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...."

The Centers for Medicare and Medicaid Services (CMS) has issued new Conditions of Participation (COPs) for hospitals and home health agencies. These new rules are effective on November 29, 2019. New COPs for hospitals are applicable to acute care hospitals, long-term care hospitals (LTCHs), inpatient rehabilitation facilities (IRFs), inpatient psychiatric facilities, children's hospitals, cancer hospitals, and critical access hospitals (CAHs).

These new COPs generally require the discharge planning process to include:

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

A potential game changer is the requirement to use quality and resource use measures relevant and applicable to patients' goals of care and treatment preferences in the discharge planning process. PAC providers have complained for years that hospital discharge planners/case managers "play favorites" by referring patients to PAC providers that they prefer for a variety of reasons that may be unrelated to quality of care. New requirements to share quality data as part of the discharge planning may help patients make choices and disrupt historic patterns of referrals.