[Code of Federal Regulations]

[Title 42, Volume 3]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR484.55]



[Page 588-589]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 484_HOME HEALTH SERVICES--Table of Contents

 

                    Subpart C_Furnishing of Services

 

Sec. 484.55  Condition of participation: Comprehensive assessment 

of patients.



    Each patient must receive, and an HHA must provide, a patient-

specific, comprehensive assessment that accurately reflects the 

patient's current health status and includes information that may be 

used to demonstrate the patient's progress toward achievement of desired 

outcomes. The comprehensive assessment must identify the patient's 

continuing need for home care and meet the patient's medical, nursing, 

rehabilitative, social, and discharge planning needs. For Medicare 

beneficiaries, the HHA must verify the patient's eligibility for the 

Medicare home health benefit including homebound status, both at the 

time of the initial assessment visit and at the time of the 

comprehensive assessment. The comprehensive assessment must also 

incorporate the use of the current version of the Outcome and Assessment 

Information Set (OASIS) items, using the language and groupings of the 

OASIS items, as specified by the Secretary.

    (a) Standard: Initial assessment visit. (1) A registered nurse must 

conduct an initial assessment visit to determine the immediate care and 

support needs of the patient; and, for Medicare patients, to determine 

eligibility for the Medicare home health benefit, including homebound 

status. The initial assessment visit must be held either within 48 hours 

of referral, or within 48 hours of the patient's return home, or on the 

physician-ordered start of care date.

    (2) When rehabilitation therapy service (speech language pathology, 

physical therapy, or occupational therapy) is the only service ordered 

by the physician, and if the need for that service establishes program 

eligibility, the initial assessment visit may be made by the appropriate 

rehabilitation skilled professional.

    (b) Standard: Completion of the comprehensive assessment. (1) The 

comprehensive assessment must be completed in a timely manner, 

consistent with the patient's immediate needs, but no later than 5 

calendar days after the start of care.

    (2) Except as provided in paragraph (b)(3) of this section, a 

registered nurse must complete the comprehensive assessment and for 

Medicare patients, determine eligibility for the Medicare home health 

benefit, including homebound status.

    (3) When physical therapy, speech-language pathology, or 

occupational therapy is the only service ordered by the physician, a 

physical therapist, speech-language pathologist or occupational 

therapist may complete the comprehensive assessment, and for Medicare 

patients, determine eligibility for the Medicare home health benefit, 

including homebound status. The occupational therapist may complete the 

comprehensive assessment if the need for occupational therapy 

establishes program eligibility.

    (c) Standard: Drug regimen review. The comprehensive assessment must 

include a review of all medications the patient is currently using in 

order to identify any potential adverse effects and drug reactions, 

including ineffective drug therapy, significant side effects, 

significant drug interactions, duplicate drug therapy, and noncompliance 

with drug therapy.

    (d) Standard: Update of the comprehensive assessment. The 

comprehensive assessment must be updated and revised (including the 

administration of the OASIS) as frequently as the patient's condition 

warrants due to a major decline or improvement in the patient's health 

status, but not less frequently than--

    (1) The last five days of every 60 days beginning with the start-of-

care date, unless there is a--

    (i) Beneficiary elected transfer;

    (ii) Significant change in condition resulting in a new case-mix 

assignment; or

    (iii) Discharge and return to the same HHA during the 60-day 

episode.

    (2) Within 48 hours of the patient's return to the home from a 

hospital admission of 24 hours or more for any reason other than 

diagnostic tests;

    (3) At discharge.

    (e) Standard: Incorporation of OASIS data items. The OASIS data 

items determined by the Secretary must be incorporated into the HHA's 

own assessment and must include: clinical record



[[Page 589]]



items, demographics and patient history, living arrangements, supportive 

assistance, sensory status, integumentary status, respiratory status, 

elimination status, neuro/emotional/behavioral status, activities of 

daily living, medications, equipment management, emergent care, and data 

items collected at inpatient facility admission or discharge only.



[64 FR 3784, Jan. 25, 1999, as amended at 65 FR 41211, July 3, 2000]



Subpart D [Reserved]