Current through February 29, 2024
Section 456.610 - Basis for determinationsIn making the determinations on adequacy of services and related matters under §456.609 for each beneficiary, the team may consider such items as whether-
(a) The medical evaluation, any required social and psychological evaluations, and the plan of care are complete and current; the plan of care and, where required, the plan of rehabilitation are followed; and all ordered services, including dietary orders, are provided and properly recorded;(b) The attending physician reviews prescribed medications-(1) At least every 30 days in psychiatric facilities, and mental hospitals; and(2) At least quarterly in ICFs;(c) Tests or observations of each beneficiary indicated by his medication regimen are made at appropriate times and properly recorded;(d) Physician, nurse, and other professional progress notes are made as required and appear to be consistent with the observed condition of the beneficiary;(e) The beneficiary receives adequate services, based on such observations as- (3) Absence of signs of malnutrition or dehydration; and(4) Apparent maintenance of maximum physical, mental, and psychosocial funtion;(f) In an ICF, the beneficiary receives adequate rehabilitative services, as evidenced by- (1) A planned program of activities to prevent regression; and(2) Progress toward meeting objectives of the plan of care;(g) The beneficiary needs any service that is not furnished by the facility or through arrangements with others; and(h) The beneficiary needs continued placement in the facility or there is an appropriate plan to transfer the beneficiary to an alternate method of care.43 FR 45266, 9/29/1978, as amended at 61 FR 38399, 7/24/1996