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Hospitals to Provide Skilled Nursing Quality Data at Discharge per New Rule

On September 29, 2019, CMS finalized a new rule focusing on the seamless exchange of patient information between health care settings by revising the discharge planning requirements that Hospitals and Home Health Agencies (HHAs) must meet in order to participate in the Medicare and Medicaid programs.

According to CMS’s Seema Verna, the final rule does not change anti-steering regulations that prevent hospitals from recommending specific skilled nursing facilities. CMS believes this rule “empowers patients to be active participants in the discharge planning process…. And also implements discharge planning requirements which will give patients and their families access to information that will help them to make informed decisions about their post-acute care, while addressing their goals of care and treatment preferences.”

For a summary of the rule, see the last 10 pages of the CMS 3317-F and CMS 3295-F:

  • CRF 42 Part 482- Conditions of Participations for Hospitals, and
  • CFR 42 Part 484 for HHA

Highlights in the final rule for Hospitals:

  • Patient Rights: The patient has the right to access their medical records, including current medical records, upon an oral or written request, in the form and format requested by the individual.
  • 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.
    • The hospital must assist patients, their families, or the patient’s representative in selecting a post-acute care provider by using and sharing data that includes, but is not limited to; HHA, SNF, IRF, or LTCH data on quality measures and data on resource use measures. 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.

Also check out changes to the Medicare Claims Processing Manual posted by CMS on 10-04-19:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R126GI.pdf

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R4409CP.pdf

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2019Downloads/R261BP.pdf

If you have questions or concerns, please contact us.

If you’d like to learn more about our post-acute care services, click here.

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