Acronyms are pervasive in healthcare, which can cause confusion for patients and families. While “SOC” occasionally refers to “Standard of Care” or “Scope of Care,” its most common meaning in the United States healthcare system is “Start of Care.” This designation represents a specific, regulated process that initiates an episode of treatment for a patient outside of a hospital or institutional setting. It is the first step in establishing a patient’s eligibility for services, determining the type of care they will receive, and securing necessary reimbursement.
Start of Care: Definition and Setting
The Start of Care (SOC) is the official, regulatory first day a patient receives professional, skilled services from a home health or hospice agency. This date establishes the beginning of a formal episode of care, which typically lasts 60 days in the home health setting. The SOC is triggered by a physician’s order for services and must be completed by the agency within a specific timeframe after the referral.
This initial visit serves as the foundation for the entire care journey and is mandatory for agencies participating in federal programs like Medicare and Medicaid. It acts as a procedural gatekeeper for reimbursement. The SOC visit establishes the medical necessity for the skilled services provided.
Components of the Initial Assessment
The Start of Care visit involves a comprehensive assessment conducted by a qualified healthcare professional, typically a registered nurse or physical therapist. This hands-on evaluation establishes a holistic view of the patient’s current status and needs. The clinician begins by gathering a detailed health history, including a review of past medical conditions, surgeries, and current diagnoses.
A detailed medication reconciliation is performed to ensure the patient’s current drug regimen is accurate and to check for potential duplications or adverse interactions. The clinical assessment includes a physical examination, measuring vital signs, evaluating skin integrity, and assessing neurological function. Functional status is also assessed by observing the patient’s ability to perform Activities of Daily Living (ADLs), such as bathing, dressing, and ambulating, to determine the level of assistance required.
The assessment also includes the patient’s environment and psychosocial status. The clinician identifies environmental safety concerns, such as fall hazards, and evaluates the patient’s cognitive function and emotional well-being. Observing the patient’s support systems helps the clinician establish realistic initial goals and identify any barriers to recovery within the home setting.
Regulatory Documentation Requirements
The clinical assessment performed at the Start of Care is linked to mandatory regulatory documentation required by the Centers for Medicare & Medicaid Services (CMS). For home health services, the SOC visit triggers the completion of the Outcome and Assessment Information Set (OASIS). This standardized data collection tool is required for all Medicare and Medicaid patients receiving skilled care.
OASIS data captures detailed clinical, functional, and service utilization information, which CMS uses to measure the quality of care and calculate reimbursement under payment models like the Patient-Driven Groupings Model (PDGM). The accuracy of the data collected during the SOC is crucial, as it establishes the baseline against which future progress and outcomes are measured. The clinician must also confirm that a required face-to-face encounter with a physician occurred within the mandated timeframe.
The completed OASIS document must be submitted to CMS electronically within a required timeframe, typically 30 days from the SOC date. This requirement ensures that home health agencies are compliant with federal regulations and that the data used for public reporting of quality measures is consistent. Failure to submit this documentation accurately and on time can lead to payment denials, audit risks, and compliance penalties for the agency.
Transitioning to the Plan of Care
The data collected during the comprehensive SOC assessment and documented in the OASIS tool is synthesized to create the patient’s formal Plan of Care (POC). This document serves as the physician-certified blueprint for the patient’s treatment over the entire episode of care. The POC translates the patient’s needs, functional limitations, and goals identified during the assessment into specific, skilled interventions.
The plan details the frequency and duration of all skilled services, such as nursing visits, physical therapy, or occupational therapy, and includes all necessary medical orders. Measurable goals are established based on the patient’s baseline status from the SOC, providing a clear trajectory for recovery and independence. Finalizing the Plan of Care involves securing the certifying physician’s signature, which attests to the medical necessity of the services outlined. This formal certification closes the SOC process and transitions the patient into the active treatment phase.