POLICY Clients are accepted for treatment in the home on the basis of reasonable criteria and under the expectation that the client’s medical, nursing, and social needs can be met adequately by Agency in the client’s place of residence. Agency shall make available and provide services to all persons without regard to race, color, creed, sex, national origin, handicap, sexual orientation, age, marital status, status with regard to public assistance or veteran status, in compliance with 45CFR parts 80, 84, 91, and other agency guidelines. All services are available without distinction to all program participants, regardless of diagnosis. Agency shall not deny admission to people with a contagious disease, including, but not limited to HIV, MRSA, and Hepatitis. All persons and organizations that either refer persons for services or recommend the agency’s services shall also be advised of same. The person designated to coordinate the agency’s compliance with Section 504 of the Rehabilitation Act of 1973 (nondiscrimination against the handicapped) is Tatyana Akhmetova who can be reached at 303-247-1111 PURPOSE To provide guidelines for accepting clients for home health care services to be provided in the client’s place of residence that are clear to the home care staff, the medical and lay community, and that abide by state/federal guidelines. To comply with Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, The Age Discrimination Act of 1975, all the requirements imposed by, or pursuant to, the regulations of the Department of Health and Human Services (45CFR Parts 80, 84, and 91) issued pursuant to these statutes and other agency guidelines. SPECIAL INSTRUCTIONS Criteria for Client Admission: A direct request for service shall be made to the agency. It may be generated by a client, physician, caregiver, health facility representative or community member. The client must live in the geographic area served by the Agency. Services for a client receiving Skilled Nursing, Therapy, Medical Social Services or Home Health Aide services must follow a written Plan of Care established and periodically reviewed by a doctor of medicine, osteopathy, or podiatric medicine. The written Plan of Care shall be reviewed at least every 60 days by that physician or their designee. There must be a reasonable expectation that the client’s medical, nursing, social, or rehabilitation needs can be adequately met in the client’s home. Reasonable expectation shall consider: Whether the agency’s personnel and resources are adequate and suitable for providing the services the client requires. The attitudes of client/caregiver toward care at home. The benefits of care at home as compared to care in a hospital, extended care facility or alternate setting. Whether the physical facilities in the client’s home are adequate for giving the client proper care. There is indication that the delivery, monitoring and coordination of home health care services will enable the client to remain within the home environment. When determined necessary based on the client’s condition, a competent caregiver and/or family member may assume responsibility for client care with intermittent services provided by the agency. Medicare beneficiaries must meet the qualifying criteria identified in the Conditions of Participation for the agency to receive payment for services from Medicare (Policy C-122). The client must be entitled to receive covered home health services under the Health Insurance for the Aged Act, Title XVIII and/or Title XIX of the Social Security Act (Medicare and Medicaid), or have other funding sources, i.e., private insurance, HMO, or ability to self pay. Agency services must be appropriate and available to meet the specific needs and requests of the client and caregiver. MEDICARE QUALIFYING CRITERIA FOR BENEFICIARY REIMBURSEMENT POLICY To accept a client for care under Medicare reimbursement, the client must meet qualifying criteria as outlined in the current CMS Internet Only Manuals 100-2, Chapter 7 (CMS Home Health Agency Manual and in the CFR 42 S93 Section 409.42). PURPOSE To provide written guidelines for determining whether clients qualify for Medicare reimbursement of home health services. SPECIAL INSTRUCTIONS The client must be confined to the home or place of residence that is not a hospital or skilled nursing facility (Homebound.) The client may leave their home for medical appointments and treatments without compromising home bound status. Attendance at adult day care does not preclude the client from receiving Medicare home health services, if indicated. The client must be under the care of a physician who establishes and reviews the Plan of Care. The client must need at least one of the following skilled services as certified by the physician: Intermittent skilled nursing. Physical therapy. Speech Language Pathology. Continuing Occupational therapy if the prior need for skilled nursing, physical therapy, or speech therapy had been established in the current or prior certification period. The services required or anticipated coverage needed must meet part-time or intermittent criteria. The services must be reasonable and necessary as determined by client condition, diagnosis, available caregivers and documentation must also reflect that services meet this criteria. Physician orders must be present and signed specifying the medical treatments to be furnished, type, frequency, and duration of services to be provided by discipline(s). Orders must be reviewed by the physician at least every sixty (60) days. Services must be furnished by a Medicare-certified agency. The client must be eligible for Medicare.