{"ref":"MI-HSP-ADM-01","title":"Referral, Eligibility and Admission","category":"Hospice care","summary":"Sets out how the Agency receives and screens referrals, the Michigan and federal admission criteria (a terminal prognosis in a physician's opinion, a voluntary request, and a physician's recommendation), the Michigan requirement that a physician review the medical history and initial assessment no more than 15 days before or 2 days after admission, the steps of the admission visit, Medicaid eligibility, health plan authorization and coordination with other Medicaid programs, and what the Agency does when it cannot admit.","inShort":["Log every referral with the date and time. Contact the person or family the same business day.","Check Medicare and Medicaid eligibility before the first visit. For a Medicaid Health Plan member, get the plan's approval first.","A physician must recommend admission and review the history and first assessment no more than 15 days before or 2 days after admission.","At the admission visit give rights before any care, then consent, election, advance directive information and the initial assessment within 48 hours of election.","Never refuse a referral on your own. The director of nursing or Administrator decides, and the reason is written down."],"primaryCitation":"MCL 333.21417","citations":["MCL 333.21417","MCL 333.20201(2)(a)","Mich. Admin. Code R 325.45351(3)-(4)","Mich. Admin. Code R 325.45129","Mich. Admin. Code R 325.45195","Mich. Admin. Code R 325.45105(f)","Mich. Admin. Code R 325.45191(2)","Mich. Admin. Code R 325.45231(2)","Mich. Admin. Code R 325.45353(1)","MCL 333.21418(2)","Michigan Medicaid Provider Manual, Hospice, Sections 1, 3, 5.4, 6.7, 6.8, 6.10 and 7.2"],"federalCitations":["42 CFR §418.25","42 CFR §418.20","42 CFR §418.22","42 CFR §418.24","42 CFR §418.52(a)","42 CFR §418.54(a)"],"surveyorAsks":["Walk me through what happens from the moment you receive a referral until the first visit.","Who recommended admission for this patient, and where is the physician review of the medical history and initial assessment?"],"forms":[{"ref":"MI-HSP-ADM-01-A","title":"Referral and Admission Checklist"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (MCL 333.21417)","5. Admission Criteria","6. Receiving a Referral","7. Physician Review, Recommendation and Diagnosis","8. Information Before Admission","9. The Admission Visit","10. Special Situations","11. When the Agency Cannot Admit","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":"mi-hospice","state":"Michigan","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}}