Criteria for Medicare Coverage .........................................................................................................55 Admission Process .............................................................................................................................60 Documentation ..................................................................................................................................62 Consent Form .................................................................................................................................62 Comprehensive Assessment ..........................................................................................................62 Advance Directives.........................................................................................................................63 Home Safety Assessment...............................................................................................................63 Medication Profile .........................................................................................................................63 Plan of Care (POC) ..........................................................................................................................64 Home Health Aide Care Plan .........................................................................................................65 Recertification Process...................................................................................................................65 Recertification Documentation .....................................................................................................66 Section 8: Outcome and Assessment Information Set (OASIS) ............................................................67 Introduction .......................................................................................................................................67 Conventions/Rules for Completing OASIS ........................................................................................69 Section 9: Skilled Nursing ......................................................................................................................72 Medicare Criteria for Skilled Nurse Coverage ...................................................................................72 Case Management .............................................................................................................................77 Nursing Clinical Progress Note ..........................................................................................................78 Medication Safety and Compliance...................................................................................................78 Care of the Dying Patient/Client .......................................................................................................79 Section 10: Therapy ...............................................................................................................................80 Medicare Criteria for Therapy ...........................................................................................................80 Assessment/Evaluation .....................................................................................................................82 Goals...................................................................................................................................................82 Medical Equipment ............................................................................................................................84 Therapy Progress Note ......................................................................................................................84 Section 11: Medical Social Services .......................................................................................................85 Medical Social Services Coverage Criteria.........................................................................................85 Social Worker Requirements .............................................................................................................88 Section 12: Home Health Aide ...............................................................................................................89 Introduction .......................................................................................................................................89 Goals of Home Health Care............................................................................................................89
