Did you know that under current Medicare requirements, a hospital discharge planner must, if possible, honor a patient’s goals and preferences in the discharge planning process, including where to be discharged to?
These requirements, called Medicare Conditions of Participation, are set forth in regulations applicable to all hospitals that are reimbursed by Medicare. Discharge planning is an important part of a successful transition from hospitals and post-acute care (“PAC”) settings. The transition may be to a patient’s home, a long-term care hospital (L), a skilled nursing facility (SNF), a rehabilitation hospital, an assisted living residence, a substance abuse treatment program, hospice, or another setting.
In general, the Medicare Conditions of Participation require participating hospitals to “have in effect a discharge planning process that applies to all patients.”[i] The Conditions of Participation also set forth what must be done as part of the discharge planning evaluation and implementation processes.
Of note, hospitals are required to supply to the patient a list of all providers in the geographic region. Id. In addition, a hospital must inform the patient or the patient’s family of their freedom to choose among participating Medicare providers of post-hospital care services and must, when possible, respect patient and family preferences when they are expressed. The hospital must not specify or otherwise limit the qualified providers that are available to the patient.
You may wonder how you can tell if a hospital is meeting the Medicare Conditions of Participation in the discharge process. As an initial step, you can see if the following conditions are met:
- The hospital must include in the discharge plan a list of HHAs, SNFs, IRFs or LTACs (LTCH) that are available to the patient, that are participating in the Medicare program and that service the geographic area in which the patient resides, or in the case of a SNF, IRF, or LTAC, in the geographic area requested by the patient. This list need only be presented to patients for whom home health care post-hospital extended care services, SNF, IRF, or LTAC services are indicated and appropriate.
- The hospital must share data from post-acute care providers with patients. These include quality data such as star ratings and outcomes data, where appropriate.
- 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.
- The hospital must also inform the patient, or the patient’s representative, of their freedom to choose among Medicare providers and suppliers of post-discharge services and must respect the patient’s goals of care and treatment preferences, when possible.
- The discharge plan must identify any HHA or SNF to which the patient is referred in which the hospital has a disclosable financial interest and any HHA or SNF that has a disclosable financial interest in a hospital under Medicare.
Proper discharge planning is imperative in ensuring that patient discharges are successful.
Making sure that the Medicare Conditions of Participation are followed is a necessary part of the process. It’s important to know that you always have a choice in your healthcare options. It is your road to recovery. Contact one of our admission coordinators to discuss how we can help you or your loved one regain health and independence after an injury, surgery, or other acute medical condition.
Resources:
- Contact Bradford Rehabilitation Hospital
- Contact Westborough Rehabilitation Hospital
- Refer A Patient
- Medicare Guidelines regarding Inpatient & Outpatient
- Discharge planning from the Center for Medicare Advocacy
- Your right to care that honors your wishes
- Patients are important members of the healthcare team
[i] All regulations referenced in this article are set forth in in 42 CFR § 482.43 – Condition of participation: Discharge planning.
