Understanding The New CMS Discharge Rules

Elizabeth Hogue, Esq

Dec 23, 2019

The Centers for Medicare and Medicaid Services (CMS) published a final rule on September 30, 2019, that requires hospitals to make substantial changes in discharge planning. The final rule is effective sixty days from publication, so it becomes effective on November 29, 2019.

In the meanwhile, many hospital discharge planners/case managers and post-acute providers who receive referrals from hospitals are especially interested in any changes regarding patients’ right to freedom of choice.

First, CMS clarifies that CoPs for hospitals apply to acute care hospitals, long-term care hospitals (LTCHs), independent rehab facilities (IRFs), short-term acute care hospitals, rehabilitation hospitals, psychiatric hospitals, children’s hospitals and cancer hospitals.

CMS then clarifies that discharge planners/case managers cannot make decisions on post-acute services on behalf of patients and their caregivers. Hospitals must focus instead on person-centered care to ensure the active participation of patients and their caregivers in decisions about post-acute care.

CMS also states that the IMPACT Act requires hospitals to take into account quality, resource use and other measures in the discharge planning process. Specifically, CMS says that hospitals’ discharge planners/case managers must use IRF Compare, Home Health Compare, Nursing Home Compare and Long-Term Care Compare to assist patients and their caregivers to make decisions about post-acute providers.

CMS says that hospital discharge planners/case managers are not expected to provide patients and their caregivers with detailed and complex analyses of quality and resource use data that may confuse patients and their caregivers. Case managers/discharge planners are also not expected to attempt to provide patients with data that does not exist. In other words, no “homemade data!”

According to CMS, discharge planners/case managers must put forth their “best effort” to answer patients’ questions about the data.

CMS says that case managers/discharge planners should also refer to www.medicare.gov for additional resources and help with regard to data presented to patients. Further information mandated by the IMPACT Act will be available in forthcoming regulations. CMS will also provide interpretive guidelines at some point after publication of the final rule.

In response to concerns about hospital discharge planners/case managers that may attempt to “steer” patients to particular post-acute providers, CMS says that they must present objective data on quality and resource measures specifically applicable to patients’ goals of care and treatment preferences, “taking care to include data on all available PAC providers and allowing patients and/or their caregivers the freedom to select a PAC provider of their choice.”

CMS says that providers will have to document all interactions regarding freedom of choice in patients’ medical records.

We will provide more information soon. Stay tuned!

Elizabeth E. Hogue, Esq.

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