Mont. Medicaid Hospice Policy Manual, Policy 410

INITIAL AND COMPREHENSIVE

ASSESSMENT OF MEMBER

The hospice must conduct and document in writing a member- specific

comprehensive assessment that identifies the member's need for hospice

care and services, and the member'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.

INITIAL ASSESSMENT

The hospice registered nurse must complete an initial assessment within

48 hours after the election of hospice care is complete unless the

physician, member, or representative requests that the initial assessment

be completed in less than 48 hours.

TIMEFRAME FOR THE

COMPLETION OF THE

COMPREHENSIVE ASSESSMENT

The hospice interdisciplinary group, in consultation with the member's

attending physician (if any), must complete the comprehensive

assessment no later than five calendar days after the election of hospice

care in accordance with 37.40.815 (Refer to Hospice Policy 404).

CONTENT OF THE

COMPREHENSIVE ASSESSMENT

The comprehensive assessment must identify the physical, psychosocial,

emotional, and spiritual needs related to the terminal illness that must be

addressed in order to promote the hospice member's well-being, comfort,

and dignity throughout the dying process. The comprehensive assessment

must take into consideration the following factors:

1. The nature and condition causing admission (including the

presence or lack of objective data and subjective

complaints);

2. Complications and risk factors that affect care planning;

3. Functional status, including the member's ability to

understand and participate in his or her own care;

4. Imminence of death;

5. Severity of symptoms;

6. Drug profile. A review of all of the member's prescription and

over-the-counter drugs, herbal remedies and other

alternative treatments that could affect drug therapy. This

includes, but is not limited to, identification of the following:

a. Effectiveness of drug therapy;

b. Drug side effects;

c. Actual or potential drug interactions;

d. Duplicate drug therapy; and

e. Drug therapy currently associated with

laboratory monitoring.

7. Bereavement. An initial bereavement assessment of the

needs of the member's family and other members focusing

on the social, spiritual, and cultural factors; and

8. The need for referrals and further evaluation by appropriate

health professionals.

UPDATE OF THE

COMPREHENSIVE ASSESSMENT

The update of the comprehensive assessment must be accomplished by

the hospice interdisciplinary group (in collaboration with the member's

attending physician, if any) and must consider changes that have taken

place since the initial assessment. It must include information on the

member's progress toward desired outcomes, as well as a reassessment

of the member's response to care. The assessment update must be

accomplished as frequently as the condition of the member requires, but

no less frequently than every fifteen days.

MEMBER OUTCOME MEASURES

The comprehensive assessment must include data elements that

allow for measurement of outcomes. The hospice must measure and

document data in the same way for all members. The data elements

must take into consideration aspects of care related to hospice and

palliation.

The data elements must be an integral part of the comprehensive

assessment and must be documented in a systematic and retrievable

way for each member. The data elements for each member must be

used in member care planning and in the coordination of services and

must be used in the aggregate for the hospice's quality assessment and

performance improvement program.