O-13-018 Acceptance to Services

🎯 PURPOSE

Adara Home Health will accept clients for home health services when there is a reasonable expectation that the agency has the capacity to meet the client’s anticipated care needs. The decision to accept or deny a referral will be made based on the evaluation of multiple criteria.

🔄 PROCESS

Referrals will be received through phone, facsimile, electronic referral portal, etc. Upon receiving a referral, intake staff, with consultation of management, will initiate a preliminary review ensuring all necessary information is provided on which a decision regarding acceptance is possible. This may include, but not limited to, client address and contact information, services being requested, physician or allowed provider orders, diagnosis, recent history and physical, discharge summary, clinic visits note (s), and/or progress notes relative to services being requested or ordered. Referrals will be escalated to the Area Manager/designee as indicated.

The following criteria utilized to evaluate the ability to accept or deny a referral will include, but not limited to each location’s:

1. Anticipated needs of the referred client including but not limited to the client diagnosis, visit frequency anticipated, disciplines required to meet needs, caregiver support, recent hospitalization, and new or exacerbation of existing condition.
2. Case level and case mix including but not limited to the average number of clients managed by clinicians, the number of complex clients on service, and specialized treatment that may be required.
3. Staffing levels and capacity including but not limited to staff out ill or on vacation, disciplines available and current caseload as outlined above.
4. Skills and competencies of staff including but not limited to staff training and competencies, staff level of education, and staff with specific certifications.
5. Admission Criteria/Acceptance to Services found in policy A-3-150.

If it is determined that the client's needs cannot be met, the location will alert the referral source in a timely manner of the declination of the referral and document the reason.  Alternative services may be recommended that may include but not limited to delay of the referral, recommend another Adara location, or recommend another home health agency or specialty clinic or facility.

If it determined that the client’s needs can be met, the location will confirm with the referral source and proceed per policy A-3-160 Admission Process.

📅 Effective: 5/13/2025 | 🛠️ Revised:  |  ✅ Approved: AM