Acceptance to Service Policy

Evaluation of Referrals
1. Referral Intake: Upon receipt of a referral, the intake coordinator will gather all necessary
patient information, including the prospective patient's medical history, diagnosis, prescribed
treatments, and specific care needs.
2. Assessment of Needs: The intake coordinator or clinical supervisor will assess the prospective
patient's anticipated needs. This includes reviewing:
o The patient's clinical condition and care requirements.
o The requested and anticipated frequency and type of services (e.g., nursing visits,
therapy, home health aide support). This will be subject to once the Case Manager has
performed an in-person initial assessment of the patient.
o Any special requirements (e.g., wound care, IV therapy, hospice services).
Capacity Evaluation
1. Caseload and Case Mix Assessment: The Director of Nursing will regularly review the
agency’s current caseload and case mix. This includes determining whether the agency has the
capacity to take on additional patients with similar or higher acuity needs without compromising
the care of existing patients. The DON will communicate any capacity or case mix concerns to
the intake coordinator so that they can quickly communicate it to referral sources.
o If the agency's current caseload exceeds capacity, the referral will be reviewed for
priority or delayed acceptance.
2. Staffing Level Evaluation: The agency will evaluate staffing availability and capacity based on
the following factors:
o The number of qualified staff (e.g., registered nurses, therapists, home health aides)
available to provide care.
o The ability of the agency to staff the required visits for the prospective patient based on
current employee schedules and availability.

Skills and Competencies of Staff: The agency will assess whether the clinical and non-clinical
staff have the necessary competencies and training to provide appropriate care for the prospective
patient’s specific needs. This includes:
o The required clinical skills and experience for specialized treatments.
o The ability to address cultural or language preferences if necessary.

Decision-Making Process
1. Acceptance Decision: Based on the evaluations in sections 1 and 2, the intake manager, along
with the Director of Nursing or Administrator as needed, will decide whether the agency has the
capacity to accept the patient.
o If the agency has the capacity to meet the patient's needs, the patient will be accepted for
services.
o If the agency lacks the necessary resources or competencies to care for the patient, the
referral will be declined, and the referring party will be informed.
2. Documentation: All evaluations, decisions, and communications regarding the acceptance or
rejection of a referral will be documented in the patient's record. The documentation will include:
o The reason for acceptance or denial.
o Any identified capacity limitations that impacted the decision.
Communication with the Referring Party
1. Notification: The referring physician or facility will be promptly notified of the decision to
accept or decline the patient. If declined, the agency will provide appropriate recommendations or
alternatives, if applicable.
2. Referral Follow-up: If the patient is accepted, the intake coordinator will initiate the admission
process and proceed to accept the patient and transfer responsibility to the Care Coordination
team, who will assign qualified Case Manager to complete the initial assessment. If declined, the
referring party will be informed of potential wait times or other reasons for the decision.
COMPLIANCE AND QUALITY ASSURANCE
 Monitoring: The agency will regularly monitor its capacity and staffing levels to ensure that the
acceptance-to-service policy is applied consistently and that the agency remains compliant with
this policy.
 Review: This policy will be reviewed annually or as needed to ensure compliance with regulatory
changes or operational adjustments.
 Training: All relevant staff will be trained in this policy and procedure to ensure consistent
application in all patient referrals