N.C. Medicaid Clinical Coverage Policy No. 3D § 5.5

The provider of hospice services shall comply with 42 CFR §418.54, Condition of

participation. The hospice shall conduct and document in writing a comprehensive

assessment that identifies the beneficiary's need for hospice care services, and the

beneficiary'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.

a. Initial assessment:

The hospice registered nurse shall complete an initial assessment within 48 hours after

the election of hospice care.

b. Timeframe for completion of the comprehensive assessment:

The hospice interdisciplinary group shall complete the comprehensive assessment no

later than five calendar days after the election of hospice care.

c. 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 to promote

the hospice beneficiary’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 beneficiary’s ability to understand and participate

in his or her own care.

4. Imminence of death.

5. Severity of symptoms.

6. Drug profile is a drug profiling assessment is a review of all the beneficiary’s

prescription and over-the-counter drugs, herbal remedies and other alternative

treatments that could affect drug therapy. This includes the identification of the

following:

i.

Effectiveness of drug therapy;

ii.

Drug side effects;

iii. Actual or potential drug interactions;

iv. Duplicate drug therapy; and

v. Drug therapy currently associated with laboratory monitoring.

7. Bereavement assessment; is an initial assessment of the needs of the beneficiary’s

family and other individuals focusing on the social, spiritual, and cultural factors

that may impact their ability to cope with the beneficiary’s death. Information

gathered from the bereavement assessment must be incorporated into the plan of

care and considered in the bereavement plan of care.

8. Referral; is the review of further evaluation by appropriate health professionals.

d. Update of the comprehensive assessment

The update of the comprehensive assessment must be completed by the hospice

interdisciplinary group and must consider changes that have taken place since the

initial assessment. It must include information on the beneficiary’s progress related to

outcomes, as well as a reassessment of the beneficiary’s response to care. The

assessment update must be completed as frequently as the condition of the beneficiary

requires, but no less frequently than every 15 days.

e. Beneficiary’s outcome measures

The comprehensive assessment must include data that allows for measurement of

outcomes. The hospice provider shall measure and document data in the same way for

all beneficiaries. The data must take into consideration aspects of care related to

hospice and palliation.

The data must be an integral part of the comprehensive assessment and must be

documented in a systematic and retrievable way for each beneficiary. The data for

each beneficiary must be used in the individual beneficiary 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.