The Centers for Medicare & Medicaid Services (CMS) has finalized changes to the discharge planning conditions of participation (CoPs) for hospitals (including long-term care hospitals (LTCHs) and inpatient rehabilitation hospitals (IRFs)), critical access hospitals (CAHs), and home health agencies (HHAs). CMS believes the rule, which implements statutory requirements under the Improving Medicare Post-Acute Care Transformation Act of 2014, “will empower patients to be active participants in the discharge planning process and will help them to make informed choices about their care, which may lead to more competition, lower costs, and improved quality of care.”

CMS notes that it made numerous changes in the final rule to “avoid any unnecessarily costly and burdensome requirements.” In fact, CMS credits public comments as being “exceptionally useful in identifying weak or unjustified provisions in the proposed rule as well as in identifying alternatives.” CMS still estimates that the final rule will impose $262 million in costs during the first year and $215 million annually thereafter – but that is about half of the cost estimates for the proposed rule. Virtually all of the annual costs will be borne by HHAs under a new requirement that an HHA’s discharge planning process provide certain information to patients discharged or transferred to another post-acute care provider, in order to assist patients and families in selecting a provider that meets the patient’s needs and goals.

The final rule also requires hospitals to 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 persons as active partners in discharge planning for post-discharge care. While CMS had proposed requiring hospitals to prepare a discharge plan for all inpatients and certain categories of outpatients, in the final rule CMS scaled back this provision. Instead, a hospital’s discharge planning process must identify, at an early stage of hospitalization (ideally when the patient is admitted as an inpatient, or shortly thereafter), those patients who are likely to suffer adverse health consequences upon discharge in the absence of adequate discharge planning. The hospital must provide a discharge planning evaluation for those patients so identified, as well as for other patients upon the request of the patient or the patient’s representative or physician. Under the final rule, a discharge planning evaluation must assess a patient’s likely need for appropriate post-hospital services, including hospice care services, post-hospital extended care services, and home health services, and must also determine the availability of those services. CMS also established a new Patients’ Rights CoP ensuring a patient’s right to access his or her own medical information from a hospital.

In other notable changes from the proposed rule, CMS withdrew most of its proposed discharge instruction provisions related to patients discharged home, and the agency did not finalize “design” language that would have established prescriptive discharge planning procedural requirements. Furthermore, CMS is not requiring hospitals, HHAs or CAHs to consult with their state’s Prescription Drug Monitoring Programs (PDMPs) and review a patient’s risk of non-medical use of controlled substances and substance use disorders, nor will CMS require providers to use or access PDMPs during the medication reconciliation process.

CMS clarifies that the final rule applies to all classifications of hospitals, including short-term acute care hospitals (and their inpatient prospective payment system-excluded rehabilitation or psychiatric units), psychiatric hospitals, LTCHs, rehabilitation hospitals, children’s hospitals, and cancer hospitals. These requirements also apply to distinct part psychiatric and rehabilitation units in CAHs.

The final rule will be published on September 30, 2019 and is effective 60 days thereafter. CMS intends to provide additional subregulatory interpretive guidance to facilitate implementation of these requirements.