Every finding on record at Dm Care Hospice

Based on observation, interview and record review, the Hospice agency failed to ensure the Condition of Participation for Initial and Comprehensive Assessment of Patients were met as follows: The Hospice agency failed to: 1. Maintain an accurate and current patient medication profiles, for three of 14 sampled patients, (Patients 2, 3, and 8). This failure had the potential in placing the patients at risk for medication errors and adverse drug reactions. (Refer to L530) 2. Ensure the patient's eligibility for hospice services related to the palliation (relief of symptoms and suffering cause by life threatening diseases) and management of the terminal illness and related conditions were accurately assessed, for six of 14 sampled patients, (Patients 2, 4, 5, 6, 8 and 10). This deficient practice resulted in patients admitted for hospice care and services not appropriately evaluated by the health care professionals. (Refer to L532) The cumulative effects of these systemic practices resulted in the failure of the Hospice agency to deliver statutorily mandated compliance with the Federal regulations for Initial & Comprehensive Assessment of Patients to ensure provision of the highest quality care to patients certified to receive the Medicare hospice benefits. --- .

Based on observation, interview and record review, the hospice agency failed to maintain an accurate and current patient medication profiles, for three of 14 sampled patients, (Patients 2, 3, and 8). This failure had the potential in placing the patients at risk for medication errors and adverse drug reactions. --- a. A review of Patient 2's clinical record indicated he was admitted to the hospice agency on 4/10/23, with a terminal diagnosis of cerebro-vascular disease (chronic obstructive pulmonary disease (damage from the brain from interruption of it's blood supply). A review of Patient 2s POC (Plan of Care)/IDG (Interdisciplinary Group- a team responsible for the holistic care of the hospice beneficiary) form dated 7/21/23, indicated the frequency of visits for skilled nurse (SN) to one visit per week visits for pain and symptoms management, and the Hospice aid to visit two times a week. The skilled nurse was to instruct the patient and/or caregiver regarding new medications or treatments, monitor for side effects, to monitor and assess effectiveness of the current and any new medications or treatments. On 8/1/23, at 11:45 a.m., a joint home visit was conducted to Patient 2's residence, with the License Vocational Nurse (LVN 1). Patient 2 was observed awake, alert, oriented, and ambulatory using a cane without any assistance from family members. On 8/1/23, at 12:10 p.m., during a review of Patient 2s current medications, Clopidogrel 75 milligram (mg) blood thinner medication was not found. However, the patients current medication profile provided by the hospice staff indicated patient was taking the medication. During an interview with PCG 1 (caregiver-daughter), she stated Patient 2 was not taking this medication over two months. b. A review of Patient 3's clinical records indicated a SOC date of 2/9/23, with a terminal diagnosis of Alzheimers disease, unspecified (a brain disorder that slowly destroys memory and thinking skills and eventually, the ability to carry out the simplest tasks). A review of Patient 3s POC Summary, indicated the frequency of visits for the licensed vocational nurse (LVN) and the hospice aide to one visit per week. The skilled nurse was to instruct the patient and/or caregiver regarding new medications or treatments, monitor for side effects, to monitor and assess effectiveness of the current and any new medications or treatments. On 8/1/23, at 1:40 p.m., a joint home visit was conducted to Patient 3's residence, with the LVN 2 (license Vocational Nurse). Patient 3 was observed lying on a hospital bed, alert, confused and PCG 2 (caregiver) was next to her and available to answer any questions. On 8/1/23, at 2 p.m., during a review of Patient 3s current medications, there was one bottle of Eliquis 2.5 mg one tab twice daily and one bottle of Omeprazole 20 mg one cap once a day found in the medication container. During an interview with PCG 2, she stated Patient 2 was taking Eliquis 2.5 mg one tab daily and Omeprazole 20 mg one cap every other day. On 8/2/23, at 1:30 p.m., during an interview with the Director of Patient Care Services (DPCS), the DPCS stated the visiting nurse need to review patients current medication and ask the patient or caregiver when and how they administer the prescribed medications every visit and update the medication profile in the patients clinical record. A review of the hospice agencys undated policy and procedure titled, ";Medication Profile", indicated patients receiving medications administered by hospice will have a current, accurate medication profile in the clinical record. Medication profiles will be updated for each change to reflect current medications and new and/or discontinued medications. c. A review of Patient 8's clinical records indicated a SOC date of 2/91523, with a terminal diagnosis of Alzheimers disease, unspecified (a brain disorder that slowly destroys memory and thinking skills and eventually, the ability to carry out the simplest tasks). A review of Patient 8s POC Summary, indicated the frequency of visits for the licensed vocational nurse (LVN) and the hospice aide to one visit per week. The skilled nurse was to instruct the patient and/or caregiver regarding new medications or treatments, monitor for side effects, to monitor and assess effectiveness of the current and any new medications or treatments. On 8/1/23, at 11:00 a.m., a joint home visit was conducted to Patient 8's residence, with the LVN 2 (license Vocational Nurse). Patient 8 was observed sitting in a chair in the living room sleeping , when his was awakened by the PCG and LVN 2, patient appeared , alert ,confused, and did not respond to the question asked of him. On 8/1/23, at 11: a.m., during a review of Patient 8s current medications, there was clear zipped empty ziplocked package of Anti-Diarrheal 2 mg one tab every six hours as needed for diarreha, with a filled date of 6/6/2023 and the quantity documented as 30.. During an interview with PCG , she stated Patient 8 has diarrhea almost all the time and takes that medication. The PCG stated patient 8 does not have any and they have been out of the medication for a few days. The PCG stated patient 8 did not have diarrhea that day. AT that time both the pcg and LVn 2 were asked who was responsible for ordering/ensuring the medication is at the board and care( B&C) facility . LNV 2 stated she is responsible and stated she was going to order the refill of the medication today . On 8/2/23, at 1:30 p.m., during an interview with the Director of Patient Care Services (DPCS), the DPCS stated the visiting nurse need to review patients current medication and ask the patient or caregiver when and how they administer the prescribed medications every visit and update the medication profile in the patients clinical record. A review of the hospice agencys undated policy and procedure titled, ";Medication Profile", indicated patients receiving medications administered by hospice will have a current, accurate medication profile in the clinical record. Medication profiles will be updated for each change to reflect current medications and new and/or discontinued medications.

Based on observation, interview, and record review, the hospice agency failed to ensure the patient's eligibility for hospice services related to the palliation (relief of symptoms and suffering cause by life threatening diseases) and management of the terminal illness and related conditions were accurately assessed, for six of 14 sampled patients, (Patients 2, 4, 5, 6, 8 and 10). This deficient practice resulted in patients admitted for hospice care not appropriately evaluated by the health care professionals to receive hospice care that are only awarded to patients certified to receive the benefits. --- a. A review of Patient 2's clinical record indicated he was admitted to the hospice agency on 4/10/23, with a terminal diagnosis of cerebro-vascular disease (chronic obstructive pulmonary disease (damage from the brain from interruption of it's blood supply). The clinical record further indicated the ";referring/attending/patient choice" physician was Physician 1 (medical director). A review of Patient 2's Physicians Certification for Hospice Benefit, dated 4/10/23 to 7/9/23, benefit period #1, indicated the Medical Director signed the attending physician referral section to indicate Patient 2 had a life expectancy of six months or less if the terminal illness runs its normal course. There was no documentation for laboratory test result, imaging data, history and physical, and biopsy results that showed evidence to support the terminal illness diagnosis. On 8/1/23, at 11:45 a.m., a joint home visit was conducted to Patient 2's residence, with the License Vocational Nurse (LVN 1). Patient 2 was observed awake, alert, oriented, and ambulatory using a cane without any assistance from family members. At 12 p.m., during an interview with Caregiver 1 (daughter) if Patient 2 was referred by her attending physician, she stated no. Caregiver 1 also stated that a family friend recommended the hospice agency for Patient 2. She also stated Patient 2 was getting weaker since recovering from her stroke episode, that she had an option of placing the patient to a nursing home but decided to refer her to this hospice agency. b. A review of Patient 4's clinical record indicated a start of care (SOC) date of 7/20/23, with a terminal diagnosis of heart failure (a chronic condition in which the heart does not pump blood as well as it should). The clinical record further indicated the ";referring/attending/patient choice" physician was Physician 1 (medical director). A review of Patient 4's Physicians Certification for Hospice Benefit, dated 7/20/23 to 10/17/23, benefit period #1, indicated the Medical Director signed the attending physician referral section to indicate Patient 4 had a life expectancy of six months or less if the terminal illness runs its normal course. There was no documentation for laboratory test result, imaging data, history and physical, and biopsy results that showed evidence to support the terminal illness diagnosis. On 8/2/23, at 3 p.m., during a phone interview with Family Member 1, he stated the patient's attending physician did not refer him to the hospice agency but by a random physician when the patient was discharged from the hospital a few months back. c. A review of Patient 5's clinical record indicated a start of care (SOC) date of 2/22/23, with a terminal diagnosis of Alzheimers disease, unspecified (a brain disorder that slowly destroys memory and thinking skills and eventually, the ability to carry out the simplest tasks). The clinical record further indicated the ";referring/attending/patient choice" physician was Physician 1 (medical director). A review of Patient 5's Physicians Certification for Hospice Benefit, dated 2/22/23 to 5/22/23, benefit period #1, indicated the Medical Director signed the attending physician referral section to indicate Patient 5 had a life expectancy of six months or less if the terminal illness runs its normal course. There was no documentation for laboratory test result, imaging data, history and physical, and biopsy results that showed evidence to support the terminal illness diagnosis. d. A review of Patient 6's clinical record indicated a start of care (SOC) date of 2/4/23, with a terminal diagnosis of chronic obstructive pulmonary disease ( a lung disease that blocks airflow and make it difficult to breathe). The clinical record further indicated the ";referring/attending/patient choice" physician was Physician 1 (medical director). A review of Patient 6's Physicians Certification for Hospice Benefit, dated 2/4/23 to 5/4/23, benefit period #1, indicated the Medical Director signed the attending physician referral section to indicate Patient 6 had a life expectancy of six months or less if the terminal illness runs its normal course. There was no documentation for laboratory test result, imaging data, history and physical, and biopsy results that showed evidence to support the terminal illness diagnosis. On 8/2/23, at 3:30 p.m., during a phone interview with Patient 6, he stated he was never told that he had six months or less to live. When asked if he knows what hospice care was, he stated that a nurse will come visits him every week. When asked how he heard about the hospice agency, he stated his daughter referred her to the hospice agency. On 8/2/23, at 1:30 p.m., during an interview with the Director of Patient Care Services (DPCS ), she stated in order for a new patient to be admitted at their hospice service, there should be a referral from the patient's attending physician, if not a referral from a social worker or a physician from the hospital where the patient gets discharged from. On 8/2/23, at 2:30 p.m., during a phone interview with Physician 1 (medical director), she stated that she was not the attending physician, and she does not know who the attending physician for Patients 2, 4, 5, 6 and 10. She stated since Patients 2, 4, 5, 6 and 10 were admitted to their hospice service, she is now the patient's attending physician, that she signed the referral attending physician section because no one would sign it. Physician 1 further stated that she determined the patients were eligible for hospice services by reviewing of patient's medical records provided by the hospital and assessment report given by the registered nurse upon their initial visit to the patients. A review of the agency's undated policy and procedure titled "Admission Criteria and Process", indicated PRN Hospice will admit any patient with a life-limiting illness that meets the admission criteria. The patients life-limiting illness and prognosis of 6 months or less will be determined by utilizing standard clinical prognosis criteria developed by the fiscal intermediarys Local Coverage Determination (LCDs). PRN Hospice will admit a patient only on recommendation of the medical director in consultation with, or input from, the patients attending physician. e. A review of Patient 8s clinical record indicated a start of care (SOC) date of 2/15/23, with a terminal diagnosis of Alzheimers disease, unspecified (a brain disorder that slowly destroys memory and thinking skills and eventually, the ability to carry out the simplest tasks). The clinical record further indicated the ";referring/attending/patient choice" physician was Physician 1 (medical director). A review of Patient 8's # Physicians Certification for Hospice Benefit, dated 5/16/23 to 8/13/23, benefit period #2, indicated the Medical Director signed the attending physician referral section to indicate Patient 8 had a life expectancy of six months or less if the terminal illness runs its normal course. There was no documentation for laboratory test result, imaging data, history and physical, and biopsy results that showed evidence to support the terminal illness diagnosis. On 8/2/23, at 3:00 p.m., during a phone interview with Patient 8s family member 1, she stated after hospitalization, patient 8 was placed in a Skilled Nursing Facility were an intermediate person found her the board and care and the hospice agency to provide care for patient 8 . Family member 1 stated she was never told by anyone that patient 8 had six months or less to live. When asked if she knows what hospice care was, Family member 1 stated that a nurse will come visits him every week to check him and another one will come to bathe him. Family member 1 stated the hospice agency never explained what hospice meant. f. A review of Patient 10s clinical record indicated a start of care date of 6/2/23, with a terminal diagnosis of Senile degeneration of brain, not elsewhere classified ( a decrease in the ability to think, concentrate or remember). The clinical record further indicated the ";referring/attending/patient choice" physician was physician 1( medical director). A review of patient 10s # Physicians Certification for Hospice Benefit dated 6/2/23 to 7/31/23, benefit period #7, indicated the Medical Director signed the attending physician referral section to indicate Patient 10 had a life expectancy of six months or less if the terminal illness runs its normal course. There was no documentation for laboratory test result, imaging data, history and physical, and biopsy results that showed evidence to support the terminal illness diagnosis. On 8/2/23, at 3:45 p.m., during a phone interview with Patient 10s family member 1, she stated patient 10 was a Kaiser patient and his doctors would not place her on hospice so she found the hospice herself, called them and had her put on hospice to provide care for patient 10 . Family member 1 stated the Kaiser physicians stated patient 10 was not hospice criteria however since she is 104 years old, and needs someone to come and visit patient 10 weekly and to bathe her, she thought she should be on hospice and the hospice doctor agreed. On 8/2/23, at 1:30 p.m., during an interview with the Director of Patient Care Services (DPCS ), she stated in order for a new patient to be admitted at their hospice service, there should be a referral from the patient's attending physician, if not a referral from a social worker or a physician from the hospital where the patient gets discharged from. On 8/2/23, at 2:30 p.m., during a phone interview with Physician 1 (medical director), she stated that she was not the attending physician, and she does not know who the attending physician for Patients 2, 4, 5, 6 and 10. She stated since Patients 2, 4, 5, 6 and 10 were admitted to their hospice service, she is now the patient's attending physician, that she signed the referral attending physician section because no one would sign it. Physician 1 further stated that she determined the patients were eligible for hospice services by reviewing of patient's medical records provided by the hospital and assessment report given by the registered nurse upon their initial visit to the patients. A review of the agency's undated policy and procedure titled "Admission Criteria and Process", indicated PRN Hospice will admit any patient with a life-limiting illness that meets the admission criteria. The patients life-limiting illness and prognosis of 6 months or less will be determined by utilizing standard clinical prognosis criteria developed by the fiscal intermediarys Local Coverage Determination (LCDs). PRN Hospice will admit a patient only on recommendation of the medical director in consultation with, or input from, the patients attending physician.

Based on observation, interview, and record review, the hospice agency (HA) failed to ensure the Condition of Participation for Medical Director was met as follows: 1. The Medical Director failed to conduct an accurate assessment, review, and verification of the patients clinical information and current health condition, necessary to support the Certification of Terminal Illness (CTI, a hospice physician narrative brief summary, a brief designed to explain clinical findings that support a life expectancy of six months or less), to qualify for hospice (health care that focuses on the palliation of a terminally ill patients pain and symptoms and attending to their emotional and spiritual needs at the end of life) care and services for six out of 14 sampled patients (Patients 2, 4, 5, 6, 8, and 10). Refer to L 667. The cumulative effect of this systemic practice resulted in the failure of the hospice to deliver statutorily mandated compliance with Federal regulation for Medical Director to ensure the highest quality of care are provided to the patients certified to receive the Medicare Hospice benefits. --- .

Based on observation, interview, and record review, the hospice agency (HA) failed to ensure the Medical Director and or designee conducted an accurate assessment, review, and verification of the patients clinical information and current health condition, necessary to support the Certification of Terminal Illness (CTI, a hospice physician narrative brief summary, a brief designed to explain clinical findings that support a life expectancy of six months or less), to qualify for hospice (health care that focuses on the palliation of a terminally ill patients pain and symptoms and attending to their emotional and spiritual needs at the end of life) care and services for six out of 14 sampled patients (Patients 2, 4, 5, 6, 8, and 10). This deficient practice resulted in patients being admitted for hospice care with no documented evidence of written clinical information of patients being reviewed and evaluated by the Medical Director to support their diagnoses of terminal illness. --- a. A review of Patient 2's clinical record indicated he was admitted to the hospice agency on 4/10/23, with a terminal diagnosis of cerebro-vascular disease (chronic obstructive pulmonary disease (damage from the brain from interruption of it's blood supply). The clinical record further indicated the ";referring/attending/patient choice" physician was Physician 1 (medical director). A review of Patient 2's Physicians Certification for Hospice Benefit, dated 4/10/23 to 7/9/23, benefit period #1, indicated the Medical Director signed the attending physician referral section to indicate Patient 2 had a life expectancy of six months or less if the terminal illness runs its normal course. There was no documentation for laboratory test result, imaging data, history and physical, and biopsy results that showed evidence to support the terminal illness diagnosis. On 8/1/23, at 11:45 a.m., a joint home visit was conducted to Patient 2's residence, with the License Vocational Nurse (LVN 1). Patient 2 was observed awake, alert, oriented, and ambulatory using a cane without any assistance from family members. At 12 p.m., during an interview with Caregiver 1 (daughter) if Patient 2 was referred by her attending physician, she stated no. Caregiver 1 also stated that a family friend recommended the hospice agency for Patient 2. She also stated Patient 2 was getting weaker since recovering from her stroke episode, that she had an option of placing the patient to a nursing home but decided to refer her to this hospice agency. b. A review of Patient 4's clinical record indicated a start of care (SOC) date of 7/20/23, with a terminal diagnosis of heart failure (a chronic condition in which the heart does not pump blood as well as it should). The clinical record further indicated the ";referring/attending/patient choice" physician was Physician 1 (medical director). A review of Patient 4's Physicians Certification for Hospice Benefit, dated 7/20/23 to 10/17/23, benefit period #1, indicated the Medical Director signed the attending physician referral section to indicate Patient 4 had a life expectancy of six months or less if the terminal illness runs its normal course. There was no documentation for laboratory test result, imaging data, history and physical, and biopsy results that showed evidence to support the terminal illness diagnosis. On 8/2/23, at 3 p.m., during a phone interview with Family Member 1, he stated the patient's attending physician did not refer him to the hospice agency but by a random physician when the patient was discharged from the hospital a few months back. c. A review of Patient 5's clinical record indicated a start of care (SOC) date of 2/22/23, with a terminal diagnosis of Alzheimers disease, unspecified (a brain disorder that slowly destroys memory and thinking skills and eventually, the ability to carry out the simplest tasks). The clinical record further indicated the ";referring/attending/patient choice" physician was Physician 1 (medical director). A review of Patient 5's Physicians Certification for Hospice Benefit, dated 2/22/23 to 5/22/23, benefit period #1, indicated the Medical Director signed the attending physician referral section to indicate Patient 5 had a life expectancy of six months or less if the terminal illness runs its normal course. There was no documentation for laboratory test result, imaging data, history and physical, and biopsy results that showed evidence to support the terminal illness diagnosis. d. A review of Patient 6's clinical record indicated a start of care (SOC) date of 2/4/23, with a terminal diagnosis of chronic obstructive pulmonary disease ( a lung disease that blocks airflow and make it difficult to breathe). The clinical record further indicated the ";referring/attending/patient choice" physician was Physician 1 (medical director). A review of Patient 6's Physicians Certification for Hospice Benefit, dated 2/4/23 to 5/4/23, benefit period #1, indicated the Medical Director signed the attending physician referral section to indicate Patient 6 had a life expectancy of six months or less if the terminal illness runs its normal course. There was no documentation for laboratory test result, imaging data, history and physical, and biopsy results that showed evidence to support the terminal illness diagnosis. On 8/2/23, at 3:30 p.m., during a phone interview with Patient 6, he stated he was never told that he had six months or less to live. When asked if he knows what hospice care was, he stated that a nurse will come visits him every week. When asked how he heard about the hospice agency, he stated his daughter referred her to the hospice agency. On 8/2/23, at 1:30 p.m., during an interview with the Director of Patient Care Services (DPCS ), she stated in order for a new patient to be admitted at their hospice service, there should be a referral from the patient's attending physician, if not a referral from a social worker or a physician from the hospital where the patient gets discharged from. On 8/2/23, at 2:30 p.m., during a phone interview with Physician 1 (medical director), she stated that she was not the attending physician, and she does not know who the attending physician for Patients 2, 4, 5, 6 and 10. She stated since Patients 2, 4, 5, 6 and 10 were admitted to their hospice service, she is now the patient's attending physician, that she signed the referral attending physician section because no one would sign it. Physician 1 further stated that she determined the patients were eligible for hospice services by reviewing of patient's medical records provided by the hospital and assessment report given by the registered nurse upon their initial visit to the patients. A review of the agency's undated policy and procedure titled "Admission Criteria and Process", indicated PRN Hospice will admit any patient with a life-limiting illness that meets the admission criteria. The patients life-limiting illness and prognosis of 6 months or less will be determined by utilizing standard clinical prognosis criteria developed by the fiscal intermediarys Local Coverage Determination (LCDs). PRN Hospice will admit a patient only on recommendation of the medical director in consultation with, or input from, the patients attending physician. e. A review of Patient 8's clinical record indicated a start of care (SOC) date of 2/15/23, with a terminal diagnosis of Alzheimers disease, unspecified (a brain disorder that slowly destroys memory and thinking skills and eventually, the ability to carry out the simplest tasks). The clinical record further indicated the ";referring/attending/patient choice" physician was Physician 1 (medical director). A review of Patient 8's Physicians Certification for Hospice Benefit, dated 5/16/23 to 8/13/23, benefit period #2, indicated the Medical Director signed the attending physician referral section to indicate Patient 8 had a life expectancy of six months or less if the terminal illness runs its normal course. There was no documentation for laboratory test result, imaging data, history and physical, and biopsy results that showed evidence to support the terminal illness diagnosis. On 8/2/23, at 3:00 p.m., during a phone interview with Patient 8s family member 1, she stated after hospitalization, patient 8 was placed in a Skilled Nursing Facility were an intermediate person found her the board and care and the hospice agency to provide care for patient 8 . Family member 1 stated she was never told by anyone that patient 8 had six months or less to live. When asked if she knows what hospice care was, Family member 1 stated that a nurse will come visits him every week to check him and another one will come to bathe him. Family member 1 stated the hospice agency never explained what hospice meant. f. A review of Patient 10s clinical record indicated a start of care date of 6/2/23, with a terminal diagnosis of Senile degeneration of brain, not elsewhere classified ( a decrease in the ability to think, concentrate or remember). The clinical record further indicated the ";referring/attending/patient choice" physician was physician 1( medical director). A review of patient 10s # Physicians Certification for Hospice Benefit dated 6/2/23 to 7/31/23, benefit period #7, indicated the Medical Director signed the attending physician referral section to indicate Patient 10 had a life expectancy of six months or less if the terminal illness runs its normal course. There was no documentation for laboratory test result, imaging data, history and physical, and biopsy results that showed evidence to support the terminal illness diagnosis. During a phone interview with Patient 10s family member 1, on 8/2/23, at 3:45 p.m., she stated patient 10 was a Kaiser patient and his doctors would not place her on hospice so she found the hospice herself, called them and had her put on hospice to provide care for patient 10 . Family member 1 stated the Kaiser physicians stated patient 10 was not hospice criteria however since she is 104 years old, and needs someone to come and visit patient 10 weekly and to bathe her, she thought she should be on hospice and the hospice doctor agreed. On 8/2/23, at 1:30 p.m., during an interview with the Director of Patient Care Services (DPCS ), she stated in order for a new patient to be admitted at their hospice service, there should be a referral from the patient's attending physician, if not a referral from a social worker or a physician from the hospital where the patient gets discharged from. On 8/2/23, at 2:30 p.m., during a phone interview with Physician 1 (medical director), she stated that she was not the attending physician, and she does not know who the attending physician for Patients 2, 4, 5, 6,8and 10. She stated since Patients 2, 4, 5, 6,8 and 10 were admitted to their hospice service, she is now the patient's attending physician, that she signed the referral attending physician section because no one would sign it. Physician 1 further stated that she determined the patients were eligible for hospice services by reviewing of patient's medical records provided by the hospital and assessment report given by the registered nurse upon their initial visit to the patients. A review of the agency's undated policy and procedure titled "Admission Criteria and Process", indicated PRN Hospice will admit any patient with a life-limiting illness that meets the admission criteria. The patients life-limiting illness and prognosis of 6 months or less will be determined by utilizing standard clinical prognosis criteria developed by the fiscal intermediarys Local Coverage Determination (LCDs). PRN Hospice will admit a patient only on recommendation of the medical director in consultation with, or input from, the patients attending physician.