Comprehensive assessment

The comprehensive assessment is the second assessment the Conditions of Participation require, after the initial assessment visit, and the one the episode’s record is built on. 42 CFR 484.55(b) requires it within five calendar days after the start of care.

It must accurately reflect the patient’s status and include, among other things:

• the patient’s current health, psychosocial, functional and cognitive status;
• the patient’s strengths, goals and care preferences;
• the patient’s continuing need for home care;
• a review of all medications the patient is using, to identify ineffective drug therapy, significant side effects, drug interactions, duplicate therapy and noncompliance (the drug regimen review, 484.55(c));
• the OASIS data items for a Medicare patient.

Under 484.55(d) it is updated as often as the patient’s condition requires, and at a minimum in the last five days of every sixty-day period, within 48 hours of the patient’s return from a hospital admission of 24 hours or more for reasons other than diagnostic tests, and at discharge.

The medication review is where outside records matter most concretely. A drug regimen review done against the list the patient produces from a kitchen drawer is not the same review as one done against the hospital’s discharge medication list and the specialist’s current orders. The regulation asks for the review; the quality of the record it is done from is the agency’s problem.