New CoP rules apply to hospitals and home health agencies. It is not intended to take the place of either the written law or regulations. The discharge planning process and the discharge plan must be consistent with the patient's goals for care and his or her treatment preferences, ensure an effective transition of the patient from hospital to post-discharge care, and reduce the factors leading to preventable hospital readmissions. Suggestions not mandatory. SUBJECT: Burden Reduction and Discharge Planning Final Rules Guidance and Process . The new rules for discharge planning went into effect on Nov. 29, 2019, which represents federal fiscal year 2020. CMS published a proposed rule in November 2015 (final action to be determined by November 2018) to revise the discharge planning requirement for hospitals (general acute, long-term care hospitals, inpatient rehabilitation facilities, and psychiatric hospitals), critical access hospitals, and home health agencies. Find inspiration for your hospital to undertake discharge … § 482.43 Condition of participation: Discharge planning. In addition to improving quality by improving these care transitions, today’s rule supports CMS’ interoperability efforts by promoting the … Centers for Medicare & Medicaid Services. Discharge Planning Conditions of Participation Final Rule. Discharge Planning §482.45 Condition of Participation: Organ, Tissue and Eye Procurement ... Medicare Conditions of Participation (CoP) in order to receive Medicare/Medicaid Copyright © 2020 Becker's Healthcare. Medicare.gov. • Use quality and resource measures relevant to patients’ goals of care and treatment preferences in the discharge planning process. Conditions of Participation (CoP) –Discharge Planning. CMS gives tips on discharge planning. Name: Reason for admission: 2 During your stay, your doctor and the staff will work with you to plan for your discharge. Each of these represents core roles that case management professionals perform, and will be our focus this month. NATIONAL HEALTH POLIC FORUM FEBRUAR 9, 2016 www.nhpf.org 3 In explaining the rationale for changes included in the rule, CMS expressed concern that there is too … The final rule (Revisions to Discharge Planning Requirements [CMS-3317-F]) revises the discharge planning requirements that hospitals (including long-term care hospitals, critical access hospitals [CAHs] psychiatric hospitals, children’s hospitals, and cancer hospitals), inpatient rehabilitation facilities, and home health agencies must meet to participate in Medicare and Medicaid programs. CY 2021 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS-1736-FC) Trump Administration Finalizes Policies to Give Medicare Beneficiaries More Choices around Surgery. . Standard: Discharge Planning Process – CMS proposed 10 specific elements to be addressed in the discharge planning process, detailing an extensive list of requirements for identifying each patient’s anticipated post-discharge goals, preferences, and needs, and for developing an appropriate discharge plan for patients. Timely QIO Review ; In order for the review request to be considered “timely,” beneficiaries must submit their requests in writing or by telephone no later than midnight of the day of discharge and before they leave the hospital. While CMS does not specify when to perform the initial discharge planning evaluation, best practice calls for it to be completed on the day of admission whenever possible. • The list should only be present to patients for whom home healthcare or post-hospital extended care services are indicated and appropriate. Table of Contents (Rev. Every hospital that accepts Medicare and Medicaid must be in compliance with the CMS discharge planning guidelines. • For patients enrolled in managed care organizations, the hospital must indicate availability of home health and post-hospital extended care services through individuals and entities that have contracted with the managed care organizations. Background On September 30, 2019, CMS published two final rules which revised regulatory requirements for the various certified provider and supplier types. • Patients who require discharge planning evaluation must be identified early in the hospital stay. The new regulations cover sections on patient timely access to medical records, the discharge planning process, discharge instructions, discharge planning requirements. • Assist patients, families, or representatives in selecting post-acute care service providers or suppliers by sharing data on quality and resource use measures that are relevant to patients’ goals of care and treatment preferences. PDF download: Discharge Planning – CMS. CMS moves to empower patients to be more active participants in the discharge planning process. This can be difficult as issues such as availability and insurance coverage will have to be considered. CMS’ Discharge Planning Rule Supports Interoperability and Patient Preferences. While the selected rules may not be as dramatic as the entire set of proposed rules, some of the new rules will require changes in how case management departments perform some components of discharge planning. The change here is that it must be in either electronic or written format. The rule includes removing a requirement for hospitals and critical access hospitals to provide routine and emergency dental care for swing-bed patients, which the ADA supported in 2018 comments to CMS. CMS is finalizing certain standards for discharge planning for hospitals that outline the discharge planning process, the provision and transmission of the patient’s necessary medical information upon discharge, and requirements related to post-acute care (“PAC”) services. This can be achieved by placing an asterisk in front of any of these providers with a footnote explaining their financial interest. 2013; 21(8):106, 111-2 (ISSN: 1087-0652) The need for timely and comprehensive discharge planning takes on new importance as the Centers for Medicare & Medicaid Services (CMS) issues revised Discharge Planning Interpretive Guidelines for surveyors to use to assess a hospital's compliance with the Medicare Conditions of … It requires the discharge planning … • Focus on patients’ goals of care and treatment preferences. One commenter requested clarification as to whether the proposed requirements would apply to partial hospitalization and intensive outpatient programs at hospitals. CMS issued a long-awaited final rule on how hospitals must handle discharge planning, introducing new requirements on records access. • Advisory Boxes: Included in the updated interpretive guidelines are “blue boxes,” to 1-800-MEDICARE (1-800-633-4227). Every hospital that accepts Medicare and Medicaid must be in compliance with the CMS discharge planning guidelines. Good discharge notices and good discharge planning should go hand in hand. CMS had initially issued the proposed regulations in November 2015 to update discharge planning requirements for hospitals, critical access hospitals (“CAHs”) and post-acute care (“PAC”) providers, such as home health agencies (“HHAs”), as part of CMS’s Conditions of Participation (“CoPs”). Items are to be assessed by a combination of observation, interviews with hospital staff, review of the hospital’s discharge planning program documentation including policies and … Issued by: Centers for Medicare & Medicaid Services (CMS) Issue Date: January 01, 2020 DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. This is the first major update to hospital discharge planning rules since surveyor guidelines were updated in 2013. The discharge planning process and the discharge plan must be consistent with the patients goals for care and his or her treatment preferences, ensure an effective transition of the patient from hospital to post-discharge care, and reduce the factors leading to a preventable hospital readmissions. At this time, choice lists need only be given for patients transferring to home health or to a SNF. CMS published a proposed rule in November 2015 (final action to be determined by November 2018) to revise the discharge planning requirement for hospitals (general acute, long-term care hospitals, inpatient rehabilitation facilities, and psychiatric hospitals), critical access hospitals, and home health agencies. 2. The original CoPs were written in 1983, and were developed to ensure quality standards in hospitals and other provider settings. Every hospital that accepts Medicare and Medicaid must be in compliance with the CMS discharge planning guidelines. • The hospital must transfer or refer patients, along with necessary medical information, to appropriate facilities, agencies, or outpatient services, as needed, for follow-up or ancillary care. • Arrange for the development and initial implementation of a discharge plan. Federal … The Centers for Medicare and Medicaid Services announced a final rule Sept. 25 that revises hospital discharge planning requirements for long-term care hospitals and similar facilities. Without documentation of these tasks in the medical record, case managers will not receive will not get credit for completing them. The Centers for Medicare and Medicaid Services announced a final rule Sept. 25 that revises hospital discharge planning requirements for long-term care hospitals and similar facilities. • The evaluation should determine the likelihood of the patient needing post-hospital services, and availability of the services. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. CMS requires several discharge planning policies and procedures so come learn which ones are required and why. You must have JavaScript enabled to enjoy a limited number of articles over the next 360 days. • Ensure patients can access their medical records when requested. CMS updates discharge planning guidelines. The Centers for Medicare & Medicaid Services (CMS) published a final rule on hospital discharge planning that is set to go into effect on November 30, 2019—a few short weeks from now (see excerpts at end of this post). CMS has significantly revised the proposed requirements to … These standards must be followed for all patients and not just Medicare or Medicaid. In 2015, the Centers for Medicare & Medicaid Services (CMS) introduced proposed rules for discharge planning. Every hospital that accepts Medicare and Medicaid must be in compliance with the CMS discharge planning guidelines. Instead, CMS is preserving the original proposal but with minor revisions of current requirements, ie, that hospitals identify, at an early stage, all patients who are likely to suffer adverse health consequences upon discharge in the absence of adequate discharge planning or for other patients upon request. 7500 Security Boulevard, Baltimore, MD 21244 CMS & HHS Websites [CMS Global Footer] Medicare… • Visit . CMS revises discharge planning guidelines The Centers for Medicare & Medicaid Services has revised the State Operations Manual’s Hospital Appendix to clarify the discharge planning requirements for hospitals, including when discharging patients to skilled nursing facilities, rehabilitation centers, home health agencies and other post-acute service centers. These proposed rules were to be used to update the current rules under the Conditions of Participation for Discharge Planning. This means a case manager must consider alternatives when the patient’s goals diverge from the initial discharge plan. (a) Standard: Discharge planning process. Understand these two elements of Medicare Advantage plans: • The discharge planning evaluation is not required to include information on the availability of home health services through individuals and entities that do not have a contract with the organization. Typically, registered nurse or social work case managers complete the discharge planning assessment. The hospital must develop discharge plan for patient. • Develop the plan under the supervision of a registered nurse, social worker, or other qualified personnel. Fill out this worksheet. Interested in LINKING to or REPRINTING this content? CMS news. Hospitals that have a higher readmission rate can be financially penalized. 1-800-370-9210 The rule requires that if a patient is being discharged to a post-acute care (PAC) provider, that the hospital’s care team must “assist patients, their families, or the patient’s representative in selecting a PAC provider by sharing key performance data. CMS requires the Health and Human Services Secretary to develop discharge planning guidelines to ensure a timely and smooth transition to the most appropriate post-hospital care. Broadly, the changes are part of CMS’s efforts to make patients a more active part of their care transitions out of the hospital and into other settings. CMS this week published its long-awaited discharge planning rule. The first thing to consider is focusing on including the patient’s goals and preferences in the planning process. In the newly revised Discharge Planning Interpretive Guidelines, the Centers for Medicare & Medicaid Services (CMS) includes what it calls "blue boxes" that advise hospitals on best practices in discharge planning and care transitions. Interested in linking to or reprinting our content? Next, discharge planners must share data from post-acute care providers with patients. Want to determine if your hospital is meeting CMS requirements concerning discharge planning? Continuing to stress the importance of discharge planning and preventing unnecessary readmissions, the Centers for Medicare & Medicaid Services (CMS) has issued a revised set of Discharge Planning Interpretive Guidelines that surveyors will use to assess a hospital's compliance with Medicare… View our policies by, Clinical Leadership & Infection Control E-Newsletter, Becker's 2021 Women’s + Diversity Leadership Virtual Forum, Becker's 2021 January Dental + DSO Review Virtual Event, Becker's 2021 Payer Issues Virtual Summit, Becker's 2021 Patient Experience + Marketing Virtual Forum, Becker's 2021 Health IT + Revenue Cycle Management Virtual Forum, Becker's 2021 Pediatric Leadership Virtual Forum, Becker's 2021 Community Hospitals Virtual Forum, Becker's 2021 Clinical Leadership + Pharmacy Virtual Forum, Becker's 2021 Orthopedic, Spine + ASC Virtual Event, Becker's 2021 Physician Leadership Virtual Forum, Becker's 2021 April DSO + Dental Virtual Forum, Becker's 2021 Emergency Medicine Virtual Forum, Becker's 2021 Data and Innovation Virtual Event, Becker's Ambulatory Surgery Centers Podcast, Current Issue - Becker's Clinical Leadership & Infection Control, Past Issues - Becker's Clinical Leadership & Infection Control, 50 hospital and health system CNOs to know | 2020, Women hospital and health system CFOs to know, White House shares $916B relief proposal; 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