CMS SOM App. H, Tag V515

The patient’s comprehensive assessment must

include, but is not limited to, the following:

(12) Evaluation of current patient physical activity level.

(13) Evaluation for referral to vocational and physical rehabilitation services.

Interpretive Guidance §494.80(a)(12) and (13)

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These requirements are not intended to indicate that the facility is responsible for fully assessing

each patient’s activity level/physical capabilities. It is expected that the IDT would be able to

evaluate each patient’s activity level to the extent necessary to determine whether the patient is a

candidate for referral to the appropriate professional(s) for further evaluation and possible

rehabilitation services.

A member of the IDT should interview the patient/designee about the patient’s current level of

physical activity, ability to perform activities of daily living, and/or barriers to independence.

The assessment should include observation of the patient’s ability to ambulate, transfer, and

perform other physical activities pertinent to the dialysis environment (e.g., holding needle sites,

etc.).

Pediatric patients may also warrant rehabilitation services. Pediatric patients should be

encouraged to attend school full-time, if possible. If school attendance is not possible, other

options should be offered for school-age children to obtain an education.

Vocational rehabilitation referrals may be appropriate for older youth and adult patients who

wish to return to work and/or enhance their independent living skills.

Patients who may warrant physical rehabilitation referrals include those with physical

limitations and/or difficulty in performing activities of daily living independently.

The requirements for the plan of care for rehabilitation status (including making referrals) are at

V555.