CMS Issues New Conditions of Participation for Discharge Planning for Hospitals and Home Health Agencies
by With Thanks to Elizabeth E. Hogue, Esq.
Published on Oct 01, 2019
As part of the new discharge planning rules, CMS decided that a discharge assessment for every patient had "to be scaled back in its scope and applicability to a more flexible requirement" because as originally proposed "could potentially have the unintended consequence of shifting hospital resources away from those patients most in need of a discharge plan." The new requirement states that the "hospital's discharge planning process must identify, at an early stage of hospitalization (ideally when the patient is admitted as an inpatient, or shortly thereafter), those patients who are likely to suffer adverse health consequences upon discharge in the absence of adequate discharge planning and must provide a discharge planning evaluation for those patients so identified...."
- Focus on patients' goals of care and treatment preferences
- Assistance to patients, their families and representatives to select post-acute care (PAC) services providers or suppliers by using and sharing PAC data on quality measure and resource use measures that is relevant and applicable to patients' goals of care and treatment preferences
- Transfer and referrals of patients along with necessary medical information at the time of discharge to appropriate PAC services providers and suppliers, facilities, and agencies and to other patient service providers and practitioners responsible for patients' follow-up or ancillary care
- Compliance with requests made by receiving facilities or health care practitioners for additional clinical information necessary for treatment of patients
- Sending necessary medical information to receiving facilities or appropriate PAC providers and practitioners responsible for patients' follow up care after patients are discharged from hospitals or transferred to other PACs or, for HHAs, other HHAs
- Hospitals ensuring and supporting patients' rights to access their medical records in the form and format requested by patients, if information is readily producible in such form and format, including in electronic form or format when medical records are maintained electronically