On September 30, 2019, the Centers for Medicare and Medicaid Services (CMS) released the long-awaited final rule revising the discharge planning requirements for hospitals, critical access hospitals, and home health agencies. The new requirements, which follow the proposed rule originally issued in 2015 under the Obama Administration, will go into effect on November 29, 2019.
These updated requirements, which are mandated under the IMPACT Act of 2014, modify the Medicare Conditions of Participation for all hospitals, including inpatient rehabilitation hospitals and units. The final rule emphasizes the importance of discharge planning to successfully transition patients from hospitals to post-acute care settings, and aims to standardize the discharge planning process across hospitals. While the 2015 proposed rule included a laundry list of specific, potentially burdensome requirements, the final rule includes a more tailored, select set of changes to ensure effective transition while avoiding unnecessary burden on providers.
Some of the most important new requirements are summarized below. For a more in-depth analysis of the final rule, please see this memorandum from the Academy’s Washington counsel at Powers Law.
- The new discharge planning requirements must be followed for all patients who have been identified as likely to suffer adverse health consequences upon discharge without adequate planning.Hospitals must also provide a discharge planning evaluation if the patient or the patient’s representative, or the attending physician, requests it.
- Discharge planning evaluations must be made on a timely basis, but CMS removed a proposed requirement to require discharge planning within 24 hours of admission.
- Discharge planning must include an evaluation of a patient’s likely need for “appropriate” post-hospital services, including extended care services, home health services, and non-health care services and community-based providers.
- Discharge planning must be supervised by a registered nurse, social worker, or other “qualified” personnel, but CMS is not requiring the practitioner responsible for the patient’s care to themselves supervise the discharge planning process.
- Hospitals must consider quality data from PAC providers when helping patients and their families select a PAC provider.
- At the time of discharge, hospitals must provide the receiving post-acute care setting with “all necessary medical information pertaining to the patient’s current course of illness and treatment, post-discharge goals of care, and treatment preferences.”
- Finally, hospitals must include in the discharge plan a list of Medicare-participating PAC providers that serve the geographic area of the patient for whom PAC services are indicated in order to facilitate patient choice. This list must include home health agencies, skilled nursing facilities, long-term care hospitals, and inpatient rehabilitation facilities.The additional of IRFs and LTCHs is a new requirement that will expose patients to the availability of new PAC options, assuming they qualify for coverage. Hospitals must also disclose any financial interests they may have in the referred PAC provider.
While many of the proposed rule’s provisions were not adopted in the final rule due to stakeholder concerns about regulatory burdens, the final rule offers several improvements to the current discharge planning process that should benefit patients in need of medical rehabilitation. The new requirements will likely improve transitions from acute to PAC settings, decreasing readmissions to the acute care hospital and potentially improving access to traditional and non-traditional PAC services, especially for individuals with disabilities and chronic conditions.