48-Hour Start-of-Care for Anti-infectives & IVIG: Protect Safety, Payment, and Time.

If your biologic ships Friday and the nurse doesn’t show up until Tuesday, you lose therapy days, safety gets shaky, and your claim looks weak. The fix? A 48-hour Start-of-Care (SOC) standard. Tie it to EVV timestamps and a prefilled OASIS narrative. The nurse shows up on time, the note is audit-ready, and the infusion stays on schedule. CMS doesn’t require 48 hours (they allow ≤5 days for the comprehensive assessment). But making 48 hours your standard keeps patients safe and claims cleaner. The One Idea Promise this to specialty pharmacies: “From order receipt to first skilled visit in ≤48 hours for anti-infectives/IVIG, with EVV proof and an OASIS narrative starter ready for the HHA.”.

Why it matters?

Protects therapy persistence (no missed starts). Reduces rework for HHAs. Defends your story when auditors ask, “Why was this drug in the home on that day?” What 48-Hour SOC Looks Like Clock starts at verified order. RX + payer approval = Day 0. Schedule the first skilled visit within 48 hours. Line it up with drug stability, caregiver readiness, and nurse availability. Use EVV on every visit. Capture who/what/when/where—meets Medicaid HHCS requirements. Prefill the OASIS narrative. Give the HHA a ready-to-drop-in block (risks, interventions, patient education). They finish their assessment faster, with fewer errors. Tactical Workflow (Copy This) Day 0 (Order Verified): Confirm therapy, access type (PIV, CVC, port), BUD window. Send OASIS narrative starter + SOC slots to the HHA. Day 1 (Schedule & Prep): Lock visit within 48h. Push EVV visit object to HHA’s system. Stage supplies. Confirm caregiver readiness. Day ≤2 (First Skilled Visit): Nurse completes EVV on arrival/departure, gives dose, teaches, documents vitals/line care. Return OASIS narrative to HHA. What the HHA Gets EVV proof that meets federal Medicaid HHCS expectations. OASIS narrative that lines up with CMS OASIS-E/E1 guidance. Plan-of-care continuity that mirrors Medicare Home Infusion Therapy rules.

Metrics to Track
Referral-to-First-Stick ≤48h (median). On-time SOC within BUD window (%). OASIS completion without revision (%). Rework rate (notes sent back for clarification). Common Pushbacks (and Answers) “CMS doesn’t say 48 hours.” True. CMS says ≤5 days. But 48h is better for specialty drugs and payer reviews. “EVV is just Medicaid.” Wrong. Commercial plans often expect similar proof. Capturing it once protects you everywhere. “OASIS is the HHA’s job.” Exactly. We don’t do OASIS—we give them a clean narrative starter so they can close faster. Compliance Guardrails Follow 42 CFR Part 484: CMS requires ≤5 days for the comprehensive assessment; our 48h SLA is stricter, not a replacement. EVV comes from the 21st Century Cures Act; state rules vary. Confirm with each HHA partner. Medicare HIT benefit defines infusion nursing as a professional service; plans expect a documented plan of care and 24/7 support. This blog is educational, not legal advice. Always confirm payer-specific requirements. Bottom line: A 48-hour SOC SLA isn’t required—but it’s the fastest way to keep patients safe, protect therapy days, and keep your claims defensible.

References

1. 42 CFR Part 484 – Home Health Conditions of Participation
2. Medicaid.gov – Electronic Visit Verification (EVV)
3. CMS – OASIS User Manuals
4. CMS – Home Infusion Therapy Benefit
5. CMS – Home Health Quality Reporting