CMS SOM App. B, Tag G724

Interpretive Guidelines §484.75(c)

Documentation in the clinical record should show how communication and oversight

exist between the skilled professional and assistant regarding the patient’s status, the

patient’s response to services furnished by the assistant, and the effectiveness of any

written instructions provided by the skilled professional to the assistant.

Any specific written instructions by skilled professionals to assistants are based on

treatments prescribed in the patient’s plan of care, patient assessments by the skilled

professional, and accepted standards of professional practice. The skilled professional

must periodically evaluate the effectiveness of the services furnished by the assistant to

ensure the patient’s needs are met.

Survey Procedures §484.75(c)

Documentation in the clinical record should demonstrate evidence that the skilled

professionals supervise professional assistants as per HHA policy. Supervision of the

skilled assistants must be conducted by the same discipline as the skilled professional

that developed the assistant’s instructions. Look for evidence in the clinical record that

the skilled professional remains active in the ongoing plan of care through periodic

supervisory follow-up. Review clinical notes to verify that professional assistants adhere

to the instructions established by the skilled professional and that they document the

treatment and patient response to the treatment.