CMS SOM App. M, Tag L523

The hospice interdisciplinary group, in consultation with the individual’s attending

physician (if any), must complete the comprehensive assessment no later than 5

calendar days after the election of hospice care in accordance with §418.24.

Interpretive Guidelines §418.54(b)

All members of the IDG must be involved with completing the comprehensive

assessment in order to identify the patient/family’s physical, psychosocial, emotional and

spiritual needs and contribute to the development of the plan of care to address those

needs. The individuals/disciplines that complete the assessment should be consistent

with the hospice's own policies and procedures and the discipline's scope of practice. The

RN, in consultation with the other members of the IDG, considers the information

gathered from the initial assessment as they develop the plan of care and the group

determines who should visit the patient/family during the first 5 days of hospice care in

accordance with patient/family needs and desires and the hospice's own policies and

procedures.

The patient may or may not have an attending physician. If the attending physician is

unavailable or unresponsive, the hospice physician must assume this role. If the patient

does have an attending physician, one or more members of the IDG should consult with

this physician in completing the comprehensive assessment. This consultation can occur

through phone calls or other means of communication (Fax, e-mails, text messages, etc.,)

and will help to acquire a better understanding of the patient and family. Attending

physicians can often provide a history of the patient’s disease process and family

dynamics that can help the hospice make better care planning decisions that address all

areas of need related to the terminal illness and related conditions, resulting in improved

patient outcomes.

The “election of hospice care” is the effective date of the election statement. The patient

may sign the hospice election statement with a later (not earlier) effective date. Hospices

may choose to complete the comprehensive assessment earlier than 5 days after the

effective date of the election (e.g., it may complete the comprehensive assessment at the

same time the initial assessment is completed).