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Are there specific guidelines for pain management?

CMS has not yet published final guidelines for pain management. However, we hear that may happen by the end of this year. The surveyor guidance for F-tag 309 is anticipated to be revised to include both pain management and end of life care.

In the meantime, there are guidelines out there that will assist your facility in meeting the Standard of Practice related to pain management. You should contact the Quality Improvement Organization (QIO) within your state to see if they have any resources.

Another guideline is the AMDA Clinical Standards of Practice, which is widely accepted as good practice. CMS did publish draft guidelines on May 31, 2006. The Standard of Practice today includes assessing your resident for pain on admission, quarterly, annually and with significant change or any time they have an onset of pain. That assessment should include identification of the degree of pain utilizing a 1 to 10 pain scale.

You need to assess for causes of pain and also ask the resident the acceptable level of pain for her or him. Then your staff members should ask the resident every time they give pain medication, whether routine or prn, what rating of pain they have and reassess for the results of the medication.

You can utilize the acceptable level of pain as your measurable goal on the care plan.  This is not an optional program in your facility, it is the Standard of Practice.  

What is happening with the Part B therapy caps?

On July 15, Congress overrode President Bush's veto of a bill that, in part, extends the sweeping therapy-caps exception process 18 months. In addition, CMS said it would reprocess any claims from the first two weeks of July, when the exceptions technically were expired.

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