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 of the patient's condition (§ 40.1.2.1), teaching and training activities (§ 40.1.2.3), management and evaluation of the patient care plan (§ 40.1.2.2), confined to the home / homebound (§ 30.1), and reasonable and necessary services (§ 20.1.2).
• 42 CFR Part 484 — Conditions of Participation for Home Health Agencies. Comprehensive assessment of patients (§ 484.55) and care planning, coordination of services, and quality of care (§ 484.60).
• CMS OASIS-E2 Guidance Manual, effective April 1, 2026. Outcome and Assessment Information Set used for the comprehensive assessment, case-mix grouping under PDGM, 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.] Clinical record and skilled-care documentation standards (NextGen Home Healthcare is CHAP-accredited).
• 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure (Heidenreich PA, et al. Circulation. 2022;145:e895–e1032; published concurrently in JACC and the Journal of Cardiac Failure). Heart-failure stages, classification by LVEF, and guideline-directed medical therapy — applied with the CHF overlay.
• 2025 AHA/ACC Multisociety Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults (Jones DW, et al. J Am Coll Cardiol. 2025;86(18):1567–1678; Circulation 2025). Replaces the 2017 guideline; general treatment target < 130/80 mmHg with patient-specific exceptions; PREVENT risk estimation — applied with the Hypertension overlay. The patient's ordered parameters always control the visit.
• Anticoagulation references are maintained in the Anticoagulation Therapy disease overlay (DX-ANTICOAG) with exact guideline titles and years.

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.