CMS SOM App. M, Tag L547

to meet the specific patient and family needs.

Interpretive Guidelines §418.56(c)(2)

The use of visit ranges in the patient plan of care should follow these parameters:

• The plan of care may include a range of visits and ’provide as needed’ orders for

visit frequencies to ensure the most appropriate level of service is provided to the

patient.

• A range of visits is acceptable as long as it continues to meet the identified needs

of the patient/family.

• Visit ranges with small intervals are acceptable (i.e., 1-3 visits/week; 2-4

visits/week) but ranges that include “0” as a frequency are not allowed.

• The IDG may exceed the number of visits in the range to address patient/family’s

needs. There should be documentation in the record to support the need for the

extra visit(s).

If the patient requires frequent use of PRN visits, the plan of care should be updated to

include the need for additional visits.

Standing orders or routine orders must be individualized to address the specific patient’s

needs and signed by the patient’s physician.

The IDG should be proactive in developing each patient’s plan of care by planning ahead

for anticipated patient changes and needs. Decisions should reflect the patient/family

preferences rather than be solely a response to a crisis.