializes in Hospice/HHC.

From what I know all disciplines must be present with the IDG meeting. It is up to the company if all disciplines stay present through the meeting, or rotate in/out per caseload. Many times we all stayed in the meeting due to other nurses covering for the primary RNCM, or on-call seeing the patient.

With patient's who get ancillary service from what I know the regulations state that the RNCM is the one who initiates other services (Chaplin). If the patient declines Chaplin services or other services then "No, the Chaplin does not have to be present." The nurse will need to be sure to document that services were offered, and declined by patient. This will cover you when a survey is done. If ancillary services are requested (MSW, Chaplin) then that discipline has 5 days to do their assessment, and can be discussed at the next IDG meeting.

With my past hospice job, my experience was if MD was unable to make it to IDG we would either have the back-up medical director attend, conference all the medical director, or the manager would get with the MD prior to the IDG to discuss cases.

Hope that helps.

Thanks. It does help.

We are a small hospice with 2 nurses who see patients and we share call. Our manager also is a nurse who takes call and see patients if need be. We all do admits if needed.

All the nurses stay in the room because we all see all the patients.

Everyone stays for the meeting, regardless of whether they are assigned a patient.

My concern was we needed to meet with the physician, who has been away, regarding some complicated issues. And was told that because I moved the day of the meeting to make sure he could be there, it wouldn't work because the chaplain wasn't available.

So many regulations to keep in mind . . . no wonder we go to those hospice conferences to keep up!

Specializes in Hospice/HHC.

When I return to work I will see if I can get you the regulation & post it for you.

Specializes in Hospice consultant with over 24 years in the field.

CMS requires that an RN, SW, and SC be present at all times during the IDT meeting. It does not have to be the assigned discipline for that particular patient being discussed as long as there is one of each discipline including the MD present. IF one of those disciplines leaves the room and/or is not present IDT must cease and can not continue until all disciplines are represented, regardless if the patient has refused the discipline or not. You have to show that all disciplines are involved and effort was made at each re-cert to "re-offer" said refused disciplines.

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