CMS SOM App. H, Tag V512

The patient’s comprehensive assessment must

include, but is not limited to, the following: (9) Evaluation of the patient’s abilities,

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interests, preferences, and goals, including the desired level of participation in the dialysis

care process; the preferred modality (hemodialysis or peritoneal dialysis), and setting, (for

example, home dialysis), and the patient’s expectations for care outcomes.

Interpretive Guidance §494.80(a)(9)

Evaluation of abilities, interests, preferences, and goals may be demonstrated by at least one

member of the team documenting an assessment of the patient’s current interests in life and

ability to pursue those interests, preferences for treatment, and goals, including what they expect

from dialysis treatment. Patients should be encouraged to participate in their care, within the

limits of their capacity and desire.

If patients express a desire for enhanced participation in their own care (e.g., weighing

themselves, monitoring blood pressure, holding needle sites, self-cannulation), the facility staff

should evaluate and plan for applicable self-care training.

Refer to the Condition for Care at Home at V585.

Evaluation of the preferred modality means that all options of modalities (hemodialysis,

peritoneal dialysis) and settings (in-center, home) were presented to each patient, and their

goals, preferences, and expectations were given priority in decision-making.

If a patient is determined not suitable for or declines home dialysis therapy, the reason must be

documented in their plan of care, as required at V553