Decision guide
May this home accept or keep a person with this condition?
Is it prohibited: stage 3 or 4 pressure injury, gastrostomy or naso-gastric tube, serious infection, tracheostomy, or needing others for all daily living?
- Yes
Is the person diagnosed as terminally ill and receiving hospice care, with this condition's treatment in the hospice care plan?
- Yes
Does the home hold a hospice care waiver from the Department?
- Yes
Hospice route: the home may accept or keep her without a separate exception request. Keep the plan current, notify the Department in writing within five working days of hospice starting, and leave professional-only procedures to professionals.
- No
Prohibited: do not admit. For a current resident, document the change and report it at once. She may be admitted or stay only with written approval of an exception request, or under a hospice care waiver and plan. Ask the licensing office.
- No
Prohibited: do not admit. For a current resident, document the change and report it at once. She may be admitted or stay only with written approval of an exception request, or under a hospice care waiver and plan. Ask the licensing office.
- No
Is the condition, or the service it needs, on the restricted list, such as oxygen, a catheter, diabetes, injections or wound care?
- Yes
Does the physician's documentation show she can do the procedure herself, or name an appropriately skilled professional who will?
- Yes
Restricted, with requirements: before admission, complete the physician's five items, talk with her other providers, and finish hands-on staff training by a licensed professional. For oxygen, IPPB, colostomy, contractures or a healing wound, a licensee with recent probation or similar action gets Department approval first.
- No
Not on these terms: the condition's section is not met. Ask the physician or the referrer who will do the procedure, and get it documented before the home decides.
- No
Has the physician documented the condition as stable and needing only incidental medical services the home may give?
- Yes
Allowable: the home may accept her. Keep the record of care, watch her ability to care for herself, document changes and follow the physician's orders.
- No
Ask licensing: the prohibited list is not closed, so a condition on no list is not an automatic yes. Send the medical assessment and ask the licensing office before the home decides.
This guide sorts a condition for a conversation; it does not decide an admission. A physician or licensed professional diagnoses and stages a condition. The licensee decides within the rules. The Department decides exceptions, waivers, reviews and relocation.
Step through it one question at a time: alwbeta.com/training/courses/rcfe-condition-limits-guide#decision-guide
Lesson 1
Incidental medical services: what an RCFE may take on
A referral arrives with a list of diagnoses. Before anyone talks about a move, someone sorts each condition: may this home care for it, and on what terms? This lesson sets up that sort. It covers incidental medical services, the three lists, and why a condition on no list is not an automatic yes.
- Non-medical home: no skilled nursing care
- Allowable: a specific regulation or an approved exception allows it
- Restricted conditions are allowable ones with extra duties
- Read the condition's own section (87618 to 87631)
- On no list: ask licensing; do not guess
Lesson: alwbeta.com/training/courses/rcfe-condition-limits-guide#lesson-cond-incidental-services
Lesson 2
Restricted conditions: what the home must have in place
A home may care for a restricted condition once certain things are in place. Leaders sign off on the move, and referrers need to know what to send. This lesson lists the record, the people, the training and the approvals that come before admission, and what keeps them current afterward.
- Find the condition's own section and read its terms
- Physician documents five things in the record of care
- Before admission: talk with other providers; hands-on training by a licensed professional
- Recent probation or similar action: Department approval first for oxygen, IPPB, colostomy, contractures, healing wounds
- After admission: monitor, report changes at once, plan around refusals
Lesson: alwbeta.com/training/courses/rcfe-condition-limits-guide#lesson-cond-restricted-requirements
Lesson 3
Prohibited conditions: admission, retention and relocation
The hardest calls often come after a resident has settled in. A wound gets worse, or she comes back from the hospital with a new device. Leaders decide what happens next, and referrers need to know what a home cannot take on. This lesson covers the prohibited list, what retained means, and the steps when the Department acts.
- Prohibited means not admitted or retained
- Stages and diagnoses come from a physician or skilled professional
- Report significant changes at once to physician and representative
- Department review: send documents within 10 days
- Relocation order: written plan, 30 days or less
- Team review: written request within three working days
Lesson: alwbeta.com/training/courses/rcfe-condition-limits-guide#lesson-cond-prohibited-retention
Lesson 4
Exceptions and the hospice route
Sometimes a home believes it can safely care for a person the lists would rule out. Two paths exist: a written exception request, and the hospice route for a terminally ill resident. Neither is the home's own call. This lesson shows what each path needs and who decides it, so no one acts before the answer arrives.
- Exception: written request with medical reports, a care plan and an impact plan
- No exception until written approval arrives
- Hospice route: waiver, terminal diagnosis, hospice plan that addresses the condition
- The resident or her surrogate contracts the hospice
- Hospice start: written notice within five working days
- Hospice stop other than death: phone in one working day, writing in five
Lesson: alwbeta.com/training/courses/rcfe-condition-limits-guide#lesson-cond-exceptions-hospice
Lesson 5
Reading the medical assessment
Every decision in this course rests on paper from a licensed medical professional. Decision makers read it to sort the condition; referrers send it so the home can decide. This lesson shows what the medical assessment must contain, how the state's form LIC 602A asks for it, and which answers point to which rule.
- Signed by a licensed medical professional, made within the last year
- Diagnoses, TB and infections, medications, limits, mobility, cognition, behavior
- LIC 602A is the RCFE form; LIC 602 is a different form
- Self-management answers point to the condition's own section
- Hospice "Yes": check the waiver and the hospice plan
- Physician documents method and who performs the procedure
Lesson: alwbeta.com/training/courses/rcfe-condition-limits-guide#lesson-cond-medical-assessment
