SUMMARY OF CHANGES: This transmittal updates Chapter 12, §30.6.9.1 with initial hospital care policy including Admission and Discharge Services on the same calendar date of service. CMS did not finalize its proposal to require hospitals to send a copy of the discharge instructions and the discharge summary within 48 hours of the patient’s discharge; pending test results within 24 hours of their availability, and all other necessary info, as specified in proposed Section 482.43(e)(2). (4) Upon the request of a patient’s physician, the hospital must arrange for the development and initial implementation of a discharge plan for the patient. Observation status is covered under Medicare. Medicaid programs and regulations, on the other hand, vary by State. A. CMS did not specify content of transfer or discharge summaries as was in the proposed rule. Hospitals/CAHs must discharge, transfer, or refer patients with their applicable medical information at the time of discharge, transfer, or referral. laws and standards that every provider in every State must follow. xref (2) A discharge planning evaluation must include an evaluation of a patient’s likely need for appropriate post-hospital services, including, but not limited to, hospice care services, post-hospital extended care services, home health services, and non-health care services and community based care providers, and must also include a determination of the availability of the appropriate services as well as of the patient’s access to those services. 0000002296 00000 n 0000006789 00000 n 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. 0000004703 00000 n https://www.cms.gov/newsroom/fact-sheets/cms-discharge-planning-rule-supports-interoperability-and-patient-preferences. AMA Releases COVID-19 Vaccine Code for Janssen, Combine Communication and Quality of Care, New Proposed Rules Ensure Equal Visitation Rights, CMS Takes Steps to Reduce Regulatory Burden. Discharge Summary; C-0388 has similar requirements – but a few additions as well, including: Recapitulation of the resident’s stay; Final summary of the resident’s status (The final summary must include all of the elements required as part of the initial assessment). (iii) The hospital must document in the patient’s medical record that the list was presented to the patient or to the patient’s representative. It includes specific requirements for discharge instructions. (5) Any discharge planning evaluation or discharge plan required under this paragraph must be developed by, or under the supervision of a registered nurse, social worker, or other appropriately qualified personnel. A “discharge” occurs when a Medicare beneficiary leaves an acute care hospital after receiving acute care treatment; or dies in the hospital. The reassessment may be completed by telephone. Medicaid is a unique program and is quite different from Medicare. The reassessments should typically occur every 4-6 hours. (2) The hospital, as part of the discharge planning process, must inform the patient or the patient’s representative of their freedom to choose among participating Medicare providers and suppliers of post-discharge services and must, when possible, respect the patient’s or the patient’s representative’s goals of care and treatment preferences, as well as other preferences they express. 327 0 obj<> endobj 0000003639 00000 n As a contributor you will produce quality content for the business of healthcare, taking the Knowledge Center forward with your knowhow and expertise. With the exception of the discharge planning requirements of the IMPACT Act (see 482.43(a)(8)), the Centers for Medicare & Medicaid Services (CMS) says hospitals and CAHs are already conducting most of the revised discharge planning requirements. (b) Standard: Discharge or transfer summary content. The elements of discharge summaries are set forth by CMS and accreditation bodies and incorporated in hospital bylaws. (2) Within 48 hours of the patient's return to the home from a hospital admission of 24 hours or more for any reason other than diagnostic tests, or on physician or allowed practitioner-ordered resumption date; (3) At discharge. (ii) For patients enrolled in managed care organizations, the hospital must make the patient aware of the need to verify with their managed care organization which practitioners, providers or certified suppliers are in the managed care organization’s network. We are looking for thought leaders to contribute content to AAPC’s Knowledge Center. SNF Discharge Planning; A facility must provide sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility (42 C.F.R. The HHA must ensure that the post-acute care data on quality measures and data on resource use measures is relevant and applicable to the patient’s goals of care and treatment preferences. Hospitals/CAHS must actively use a discharge planning process that involves patients and/or patients’ representatives and takes into account data on quality measures and resource use measures. The final rule, published in the Sept. 30 Federal Register, gives hospitals, HHAs, and CAHs 60 days to comply. Additionally, CMS will now require the evaluation of a patient’s discharge needs and discharge plan to be documented in a timely manner. (d) Standard: Electronic notifications. admission screening is completed more than 48 hours prior to admission, there must be a reassessment. (vii) Discharge summary with outcome of hospitalization, disposition of case, and provisions for follow-up care. CMS states in the final rule. In the majority of cases, the decision whether to discharge a patient from the hospital following resolution of the reason for the observation care or to admit the patient as an inpatient can be made in less than 48 hours, usually in less than 24 hours. [CMS did not finalize the proposed design requirements.]. ACTION: Final rule. (a) Baseline care plans. 0000000016 00000 n Even industry experts are often confused by the rules for baseline care plans laid out in F655 in Appendix PP , “Guidance to Surveyors for Long-term Care Facilities,” of the State Operations Manual , particularly what exactly does—and doesn’t—have to be done within that initial 48-hour window post-admission. 0000002878 00000 n The baseline care plan must - (i) Be developed within 48 hours of a resident's admission. §483.20(l)). Any changes from the previous assessment must be documented. hospital or to order outpatient tests. 0 §483.12(a)(7)). 0000001148 00000 n However, no citations will be made if the identification of patients likely to need discharge planning is completed at least 48 hours in advance of the patient’s discharge and there is no evidence that the patient’s discharge was delayed due to the hospital’s failure to complete an appropriate discharge planning evaluation on a timely basis or that the patient was placed unnecessarily in a … Discharge Comprehensive Assessment (including the OASIS data); and 3. • A big focus is providing the primary care physician with the discharge summary and other comprehensive information to the patient’s primary care physician within 48 hours of discharge and pending test results within 24 hours of their availability. When a patient has been admitted to inpatient hospital care for a minimum of 8 hours but less than 24 hours and discharged on the same calendar date, Observation or Inpatient Hospital Care Services (Including Admission and Discharge Services), from CPT code range 99234 – 99236, shall be reported. The hospital must ensure that the post-acute care data on quality measures and data on resource use measures is relevant and applicable to the patient’s goals of care and treatment preferences. In most instances, observation status payment will be bundled or “packaged” with other services (e.g., clinic, outpatient surgery, or emergency department services). This should include a summary of the observation stay, including any pertinent physical exam and diagnostic findings, as well as a plan for follow up. (c) Standard: Requirements related to post-acute care services. 0000000696 00000 n The hospital’s discharge planning process must identify, at an early stage of hospitalization, those patients who are likely to suffer adverse health consequences upon discharge in the absence of adequate discharge planning and must provide a discharge planning evaluation for those patients so identified as well as for other patients upon the request of the patient, patient’s representative, or patient’s physician. The hospital must discharge the patient, and also transfer or refer the patient where applicable, along with all necessary medical information pertaining to the patient’s current course of illness and treatment, post-discharge goals of care, and treatment preferences, at the time of discharge, to the appropriate post-acute care service providers and suppliers, facilities, agencies, and other outpatient service providers and practitioners responsible for the patient’s follow-up or ancillary care. The affected hospitals, which include short-term acute-care hospitals, long-term care hospitals (LTCHs), rehabilitation hospitals, psychiatric hospitals, children’s hospitals, and cancer hospitals, are now tasked with learning what the requirements are for “discharge planning,” which is the process of preparing to move patients from acute care into post-acute care (PAC), and implementing those changes. 0000006283 00000 n Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. 0000007359 00000 n 0000001115 00000 n The regulations included in Phase 3 must be implemented by November … CMS Centers for Medicare & Medicaid …. %PDF-1.5 %���� This includes the prescription drug monitoring program, the 24 hour requirement to initiate a discharge plan, 8 things to be in the discharge planning assessment, 21 things to be included in the transfer form, medication reconciliation, the discharge summary and instructions must be sent within 48 hours of discharge and more. ends with his discharge from services. These facilities have until Nov. 29, 2019, to institute the provisions in the Revisions to Discharge Planning Requirements Final Rule [CMS-3317-F]. 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. The discharge plan must be updated, as needed, to reflect these changes. Under the Medicare conditions of par­ticipation (Sec. <]>> Hospitals/CAHS must supply patients with their medical records within a reasonable time frame. I know this is an inpatient requirement but if a patient stays that long, it seems like something more than a discharge diagnosis is needed. CMS acknowledges that often people receiving outpatient services, including those classified as outpatients who stay in the hospital on observation status, even those who are in the hospital for 48 hours or less, may have complex medical needs for which discharge …