Proposed:

"within the 30 days preceding admission, a participant shall have a physical examination by a licensed physician"

Current

"Screening for tuberculosis and a physical examination by or under the direction of a licensed physician shall be obtained either within 30 days prior to acceptance for admission or within 30 days prior to admission."

Two comments regarding this:

1)  Having the phrase  "acceptance for admission" included is crucial to the admission process.  Many times, a potential participant gets a physical exam and /or TB screening, submits it and is approved for admission, but then more than 30 days pass before they actually start services.  They are then unable to get an additional physical exam due to insurance restrictions.  They may not start immediately due to a variety of reasons.  Having the "acceptance for admission gives a little more flexibility to the admission process and eliminates undue hardship for the participant in attaining the examination and?or TB.

2) Please add back in "or under the direction of a licensed physician" so that the potential participant may be seen by a nurse practitioner or PA.