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24.5.5 Home Health Skilled Nursing and Home Health Aide Services Assessments and Reassessments
When a provider has received a referral and has physician orders for SN and/or HHA services, the provider must have a RN perform an initial client assessment in the client's home. A client can be referred to a home health agency for SN and/or HHA services by the client, the client's physician, or the client's family.
The client assessment or reassessment should include, but is not limited to, the following:
• Whether the setting can support the health and safety needs of the client and is adequate to accommodate the use, maintenance, and cleaning of all medical devices, equipment, and supplies required by the client.
•Comprehension level of client, parent, guardian, or caregiver.
•Receptivity to training and ability level of the client, parent, guardian, or caregiver.
•A nursing assessment of medical necessity for the requested visits which includes:
•Complexity and intensity of the client's care.
•Stability and predictability of the client's condition.
•Frequency of the client's need for SN care.
•Identified medical needs and goals.
•Description of wounds, if present.
•Cardiac status.
The initial assessment and any reassessments performed by a RN are required when changes in the client's condition occur during the course of the authorization period. If there is no change in the client's condition, the reassessment must document medical necessity, as defined in the Statement of Benefits, to support continued and ongoing SN and/or HHA visits beyond the initial 60-day authorization period.
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