CMS SOM App. H, Tag V557

(2) Implementation of

the initial plan of care must begin within the [later][sic] of 30 calendar days after admission

to the dialysis facility or 13 outpatient hemodialysis sessions beginning with the first

outpatient dialysis session…

Interpretive Guidance § 494.90(b)(2)

The timeline for both the completion of the initial comprehensive assessment and the beginning

of implementation of the initial patient plan of care is the later of 30 days from the date of

admission or 13 hemodialysis treatments at the facility. Refer to V516. For patients who have

more than 3 treatments a week, e.g., those on peritoneal dialysis or daily/nocturnal

hemodialysis, the plan of care is expected to be completed within 30 days from the date of

admission, excluding any days the patient is hospitalized during that period.

The plan of care should be dated to indicate when the plan was initiated. Although the plan of

care must be initiated within the required timeline, the schedule for full implementation of the

plan will vary depending upon the complexity of the plan.

In order for dialysis treatment to be initiated, each patient must have an initial dialysis

prescription, orders for care, and baseline physical and nursing assessments before treatment is

begun at the facility. See V715 under the Condition for medical director for this requirement.