• The list should only be present to patients for whom home healthcare or post-hospital extended care services are indicated and appropriate. 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.”. Find inspiration for your hospital to undertake discharge … This is the foundation of the case management admission assessment. CMS dropped a mandatory requirement for providers to access their states’ prescription drug monitoring programs while discharge planning. • Visit . • Use quality and resource measures relevant to patients’ goals of care and treatment preferences in the discharge planning process. View our policies by clicking here. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. One commenter requested clarification as to whether the proposed requirements would apply to partial hospitalization and intensive outpatient programs at hospitals. On September 26, 2019, the Centers for Medicare & Medicaid Services (CMS) announced a new Final Rule, Revisions to Discharge Planning Requirements (CMS-3317-F) in a bid to “improve engagement, choice and continuity of care across hospital settings.” The Final Rule requires the Medicare Conditions of Participation to implement more comprehensive discharge planning requirements for … • Focus on patients’ goals of care and treatment preferences. 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. At this time, choice lists need only be given for patients transferring to home health or to a SNF. CMS issued a long-awaited final rule on how hospitals must handle discharge planning, introducing new requirements on records access. The third issue is the need to include the caregiver or support person along with the patient to develop the discharge plan. Each of these represents core roles that case management professionals perform, and will be our focus this month. Provided by CMS, it lists those items surveyors are expected to assess during an on-site visit to determine compliance with the discharge planning condition of participation. Hosp Case Manag. As case managers implement new rules, be sure to include parameters for correct documentation. This month, we will discuss the current rules, the proposed rules, and the final rules published in 2019. The CMS guidelines provide that the appeal for expedited review must be made before the beneficiary leaves the hospital. CMS only requires evaluation of patients who are identified for a discharge plan, or when someone requests one. 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. Repisodic Choice is free, easy to use, and can get you compliant immediately. 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. This reinforces the best practice of assessing the patient on the day of admission. 3) - March 2020, Centers for Medicare and Medicaid Services – New Interpretative Guidelines for the Conditions of Participation for Discharge Planning – Part 2, CMS 2020 Final Rules: Discharge Planning Revisions Released, Preventing readmissions is a core focus of new discharge planning rules, Centers for Medicare and Medicaid Services – New Interpretative Guidelines for the Conditions of Participation for Discharge Plannin | Single Article, Discharge and Transitional Planning Under The Current and New CMS Rules: Boot Camp Ep. CMS’ Discharge Planning Rule Supports Interoperability and Patient Preferences. Document emphasizes importance of a plan. This means the case manager must discuss the plan and preferences with the patient’s family or other supports along with the patient, when appropriate, and ensure they agree with the plan. CMS updates discharge planning guidelines. Target Client Population: The target population includes all neonates admitted to the NICU. 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… . © Copyright ASC COMMUNICATIONS 2020. • The patient and family members or interested persons must be counseled to prepare them for post-hospital care. The two final rules are as follows: 1. Guidelines for 42 CFR 482.43, Discharge Planning . Regulations and Interpretive Guidelines for Hospitals . • Include in the evaluation the patient’s need for appropriate post-hospital services, and the availability of such services. Please note these entities are all acute care: • Medicare and Medicaid participating hospitals; • Long-term, children’s, and alcohol/drug facilities. cms guidelines for discharge summaries. 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. Every hospital that accepts Medicare and Medicaid must be in compliance with the CMS discharge planning guidelines. 28, No. Discharge Planning Conditions of Participation Final Rule. 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. Good discharge notices and good discharge planning should go hand in hand. be helping you) are important members of the planning team. www.cms.gov. Medicare’s Discharge Planning Regulations (which were updated in November 2019) requires that hospital assess the patient’s needs for post-hospital services, and the availability of such services. Our platform makes it easy to put together CMS-compliant lists of post-acute care providers that includes the most recent quality measures and resource use measures for patient review. Repisodic is the Best Solution to Ensure Compliance. The current federal standards for hospitals participating in the Medicare and Medicaid programs are presented in the Code of Federal Regulations (CFR) as 13 Conditions of Participation (CoPs). Suggestions not mandatory. In fact, 2,573 hospitals forfeited $564 million. CMS requires several discharge planning policies and procedures so come learn which ones are required and why. The process begins at the point of admission, and continues until the patient is safely in the community. www.cms.gov. Please click here to continue without javascript.. ED Care Transition Teams Can Address Behavioral, Social Needs, Use Data-Driven Dashboard, Other Tools to Assist ED Navigation Team, Ensure Adherence by Addressing Patients’ Social Needs, Health System Makes Utilization Review Paperless, More Efficient, Getting Involved: Case Managers Go to Washington, How to Initiate Serious Illness Conversations With Patients, The Conditions of Participation for Discharge Planning: Current Rules and 2020 Updates. CMS expects providers to factor in these quality measures when assisting patients and families in discharge planning and to document all efforts in the patients’ records. Center for Clinical Standards and Quality/Survey … – CMS. This checklist is a tool to promote optimal adherence to the processes and practices outlined as guidance and proposed updates to the CMS Discharge Planning Conditions of Participation. CMS finalized a rule Sept. 26 that revises discharge planning requirements for hospitals.. Three things to know: 1. Centers for Medicare & Medicaid Services. Every hospital that accepts Medicare and Medicaid must be in compliance with the CMS discharge planning guidelines. Typically, registered nurse or social work case managers complete the discharge planning assessment. You and your caregiver (a family member or friend who may . Today, the CoPs are managed under the Department of Health and Human Services. the discharge planning for post-discharge care. The first thing to consider is focusing on including the patient’s goals and preferences in the planning process. Survey Protocol. New CoP rules apply to hospitals and home health agencies. We present cms guidelines for discharge summaries and numerous ebook collections from fictions to scientific research in any way. 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 Participation. • Ensure patients can access their medical records when requested. 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. Available at. It will cover transfers to other facilities, assessment of readmission within 30 days, caregiver rights and recommendations, reduction of factors that lead to preventable readmissions, timely discharge planning, and more. CMS gives tips on discharge planning. In 2019, CMS provided the elements of the proposed rules that would be adopted in November 2019. • The hospital must continually reassess its discharge planning process. Table of Contents (Rev. Conditions of Participation (CoP) –Discharge Planning. New CMS Discharge Planning Rules Explained. 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. Table of Contents (Rev. PDF download: Discharge Planning – CMS. This can be achieved by placing an asterisk in front of any of these providers with a footnote explaining their financial interest. This can be difficult as issues such as availability and insurance coverage will have to be considered. Task 2 - Entrance Activities Task 3 - Information Gathering/Investigation. 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. Fill out this worksheet. 5 (Series) 1.5 CME/CE, Discharge & Transitional Planning Under the Current & Proposed CMS Rules. Name: Reason for admission: 2 During your stay, your doctor and the staff will work with you to plan for your discharge. Memorandum Summary • Discharge Planning Guidance Revised: SOM Hospital Appendix A has been revised to update the guidance for the discharge planning Condition of Participation (CoP). The Department may not cite, use, or rely on any guidance that is not … Next, discharge planners must share data from post-acute care providers with patients. • Reassess discharge plan if care needs change. • When a patient is discharged, all necessary medical information (including communicable diseases) Interested in linking to or reprinting our content? It should be noted that discharge planning also occurs in skilled nursing facilities, acute care, and home care. CMS describes discharge planning as a process, not an outcome.1 Because it is a process, case management professionals should always follow the CoP for discharge planning, as well as their department’s policies and procedures. The rules combine multiple proposals from 2015 through 2018.According to CMS, the burden red Regulations and Interpretive Guidelines for Hospitals . This means a case manager must consider alternatives when the patient’s goals diverge from the initial discharge plan. • Be consistent with Section 1802 (Freedom of Choice) by not specifying or limiting qualified providers. Hospitals that have a higher readmission rate can be financially penalized. The original CoPs were written in 1983, and were developed to ensure quality standards in hospitals and other provider settings. Read More. 11 Best Practices for Discharge Planning From CMS • Schedule follow-up appointments with the patient's primary care physician or practitioner and in-home providers of... • Fill prescriptions prior to discharge. CMS requires a number of discharge planning policies and procedures so come learn which ones are required and why. In fact, 2,573 hospitals forfeited $564 million. 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. Discharge Planning Conditions of Participation Final Rule. 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”). In 2019, CMS provided the elements of the proposed rules that would be adopted in November 2019. • 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. Hospitals that have a higher readmission rate can be financially penalized. The Centers for Medicare and Medicare Services (“CMS”) published two final rules intended to reduce provider burdens and improve hospital discharge planning. • Include evaluation in the medical record, and discuss the results with the patient or his or her representative. § 482.43 Condition of participation: Discharge planning. It is therefore important that notice is: … 200, 02-21-20) Transmittals for Appendix A. 3. It is not intended to take the place of either the written law or regulations. Federal … Hospitals. Modernizing and Clarifying the Physician Self-Referral Regulations Proposed Rule (CMS-1720-P) On October 9, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to modernize and clarify the regulations that interpret the Medicare physician self-referral law (often called the “Stark Law”), which has not been significantly updated since it was enacted in 1989. The current discharge planning requirements under the Conditions of Participation for Discharge Planning; The new CMS changes related to transitional and discharge planning and how they will impact your practice; How to engage providers and patients across the continuum in the discharge planning … CMS updates discharge planning guidelines. • Include the evaluation in the patient’s medical record. • Document that the list was given to the patient and/or the patient’s representative. ACTION: Final rule. These include quality data such as star ratings and outcomes data, where appropriate. Discharge Planning Checklist: For patients and their caregivers preparing to leave a hospital, nursing home, or other care setting. The process standards go on to say that hospitals must: • Identify patients in need of discharge planning early in their hospitalization. Medicare discharge planning is a Condition of Participation for hospitals, including psychiatric hospitals. • The plan may specify or limit the provider (or providers) of post-hospital home health services or other post-hospital services under the plan. On May 17, 2013, the Centers for Medicare & Medicaid Services (CMS) released an update of Appendix A of the State Operations Manual (SOM) revising its interpretive guidelines for hospital Discharge Planning. CMS has significantly revised the proposed requirements to … CMS news. SUBJECT: Burden Reduction and Discharge Planning Final Rules Guidance and Process . CMS withdrew some of its proposed discharge instruction provisions related to patients discharged home. 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 change here is that it must be in either electronic or written format. Best practice tells us that all patients should receive a discharge planning evaluation. The new regulations cover sections on patient timely access to medical records, the discharge planning process, discharge instructions, discharge planning requirements. CMS this week published its long-awaited discharge planning rule. 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. 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. In addition to improving quality by improving these care transitions, today’s rule supports CMS’ interoperability efforts by promoting the … • Patients who require discharge planning evaluation must be identified early in the hospital stay. • The evaluation should determine the likelihood of the patient needing post-hospital services, and availability of the services. • Complete the evaluation early to ensure appropriate arrangements are in place before discharge to avoid unnecessary delays. While all the CoPs are important, the two that apply most closely to case management include Section 482.30 (Utilization Review) and 482.43 (Discharge Planning). The discharge planning rule, proposed in 2015, finalizes provisions requiring hospitals and CAHs to create discharge planning evaluations for patients who are likely to suffer adverse health consequences in the absence of adequate discharge planning, and when a patient, their representative or physician requests such a plan. 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. In other words, discharge planning allows for a smooth move for the patient across the continuum, and at all transition points. • Advisory Boxes: Included in the updated interpretive guidelines are “blue boxes,” to In 2015, CMS introduced proposed rules for discharge planning. Providers are required to consider the patient’s health objectives and care preferences during the discharge planning process to ensure that patients receive the desired care. The 13 Conditions of Participation include these categories: • Quality assessment and performance improvement program; The following requirements outline the rules as they relate to discharge planning: • The hospital must establish a discharge planning process for all patients. 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”). It is important to understand these federal regulations only apply to the following entities. While you can provide choices for other discharge destinations, you have no regulatory requirement to do so. 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. Developed based on the *May 17, 2013, Centers for Medicare & Medicaid Services updated interpretive guidelines for hospital discharge planning (CMS Revision to State Operations Manual (SOM), Hospital Appendix A - … Copyright © 2020 Becker's Healthcare. • Provide a discharge planning evaluation for those identified patients, or at the request of the patient, representative, or physician. 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 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. 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 … A notice is any written or oral discussion of one’s rights and protections, particularly with respect to costs and services available in a proposed care setting. This should include the original and the new rules. Optimal discharge planning can help prevent unnecessary readmissions. 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. 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. Glossary: Discharge Planning. • Call . Every hospital that accepts Medicare and Medicaid must be in compliance with the CMS discharge planning guidelines. Hospital Discharge Planning in Medicare: Current Requirements and ... the CoPs and interpretive guidance pertaining to discharge planning issued by CMS every five years.9 Comments on the proposed rule were due January 4, 2016. CMS says other personnel can complete the assessment under the supervision of the nurse or social worker. These proposed rules were to be used to update the current rules under the Conditions of Participation for Discharge Planning (CoP). Interested in LINKING to or REPRINTING this content? Facilities that must adhere to the new rules include: CMS estimates that hospitals and home health agencies will spend $215 million per year to comply with the discharge planning changes, and will incur an additional $46.5 million in one-time costs. • A patient’s physician can request a discharge plan. By Jeanie Davis New rules intended to help empower patients preparing to move from acute care into post-acute care will soon govern hospital discharge planning, according to the Centers for Medicare & Medicaid Services (CMS). To comply with the new discharge planning requirements, CMS estimates there will be a total one-time cost of approximately $17.7 million for all hospitals, approximately $10.8 million for all HHAs, and approximately $1.9 million for all CAHs. 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. The commenter recommended that CMS explicitly state which Start Printed Page 51839 provider types would be required to comply with the discharge planning CoPs. 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. 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 … • Develop the plan under the supervision of a registered nurse, social worker, or other qualified personnel. Background On September 30, 2019, CMS published two final rules which revised regulatory requirements for the various certified provider and supplier types. Discharge Planning §482.45 Condition of Participation: Organ, Tissue and Eye Procurement ... Medicare Conditions of Participation (CoP) in order to receive Medicare/Medicaid Hospital Discharge Planning Worksheet. [email protected], Do Not Sell My Personal Information  Privacy Policy  Terms of Use  Contact Us  Reprints  Group Sales, For DSR inquiries or complaints, please reach out to Wes Vaux, Data Privacy Officer, [email protected], Design, CMS, Hosting & Web Development :: ePublishing, Hospital Case Management (Vol. The new rules for discharge planning went into effect on Nov. 29, 2019, which represents federal fiscal year 2020. • Hospitals and home health agencies are required to transfer and refer patients along with necessary medical information — including course of illness and treatment — to post-acute services, providers, facilities, agencies, and other patient service providers and practitioners responsible for patient’s follow-up care to ensure a safe transition. 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. Even though Case Management Week is not for two weeks (October 13 – 19, 2019), the release of the Discharge Planning Conditions of Participation (CoP) Final Rule is a reason for an early celebration as evidenced by the following quote from CMS … Geographic Direct Contracting Model (“Geo”) CMS Announces New Model to Advance Regional Value-Based Care in Medicare. 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 … Document emphasizes importance of a plan. This applies to anyone who will be caring for the patient after discharge. 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. If you need help choosing a home health agency or nursing home: • Talk to the staff. Medicare and Medicaid Programs; Regulatory Provisions to Promote Program CMS requires a number of discharge planning policies and procedures so come learn which ones are required and why. To find information on the entire Conditions of Participation, visit: https://bit.ly/2N4xn3V. Financial Disclosure: Author Melinda Young, Author Jeanie Davis, Editor Jill Drachenberg, Editor Jonathan Springston, Editorial Group Manager Leslie Coplin, and Nurse Planner Toni Cesta, PhD, RN, FAAN, report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study. • Case managers must determine the patient’s capacity for self-care, or the likelihood of needing home care services. The hospital must develop discharge plan for patient. It requires the discharge planning … More information for people with Medicare. You must have JavaScript enabled to enjoy a limited number of articles over the next 360 days. Optimal discharge planning can help prevent unnecessary readmissions. 7500 Security Boulevard, Baltimore, MD 21244 CMS & HHS Websites [CMS Global Footer] Medicare… Objectives:- Discuss the CMS has revised the discharge planning … CMS moves to empower patients to be more active participants in the discharge planning process. 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. Notice is: … CMS updates discharge planning Conditions of Participation for hospitals including... Be difficult as issues such as star ratings and outcomes data, where appropriate early to ensure they appropriate... 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