Chapter 8: Continuity of Care and Hospital Admitting

In this chapter:

• Authority
• Requirements
• Demonstrating Compliance
• Related Considerations

Authority

Section 330(k)(3)(A) and 330(k)(3)(L) of the PHS Act; and 42 CFR 51.c.303(a) and 42 CFR 56.303(a)

Requirements

• The health center must provide the required primary health services of the center promptly and in a manner which will assure continuity of service to patients within the center's catchment area (service area).
• The health center must develop an ongoing referral relationship with one or more hospitals.

Demonstrating Compliance

A health center would demonstrate compliance with these requirements by fulfilling all of the following:

1. The health center has documentation of:
   • Health center provider¹ hospital admitting privileges (for example, provider employment contracts or other files indicate the provider(s) has admitting privileges at one or more hospitals); and/or
   • Formal arrangements between the health center and one or more hospitals or entities (for example, hospitalists, obstetrics hospitalist practices) for the purposes of hospital admission of health center patients.
2. The health center has internal operating procedures and, if applicable, related provisions in its formal arrangements with non-health center provider(s) or entity(ies) that address the following areas for patients who are hospitalized as inpatients or who visit a hospital’s emergency department (ED):²
   • Receipt and recording of medical information related to the hospital or ED visit, such as discharge follow-up instructions and laboratory, radiology, or other results; and
   • Follow-up actions by health center staff, when appropriate.
3. The health center follows its operating procedures and formal arrangements as documented by:
   • Receipt and recording of medical information related to the hospital or ED visit, such as discharge follow-up instructions and laboratory, radiology, or other results; and
   • Evidence of follow-up actions taken by health center staff based on the information received, when appropriate.

Related Considerations

The following points describe areas where health centers have discretion with respect to decision-making or that may be useful for health centers to consider when implementing these requirements:

• The health center determines the number and type(s) of hospitals with which its providers will have admitting arrangements based on the services included in the HRSA-approved scope of project (Form 5A: Services Provided), the patient population served, and the service area.
• The health center determines whether the most appropriate means for hospital admitting is to use its own providers, have arrangements with non-health center providers, or both.
• The health center determines the most appropriate formats and mechanisms for discharge planning and tracking (for example, use of community-wide shared electronic health record, patient hospitalization tracking log).

Footnotes

^1. In addition to physicians, various provider types may have admitting privileges, if applicable, based on scope of practice in their State (for example, Nurse Practitioners, Certified Nurse Midwives).

^2. Health center patients may be admitted to a hospital setting through a variety of means (for example, a visit to the Emergency Department (ED) may lead to an inpatient hospital admission, or a health center patient may be directly admitted to a unit of the hospital, such as labor and delivery).