Part III: Updated State Operations Manual (SOM) Reflects the Requirements of Participation (RoP)

Although many states already require an interim plan of care, the updated RoP and SOM outline more stringent requirements for a baseline care plan and summary.

The baseline care plan must be developed within 48 hours of the resident’s admission. The inclusions are very specific:

1. It must include initial goals, therapy, dietary, and physician orders, social service needs, medications, PASARR recommendations.
2. It must be person-centered.
3. The facility must use the hospital discharge information to transition to the post-acute setting to prevent re-hospitalization.
4. It must indicate who will implement the various interventions.
5. The facility must be able to prove that the resident/representative were involved in its development.
6. It must be updated as necessary once the comprehensive care plan is completed.

Policies must indicate:

• That the resident and representative will be involved in the baseline care plan development and will be given a summary once the care plan is development. The summary must be in a language that is understood, and it must contain medications, goals, treatments and diet information.
• How the baseline care plan will transition into the comprehensive one once the RAI is completed.

Comprehensive Care Plan requirements may be used in lieu of the baseline care plan only if it is developed within the required time frame (48 hours) and meets all the requirements for the comprehensive care plan.

Facilities should develop a process/plan/procedure, one that will work for evening, night and week-end admissions. The first step is to identify who will initiate the baseline care plan. Once this is determined, the next step is to identify how the process will be documented and where the documentation will be maintained. Finally, the same will be needed with regards to the summary: who will participate, submit to the resident and representative, how signatures will be obtained, and how and where this documentation will be maintained.

Another tip is to develop a template for each: the baseline care plan and summary. This will guide the staff in the completion process and ensure there is compliance for the new requirements.

If you have any questions regarding the new requirements of participation or the guidance, please contact your Marcum advisor.