Referral, Eligibility and Admission
Sets out how the Agency receives and responds to referrals, screens eligibility for Medicare, Medical Assistance and other payers, obtains the physician recommendation for admission that 42 CFR §418.25 requires, conducts the admission visit, handles patients it cannot admit, and admits children, nursing facility residents and patients near the edge of the service area.
About this policy
- Policy number
- PA-HSP-ADM-01
- Version
- 1.0
- Main rule
- 42 CFR §418.25
- Library
- Pennsylvania hospice · 60 policies
- Category
- Hospice care
- Sections
- 24
In short
- Record every referral on the referral form and contact the patient or family the same day if you can.
- No one is admitted without a recommendation from the medical director, the physician designee or the IDG physician, with the attending physician's input.
- At the admission visit, in this order: explain hospice, consent, election, rights notice and advance directive information, then the initial assessment.
- The RN initial assessment must be done within 48 hours after the election, or sooner if asked.
- Never refuse a patient because of cost, lack of a DNR order, or any discriminatory reason. If we cannot admit, explain why and help find other care.
What's inside
24 sections. The full text comes with the One-time Policy Pack.
- Terms of Reference
- 1. Purpose
- 2. Scope
- 3. Definitions
- 4. Policy Statement (42 CFR §418.25)
- 5. Receiving a Referral
- 6. Time Frames for Responding (Agency Standards)
- 7. Eligibility Screening
- 8. Physician Recommendation for Admission
- 9. The Admission Visit
- 10. When the Agency Does Not Admit
- 11. Pre-Election Evaluation and Counseling
- 12. Special Situations
- 12.1 Pediatric patients
- 12.2 Residents of nursing facilities and other facilities
- 12.3 Patients in hospital
- 12.4 Patients outside, or leaving, the service area
- 13. Responsibilities
- 14. Records and Compliance Monitoring
- 15. Staff Training
- 16. References
- 17. Related Policies and Forms
- 18. Approval
- 19. Revision History
An inspector may ask
- Who recommended admission for this patient, and where is the attending physician's input documented?
- What clinical information did the physician consider before recommending admission?
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