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CMS Announces Final Discharge Planning Rule: Compliance due by Nov. 29

Posted on: 11/16/2019

On September 30, 2019, the Centers for Medicare and Medicaid Services (CMS) published a final rule to implement new discharge planning requirements for hospitals, critical access hospitals and post-acute care (PAC) services entities. Originally mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), the long-awaited action from CMS comes four years after the original proposal was published.

“Discharge planning is an important component of a successful transition from hospitals and PAC settings.” – CMS

Read the final discharge planning rule >>>

ACMA’s Overview and Quick Reference

ACMA has been following the rule’s development since it was first proposed back in November 2015. The final rule has been scaled back from the initial proposal to lessen the regulatory burden on covered entities and to facilitate a smooth transition to compliance. CMS also recognizes and values the efforts with Patients over Paperwork and has chosen not to “focus on prescriptive and burdensome process details, and more on patient outcomes and treatment preferences through the enhanced information exchange and innovative practice standards”. Ultimately, CMS has concluded that most covered entities have already implemented the rule in some form or fashion, and because of that, the agency is mandating compliance by November 29, 2019 (60 days after publication).

“The location to which a patient may be discharged should be based on the patient's clinical care requirements, available support network, and patient and caregiver treatment preferences and goals of care.”- CMS

5 Things to Know About the Rule:

1. A hospital’s discharge planning process must identify at-risk patients and hospitals must provide a timely discharge planning evaluation of patients, and update the evaluation and plan as needed. (The discharge planning evaluation must be documented in the patient’s medical record.)

2. A discharge planning evaluation must include an evaluation of a patient’s likely need for appropriate post-hospital services, including, but not limited to, skilled nursing (SNF), home health services (HHA), inpatient rehabilitation facility (IRF), long term acute care hospitals (LTCH), and non-health care services and community based care providers, and must also include a determination of the availability of the appropriate services as well as of the patient’s access to those services. CMS also recognizes situations may rise where patients prefer not to participate or refuse, and states this the declination or refusal is to be documented in the medical record as well.

3. Hospitals must assist patients, their families, or the patient’s representative in selecting a post-acute care provider by using and sharing patient-relevant data on quality measures and resource use measures of area services, including HHA, SNF, IRF, or LTCH data, and by providing a list of HHAs, SNFs, IRFs, or LTCHs that are available to the patient, that are participating in the Medicare program, and that serve the geographic area of the hospital or the geographic area requested by the patient. The hospital must also document in the patient’s medical record that the list was presented to the patient or to the patient’s representative. CMS expects hospitals to make best efforts in providing this information to align patient’s treatment goals and preferences. CMS also expects providers to preserve the expectation of freedom of choice for patients and their caregivers in selecting post acute services and providers where required.

4. Hospitals must discharge patients with all necessary medical information pertaining to the patient’s current course of illness and treatment, post-discharge goals of care, and treatment preferences to the appropriate post-acute care service providers or other practitioners responsible for the patient’s follow-up or ancillary care. This is not a new requirement, and patient discharge instructions are already required as a part of the medical record under Medical Record Services requirements in S482.24.

5. Hospitals must share with patients their medical records in a timely manner upon request and in a form or format that is easily accessible and readable.

What is CMS Saying?

“[This] rule puts patients in the driver’s seat of their care transitions and improves quality by requiring hospitals to provide patients access to information about PAC provider choices, including performance on important quality measures and resource-use measures – including measures related to the number of pressure ulcers in a given facility, the proportion of falls that lead to injury, and the number of readmissions back to the hospital.”

Read the CMS press release here: Statement on Discharge Planning Rule >>>

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