Assessment & Care Planning

42 CFR 418.52 · 418.54 · 418.56 · SOM Appendix M L522–L544 · MBPM Ch. 9

Hospice CoP Training

Educational Use Only

Compliance Timeline - All Clocks Start at Election Effective Date

Clock	Deadline	Requirement	Authority
Patient Rights	Before any care is furnished	Deliver rights verbally and in writing; obtain signed acknowledgement. Must happen before clinical tasks begin at initial assessment visit.	42 CFR 418.52(a)
RN Initial Assessment	Within 48 hours	RN (only) completes initial assessment at location of service. Documents immediate needs, symptoms, safety, caregiver capacity. Not a social visit.	42 CFR 418.54(a); SOM L522
IDG Comprehensive	Within 5 calendar days	All 7 required domains completed by IDG. Must be IDG-driven; single-clinician completion is a citation risk.	42 CFR 418.54(b); SOM L530-L537
Plan of Care	Before care is provided	POC established through IDG collaboration. Individualized, not templated. Attending physician involvement documented.	42 CFR 418.56(b); MBPM Ch. 9
Ongoing Review	Every 15 calendar days minimum	Comprehensive assessment update + POC review. Must document specific clinical findings; 'no change' notes alone are insufficient.	42 CFR 418.54(c); 418.56(c)

7 Required IDG Comprehensive Assessment Domains (42 CFR 418.54(b))

Domain 1 - Physical

Primary diagnosis, functional status (PPS/FAST), symptom severity, wounds, nutrition, hydration

Domain 2 - Psychosocial

Emotional status, mental health history, social support, caregiver capacity and strain

Domain 3 - Emotional

Patient's and family's responses to terminal illness and anticipated death

Domain 4 - Spiritual

Spiritual needs, religious preferences, existential concerns. Chaplain domain lead.

Domain 5 - Drug Profile Review

Current medications, therapeutic duplication, appropriateness for comfort-focused care

Domain 6 - Bereavement

Bereavement risk assessment for family and caregivers. SW/chaplain domain lead.

Domain 7 - Safety / Environment

Home safety, caregiver ability, emergency access, equipment needs

Common citation failure: Marking spiritual or bereavement domains as "N/A" without clinical basis. Every domain must be completed or deferred with documented clinical rationale.

Patient Rights - Sequencing Rule (42 CFR 418.52(a))

Rights must be delivered before furnishing care. This means before any clinical assessment activity begins at the initial assessment visit.
Must be both verbal and written in a language the patient understands
Signed acknowledgement must be obtained and filed in the clinical record
Language/communication barriers require documented interpreter or representative involvement

Educational Use Only. Not legal advice. Verify against current primary sources.