CMS SOM App. W, Tag C-1048

assistant, must supervise and evaluate the nursing care for each patient, including

patients at a SNF level of care in a swing-bed CAH.

Interpretive Guidelines §485.635(d)(2)

The nursing care of each patient of the CAH must be supervised by a registered nurse or

a physician assistant where permitted by State law. Even where permitted under State

law, a CAH is not required to have nursing care supervised by a physician assistant. This

is simply an option for the CAH.

For inpatients, including patients receiving long term care services in swing beds,

evaluation of their nursing care includes evaluating the care for each patient upon

admission and, when appropriate, on an ongoing basis in accordance with accepted

standards of nursing practice and CAH policy. Evaluation would include assessing the

patient’s care needs, patient’s health status/conditioning, as well as the patient’s response

to interventions.

Nursing care plans are not developed for outpatients, so the focus of the evaluation would

be on adherence to generally acceptable standards of nursing care practice, including

requirements at §485.635(d)(3) for medication administration.

Survey Procedures §485.635(d)(2)

• Determine that a registered nurse (or physician assistant where permitted by State

law and CAH policy) supervises and evaluates the nursing care for each patient.

• Interview one or more registered nurses (or physician assistants, if applicable)

who supervise and evaluate the nursing care for CAH patients.