{"ref":"DC-HSP-ADM-01","title":"Referral, Eligibility and Admission","category":"Hospice care","summary":"Sets how the Agency receives and screens referrals, checks Medicare, DC Medicaid and other eligibility, obtains the physician recommendation and certification that admission requires, completes the admission visit in the right order, decides fairly when it cannot admit, and handles admissions of DC Medicaid adults, children under 21 and waiver participants.","inShort":["Record every referral the day it arrives and contact the family the same day, or the next business day after hours.","Check eligibility: Medicare Part A, DC Medicaid (21 or older, or the pediatric rules), service area and the patient’s wishes.","We admit only on the recommendation of the medical director, the physician designee or the IDG physician.","The registered nurse completes the initial assessment within 48 hours after the election is complete.","Never turn a patient away because of diagnosis, cost of care or any protected trait. The Administrator approves every refusal."],"primaryCitation":"42 CFR §418.25","citations":["29 DCMR §939.6","29 DCMR §939.18","29 DCMR §939.19","29 DCMR §939.25","29 DCMR §940.3","29 DCMR §940.4","29 DCMR §940.7","29 DCMR §940.14","29 DCMR §940.27","D.C. Code §2-1402.31"],"federalCitations":["42 CFR §418.20","42 CFR §418.25","42 CFR §418.22","42 CFR §418.54(a)","42 CFR §418.112(c)","42 CFR §418.200","42 CFR §418.205","45 CFR Part 92"],"surveyorAsks":["Walk me through a referral from the first call to the first visit. Who decides to admit?","Show me the medical director’s or physician’s recommendation to admit for this patient. What information did the physician consider?"],"forms":[{"ref":"DC-HSP-ADM-01-A","title":"Referral and Eligibility Screening Record"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (42 CFR §418.25)","5. Receiving a Referral","6. Eligibility","7. Information Visits and Pre-Election Counseling","8. The Physician’s Recommendation","9. The Admission Visit","10. When the Agency Does Not Admit","11. DC Medicaid Admissions (If the Agency Is Enrolled)","12. Responsibilities","13. Records and Compliance Monitoring","14. Staff Training","15. References","16. Related Policies and Forms","17. Approval","18. Revision History"],"version":"1.0","sample":false,"pack":"dc-hospice","state":"Washington, DC","service":"Hospice","guides":[{"path":"/guides/hospice-policies/","h1":"What policies are required for hospice?"},{"path":"/guides/hospice-conditions-of-participation/","h1":"Hospice Conditions of Participation: which policies each one needs"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}