The proposed rule emphasizes the importance of the patient’s goals and preferences during the discharge planning process. These improvements should better prepare patients and their caregivers to be active partners for their anticipated health and community support needs upon discharge from the hospital or post-acute care setting.
Full Answer
What if CMS finalizes the proposed discharge planning requirements?
Comment: A few commenters recommended that if CMS finalizes the proposed requirements, the final regulation and sub-regulatory guidance should not focus on the process of discharge planning alone, but allow providers greater flexibility to ensure their efforts are meaningful and adaptable over time.
Should the hospital's discharge planning process require a regular re-evaluation of the condition?
Comment: Several commenters supported our proposal to require that the hospital's discharge planning process require a regular re-evaluation of the patient's condition to identify changes that require modification of the discharge plan and that the discharge plan be updated, as needed, to reflect these changes.
Are discharge instructions a “discharge plan”?
The commenter recommended that CMS clarify that discharge plans can vary, depending on the patient, and that in many cases a patient's discharge instructions could constitute a “discharge plan.”
Who is responsible for the discharge plan in a hospital?
Section 484.60 (c) includes the discharge plan as part of the overall plan of care. Therefore, the current rules already require a clinical manager, who may be a physician, nurse, or licensed therapist, to be responsible for the discharge plan.
What factors should discharge planning include?
Your discharge plan should include information about where you will be discharged to, the types of care you need, and who will provide that care. It should be written in simple language and include a complete list of your medications with dosages and usage information.
What is Medicare safe discharge policy?
A beneficiary may be considered discharged when Medicare decides it will no longer pay for the medical services or when the physician and hospital believe that medical services are no longer required.
What is the focus of discharge planning?
What Is Discharge Planning? According to Medicare, discharge planning is a process that determines the kind of care a patient needs after leaving the hospital. Discharge plans should ensure a patient's transition from the hospital to another medical facility or to their home is as safe and smooth as possible.
What are the key factors you need to consider when planning patient is discharged from hospital?
Discharge planning involves taking into account things like:follow-up tests and appointments.whether you live alone.whether someone can help you when you go home.your mobility.equipment needed for your recovery.wound care, if needed.medicines, especially if you need multiple medications.dietary needs.More items...
What types of patient needs must be considered prior to discharge?
Hospital Discharge ChecklistTransportation – How will you get home from the hospital? ... Food – Do you have food and other necessities at home? ... Medication – Do you have all the medications you'll need? ... Doctor's Appointments – What is your follow-up care? ... Home Health Care – Are you eligible?More items...
What are discharge rights?
Their right to get services needed after leave from the hospital; Their right to appeal a discharge decision and the steps for appealing the decision; The circumstances under which one will or will not have to pay for charges for continuing to stay in the hospital; and.
Why is it important for nurses to plan for the discharge of their patients?
Effective discharge planning can help reduce medical errors during transitions of care, which is known to be a time during which patients are particularly vulnerable. Planning for discharge should involve the patient and caregiver and begin as soon as possible during the hospitalization.
When should discharge planning begin quizlet?
-Discharge Planning must begin when the patient is admitted. Some believe this to be financial because we are trying to save money and get patients discharged faster.
When should a patient discharge planning begin?
The process of discharge planning prepares you to leave the hospital. It should begin soon after you are admitted to the hospital and at least several days before your planned discharge.
Which information would the nurse include in a discharge plan?
A written transition plan or discharge summary is completed and includes diagnosis, active issues, medications, services needed, warning signs, and emergency contact information. The plan is written in the patient's language.
Which option is important to consider when designing a teaching form for patients being discharged?
Which option is important to consider when designing a teaching form for patients being discharged? Use of words the patients can understand when writing the directions is critical.
What are the steps that must be taken to successfully discharge a patient from the facility?
5 Steps For a Successful Hospital DischargeStep 1: Talk to the hospital discharge planner. ... Step 2: Discuss the pros and cons of discharge to a skilled nursing home versus home and any other issues specific to your situation with the hospital discharge planner.Step 3: Advocate for a safe discharge.More items...
What is discharge planning?
The Centers for Medicare & Medicaid Services (CMS) today issued a final rule that empowers patients to make informed decisions about their care as they are discharged from acute care into post-acute care (PAC), a process called “discharge planning.”.
What are the changes to the CAH and HHA requirements?
Final changes to hospital, CAH, and HHA requirements. Under the final rule, hospitals, CAHs, and HHAs would be required to: New discharge planning requirements, as mandated by the IMPACT act for hospitals, HHAs, and CAHs, that requires facilities to assist patients, their families, or the patient’s representative in selecting a post-acute care ...
Do hospitals have to provide access to medical records?
Hospitals must ensure and support patients’ rights to access their medical records in the form and format requested by the patient , if it is readily producible in such form and format (including in an electronic form or format when such medical records are maintained electronically).
When a hospital determines that inpatient care is no longer necessary, the Medicare beneficiary has the right to request an
When a hospital (with physician concurrence) determines that inpatient care is no longer necessary, the Medicare beneficiary has the right to request an expedited QIO review. The CMS guidelines provide that the appeal for expedited review must be made before the beneficiary leaves the hospital.
Why is discharge planning important?
This is particularly important when the beneficiary (or client)_feels that the discharge is inappropriate for any reason. Similarly, good discharge planning for patients, their families, and their healthcare providers, paves the way to successful transitions from one care setting to another.
What information is useful for Medicare beneficiaries and their advocates?
The following information for Medicare beneficiaries and their advocates is useful in challenging a discharge or reduction in services in the hospital, skilled nursing, home health, or hospice care setting: Carefully read all documents that purport to explain Medicare rights.
How long is an outpatient observation in Medicare?
Medicare beneficiaries throughout the country are experiencing the phenomenon of being in a bed in a Medicare-participating hospital for multiple days, sometimes over 14 days, only to find out that their stay has been classified by the hospital as outpatient observation. In some instances, the beneficiaries’ physicians order their admission, but the hospital retroactively reverses the decision. As a consequence of the classification of a hospital stay as outpatient observation (or of the reclassification of a hospital stay from inpatient care, covered by Medicare Part A, to outpatient care, covered by Medicare Part B), beneficiaries are charged for various services they received in the acute care hospital, including their prescription medications. They are also charged for their entire subsequent SNF stay, having never satisfied the statutory three-day inpatient hospital stay requirement, as the entire hospital stay is considered outpatient observation. The observation status issue has been challenged in Bagnall v. Sebelius (No. 3:11-cv-01703, D. Conn), filed on November 3, 2011. Litigation is ongoing. For updates, see https://www.medicareadvocacy.org/bagnall-v-sebelius-no-11-1703-d-conn-filed-november-3-2011/ (site visited May 27, 2015).
How to contact Medicare for Elder Care?
In addition, contact the Medicare program’s information line: 1-800-MEDICARE (1-800-633-4227) (TTY: 1-877-486-2048 for the hearing impaired).
When is an ABN required for Medicare?
When a beneficiary is placed in observation status by the attending physician, it is not clear whether the hospital is required to give the patient an Advance Beneficiary Notice (ABN) of non-coverage in order to shift liability to the beneficiary. If the service is a Part B service, but it “falls outside of a timeframe for receipt of a particular benefit,” then the hospital must give the beneficiary an ABN. See Medicare Benefit Policy Manual, CMS Pub. 100-02, Chapter 6, §20.6.C.
What is the face to face requirement for Medicare?
111-148, enacted March 23, 2010), §6407. The requirement is designed to reduce fraud, waste, and abuse by assuring that physicians and other healthcare providers have actually met with potential beneficiaries to ascertain their specific healthcare needs.
What is discharge planning process?
We proposed to establish a new standard, “Discharge planning process,” to require that the HHA's discharge planning process ensure that the discharge goals, preferences, and needs of each patient are identified and result in the development of a discharge plan for each patient. In addition, we proposed to require that the HHA discharge planning process require the regular re-evaluation of patients to identify changes that require modification of the discharge plan, in accordance with the provisions for updating the patient assessment at current § 484.55. The discharge plan would be updated, as needed, to reflect these changes.
What is the Home Health Agency discharge plan?
Home Health Agency Discharge Planning (Proposed § 484.58) Under the authority of sections 1861 (m), 1861 (o), and 1891 of the Act, the Secretary has established in regulations the requirements that a HHA must meet to participate in the Medicare program.
What is PDMP in discharge planning?
In the Discharge Planning proposed rule, we encouraged providers to consider using their state's Prescription Drug Monitoring Program (PDMP) during the evaluation of a patient's relevant co-morbidities and past medical and surgical history ( 80 FR 68132 ). Given the potential benefits of PDMPs as well as some of the challenges noted in the proposed rule, we solicited comments on whether providers should be required to consult with their state's PDMP and review a patient's risk of non-medical use of controlled substances and substance use disorders as indicated by the PDMP report. We also solicited comments on the use of PDMPs in the medication reconciliation process.
When a patient is transferred to another facility, that is, another CAH, hospital, or a PAC
When a patient is transferred to another facility, that is, another CAH, hospital, or a PAC provider, we proposed at § 485.642 (e) to require that the CAH send necessary medical information to the receiving facility at the time of transfer. The necessary medical information would have to include:
What is the condition of participation in discharge planning?
The hospital must have an effective discharge planning process that focuses on the patient's goals and treatment preferences and includes the patient and his or her caregivers/support person (s) as active partners in the discharge planning for post-discharge care.
What is the Congressional Review Act?
Pursuant to the Congressional Review Act ( 5 U.S.C. 801 et seq. ), the Office of Information and Regulatory Affairs designated this rule as a major rule , as defined by 5 U.S.C. 804 (2). As such, this rule has been transmitted to the Congress and the Comptroller General for review.
What is Executive Order 13771?
Executive Order 13771, titled Reducing Regulation and Controlling Regulatory Costs, was issued on January 30, 2017 and requires that the costs associated with significant new regulations “shall, to the extent permitted by law, be offset by the elimination of existing costs associated with at least two prior regulations.” This final rule imposes costs and therefore is considered to be a regulatory action under Executive Order 13771. We estimate that this rule will impose annualized costs of approximately $175 million discounted relative to 2016 over a perpetual time horizon.
CMS moves to empower patients to be more active participants in the discharge planning process
A final rule revises and implements discharge planning requirements that hospitals, critical access hospitals (CAHs), and home health agencies (HHAs) must meet as a condition of participation (CoP) in the Medicare and Medicaid programs. These facilities have until Nov.
Provisions in Brief
Hospitals/CAHS must supply patients with their medical records within a reasonable time frame.