Module 05: Admissions, Eligibility, and Medical Necessity
How people get in the door correctly: eligibility screening, functional impairment evidence, and medical necessity language that survives review.
Service Delivery
3 lessons36 minLearning outcomes
- Screen referrals against eligibility criteria
- Document functional impairment with specific evidence
- Write medical necessity statements that connect diagnosis, impairment, and service
Lessons
1. Screening the Referral
12 min
2. Documenting Functional Impairment
13 min
3. Writing Medical Necessity
11 min
Case-study exercise
A borderline referral
A 19-year-old with a recent first-episode psychosis diagnosis is referred. He is enrolled in community college, lives with parents, and says he only came because his mother insisted. His functioning is largely intact except for attendance and sleep.
- 1. Is there enough for eligibility? Identify what you still need.
- 2. Draft a two-sentence medical necessity statement or explain why you cannot yet.
- 3. How would you conduct the fit conversation with him directly?
Prototype: responses are stored locally, not submitted for grading.
Module quiz
3 questions ยท 67% required to pass