19. Sources and clinical references
MASTER-level citations, current as of the version date. Companies and agencies may append payer-specific requirements (MAC LCDs, ADR criteria, local notification parameters) as overlays without altering the MASTER version.
- CMS Medicare Benefit Policy Manual (Pub. 100-02), Chapter 7 — Home Health Services. Skilled nursing care (§ 40.1), observation and assessment (§ 40.1.2.1), teaching and training (§ 40.1.2.3), management and evaluation of the plan of care (§ 40.1.2.2), homebound (§ 30.1), and reasonable and necessary services (§ 20.1.2). Psychiatric home-health nursing has specific coverage considerations under the skilled-nursing benefit.
- 42 CFR Part 484 — Conditions of Participation for Home Health Agencies. Comprehensive assessment (§ 484.55), including the assessment of psychosocial and mental status, and care planning and coordination (§ 484.60).
- CMS OASIS-E2 Guidance Manual, effective April 1, 2026. The mood items (for example the PHQ-2 to PHQ-9 pathway) used in the comprehensive assessment and quality reporting.
- Community Health Accreditation Partner (CHAP) Standards of Excellence for Home Health. [Insert the exact standard title, version, section, and effective date per the edition held by the agency.]
- Validated screening tools and crisis resources. The Patient Health Questionnaire (PHQ-2 and PHQ-9) for depression and the Generalized Anxiety Disorder scale (GAD-7) for anxiety; a structured suicide-risk assessment per agency protocol; and the 988 Suicide and Crisis Lifeline for crisis support. Any identified risk to self or others is met with immediate safety measures, provider notification, and emergency or crisis services per severity and agency policy.
Usage note: Every narrative and smart phrase in this module is a structured example to be edited to reflect what was actually assessed and the patient's specific orders. Documentation must reflect the real visit; do not copy unchanged.