(k) This section does not require a hospital to do either of the following: (1) Adopt a policy that would delay discharge or transfer of a patient. Within a dedicated unit, all employees providing direct care must be provided appropriate PPE. (1) Any discharge planning evaluation must be made on a timely basis to ensure that appropriate arrangements for post-hospital care will be made before discharge and to avoid unnecessary delays in discharge. (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. §405.1206 (c), 42 C.F.R. Discharge planning is the process by which hospital staff work with you and your family or someone acting on your behalf to prepare and make arrangements for your care once you leave the hospital. The long-term care facility is required to accept return of the resident, as long as it can meet the medical needs of the resident and there are no statutory grounds for refusal. 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. 42 C.F.R. 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. Your hospital admittance should include a statement of your rights along with discharge information and how to appeal a discharge. 103 - Governance and Management Chap. [1, 2] Deficits in communication at hospital discharge are common, [] and accurate information on important hospital events is often inadequately transmitted to outpatient providers, which may adversely affect patient outcomes. Under Executive Order 2020-95, a hospital is only permitted to discharge the resident to: a regional hub, the resident’s prior facility, an alternate care facility, or an available swing bed. The discharge plan must be updated, as needed, to reflect these changes. believes that discharge would not be safe and would not conform to applicable law. (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. Key Information. Medicare-participating hospitals must make their discharge planning ⦠In appropriate cases, APS sends a letter to the hospital/facility requesting discharge be postponed until such time necessary services are reasonably available. The facility is required to report all presumed positive COVID-19 cases to DHHS. The burden of proof of the appropriateness of discharge, either on the basis of medical necessity or on Medicare coverage policies lies with the hospital having submitted information to the QIO that justifies discharge. Firm-wide, 44 lawyers were listed. The Department of Health and Human Services (DHHS) in Michigan is authorized to issue orders or directives to implement these requirements. 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. (2) Disclose information if the patient has not provided consent that meets the standards required by state and federal laws governing the privacy and security of protected health information. (8) 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. Like other medical malpractice lawsuits, wrongful discharge from hospital claims must prove the patientâs doctor acted negligently by deviating from the standard of care. (i) This list must only be presented to patients for whom home health care post-hospital extended care services, SNF, IRF, or LTCH services are indicated and appropriate as determined by the discharge planning evaluation. The discharge planning process and the discharge plan must be consistent with the patientâs goals for care and his or her treatment preferences, ensure an effective transition of the patient from hospital to post-discharge care, and reduce the factors leading to preventable hospital readmissions. § 483.15 Admission, transfer, and discharge rights. Medicare discharge planning is a Condition of Participation for hospitals, including psychiatric hospitals. âThis has become a real challenge with regard to uninsured patients,â says Janet L. Dolgin, PhD, JD, co-director of the Hofstra University Bioethics Center in Hempstead, NY. The following requirements involve the facility as a whole, to ensure safety for both employees and residents. The hospitalâs policies and procedures must be specified in writing. The resident may only be discharged to a facility where they can be safely isolated under the Centers for Disease Control (CDC) and DHHS guidelines. Standard: Requirements related to post-acute care services. (1) Existing law requires the State Department of Public Health to license and regulate general acute care hospitals, acute psychiatric hospitals, and special hospitals. Jennifer has particular expertise in health law and she represents providers with emphasis in the areas of physicians, hospice, home care and long term care, including one of the country’s largest long-term care organizations. HHAs must request to be listed by the hospital as available. A discharge notice must be provided to all patients (except Medicare patients who receive a copy of an "Important Message from Medicare") in writing 24 hours before they leave the hospital. (b) Standard: Discharge of the patient and provision and transmission of the patient's necessary medical information. Long-term care facilities are encouraged to use telemedicine for regular doctors’ visits, telepsychology, counseling, social work, and physical and occupational therapy. (1) In addition to the requirements in RCW 70.41.320, hospital discharge policies must ensure that the discharge plan is appropriate for the patient's physical condition, emotional and social needs, and, if a lay caregiver is designated takes into consideration, to the extent possible, the lay caregiver's abilities as disclosed to the hospital. The CoPs also require the hospital to arrange for the initial implementation of the patientâs discharge plan. You are readmitted to the hospital for the same condition only a short time later. Health Care practice group members listed in Best Lawyers are as follows: To see the full list of Foster Swift attorneys listed in Best Lawyers 2021, click here. Some patients find that they are pushed to accept a care home option because they are not offered the right support to return to live at home. § 482.43 Condition of participation: Discharge planning. Cites applicable discharge regulations. §422.622 (c). development of a discharge plan. Best Lawyers lists are compiled based on an exhaustive peer-review evaluation and as lawyers are not required or allowed to pay a fee to be listed; inclusion in Best Lawyers is considered a singular honor. Current rules and regulations restrict hospital discharge planners from, for example, pushing patients toward a specific provider that they may favor or have business relationships with. Legal Issues of Hospital Discharge Malpractice. Your medical and financial records shall not be released to anyone outside the hospital without your approval, unless you are transferred to another facility that requires the information, or release of the information is required and permitted by law. On May 17, 2013, the Centers for Medicare & Medicaid Services (CMS) released an update of Appendix A of the State Operations Manual (SOM) revising its interpretive guidelines for hospital Discharge Planning. (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. Categories: Hospice, Hospitals, Long-Term Care. New discharge planning requirements, as mandated by the IMPACT act for hospitals, HHAs, and CAHs, that requires facilities to assist patients, their families, or the patientâs representative in selecting a post-acute care (PAC) services provider or supplier by using and sharing PAC data on quality measures and resource use measures. Standard: Discharge of the patient and provision and transmission of the patient's necessary medical information. Discharge procedures may vary slightly, depending on the hospital and the physician, but there is often some paperwork that must be signed to obtain the patientâs informed consent (or that of their representative) and formalize the AMA discharge process. While the information in this article is accurate at time of publication, the laws and regulations surrounding COVID-19 are constantly evolving. To describe inpatient hospitalizations and emergency department visits in hospitals in Rhode Island. If the hospital has information on which practitioners, providers or certified supplies are in the network of the patient's managed care organization, it must share this with the patient or the patient's representative. (1) Hospitals and acute care facilities shall: (a) Work cooperatively with the department of social and health services, area agencies on aging, and local long-term care information and assistance organizations in the planning and implementation of patient discharges to long-term care services. Even if the hospital does not identify the need for a discharge plan, the patientâs physician may request one, which the hospital must provide. (2) In the absence of a finding by the hospital that a patient needs a discharge plan, the patient's physician may request a discharge plan. One possible reason that a resident may be refused readmission is if the facility no longer has capacity for them to return. When a resident is accepted back into the facility, the facility must screen them for COVID-19. The Emergency Medical Treatment and Active Labor Act (EMTALA) is an act of the United States Congress, passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). Discharge is your release from the hospital and the discharge planning process identifies the services and supports you need after you leave the hospital. (6) The hospital's discharge planning process must require regular re-evaluation of the patient's condition to identify changes that require modification of the discharge plan. Executive Order 2020-95 urges long-term care facilities to use telemedicine to the maximum extent possible. Successfully transitioning patients from hospitals to their homes or other care settings is a key part of quality care. Hospital discharge: leaflet for patients when they enter hospital. Electronic Code of Federal Regulations (e-CFR), CHAPTER IV - CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES, SUBCHAPTER G - STANDARDS AND CERTIFICATION, PART 482 - CONDITIONS OF PARTICIPATION FOR HOSPITALS. The facility is not allowed to prohibit admission or readmission of a resident based on COVID-19 testing requirements or results in a manner inconsistent with this Executive Order. 101 - General Information Chap. Hospital patient discharge process: homeless patients. Hospital Discharge Data Purpose. 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. Hospital Discharge Planning. If you arenât provided with a notice of discharge and how to file an appeal, request one from the hospital's patient advocate and follow those guidelines. Transfer and Discharge Procedures for COVID-19 Affected Residents. Many planners have traditionally been wary of crossing that line, sometimes leaving patients in the dark. Lawsuits arising from premature discharge and medical malpractice can be complicated. The facility must also report the presence of a COVID-19 affected resident to their local health department within 24 hours. âSafe dischargeâ laws preclude hospitals from discharging patients who donât have a safe plan for continued care after they leave a hospital. An alternate care facility is defined as a facility activated by the state to provide relief for hospitals that surge past capacity. Factsheet: Challenging Hospital Discharge Decisions. III. (a) Standard: Discharge planning process. The discharge planning process and the discharge plan must be consistent with the patient's goals for care and his or her treatment preferences, ensure an effective transition of the patient from hospital to post-discharge care, and reduce the factors leading to preventable hospital readmissions. At times throughout the order, nursing homes are specifically identified and have additional requirements. If a resident moved in with a family member during the COVID-19 pandemic, they do not forfeit their right to return to the facility. If a nursing home owner operates multiple facilities, it may choose to designate a whole facility as a dedicated unit. IHA advocates for discharge planning policies that best serve patients. (c) Standard: Requirements related to post-acute care services. (3) The discharge planning evaluation must be included in the patient's medical record for use in establishing an appropriate discharge plan and the results of the evaluation must be discussed with the patient (or the patient's representative). In the discharge process, the hospital should consider patient safety, safety of other residents, the resident’s wishes, and any guidance from the local health department. (a) Each hospital shall have a written discharge planning policy and process. If the individual tests positive, the facility must not accept them unless it has a dedicated unit or regional hub solely for COVID-19 positive residents. (1) The governing body shall establish and implement written admission and discharge policies to protect the health and safety of the patients and shall not assign or delegate the functions of admission and discharge to any referral agency and shall not permit the splitting or sharing of fees between a referring agency and the hospital. Your rights may be different depending on whether you are in a state hospital or a private psychiatric hospital. (3) The discharge plan must identify any HHA or SNF to which the patient is referred in which the hospital has a disclosable financial interest, as specified by the Secretary, and any HHA or SNF that has a disclosable financial interest in a hospital under Medicare. New Requirements for Hospital Discharge and Long-Term Care Facility Residents . Executive Order 2020-95 rescinds Executive Order 2020-84, which provided initial protections for long-term care residents. Please consult your attorney or advisor to make sure you have the most up to date information before taking any action. Hospital discharge planning is a process that involves determining the appropriate post-hospital discharge destination for a patient; identifying what the patient requires for a smooth and safe CANHR's mission is to educate and support long term health care advocates and consumers regarding the rights and remedies under the law, and to create a united voice for long term care reform and ⦠The transition from hospital to home can expose patients to adverse events during the postdischarge period. She has a vast array of experience in teaming with providers in the areas of regulatory compliance and contracts. If none of those options are available, the long-term care facility must attempt to send the resident to a hospital with available bed capacity. The assessment must include ongoing, periodic review of a representative sample of discharge plans, including those patients who were readmitted within 30 days of a previous admission, to ensure that the plans are responsive to patient post-discharge needs. 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. Until a safe location is determined, the individual must remain in the care of the hospital. Furthermore, the patient must prove his or her condition worsened and suffered injury as ⦠(7) The hospital must assess its discharge planning process on a regular basis. 42 CFR § 483.15 - Admission, transfer, and discharge rights. Contact a member of Foster Swift’s Health Care Group with any questions on the hospital discharge procedures or requirements for long-term care facilities under Executive Order 2020-95. Executive Order 2020-95 currently lasts through June 17, 2020. § 482.43 Condition of participation: Discharge planning. 105 - Admission and Discharge Chap. Interpretive Guidelines §482.43 . For those patients discharged home and referred for HHA services, or for those patients transferred to a SNF for post-hospital extended care services, or transferred to an IRF or LTCH for specialized hospital services, the following requirements apply, in addition to those set out at paragraphs (a) and (b) of this section: (1) The hospital must include in the discharge plan a list of HHAs, SNFs, IRFs, or LTCHs that are available to the patient, that are participating in the Medicare program, and that serve the geographic area (as defined by the HHA) in which the patient resides, or in the case of a SNF, IRF, or LTCH, in the geographic area requested by the patient. Hospital Regulations Chap. If the COVID-19 affected resident is stable and the facility has a dedicated unit, the resident must be transferred there. Since 1983, California Advocates for Nursing Home Reform has been fighting for the rights of long term care residents in California. Data are received from ten acute care (11 prior to 2018) hospitals, two psychiatric hospitals, and one rehabilitation hospital in Rhode Island. The Executive Order clarifies that if a nursing home cannot implement effective and reliable infection control procedures, it must not create or maintain a dedicated unit. Nov 27, 2017. If a resident is hospitalized due to COVID-19 and becomes stable, the hospital must conduct testing prior to discharge back to the facility. Hospitals and physicians are typically represented by large and experienced law firms who know how to delay and deny claims. Specifically, a hospital ⦠(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. (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. The hospital must not specify or otherwise limit the qualified providers or suppliers that are available to the patient. If the long-term care facility has a unit dedicated to the care and isolation of COVID-19 affected residents (a “dedicated unit”), then the resident must be transferred to the dedicated unit. Medicare patients must request a written discharge notice ("The Important Message from Medicare") if they disagree with discharge. It requires hospital Emergency Departments that accept payments from Medicare to provide an appropriate medical screening examination (MSE) to anyone seeking treatment for a medical ⦠On May 20, 2020, Governor Gretchen Whitmer issued Executive Order 2020-95, which updates precautionary and notification requirements for long-term care facilities to protect residents and employees from the spread of COVID-19.Executive Order 2020-95 rescinds Executive Order 2020-84, ⦠32 Caregiver Advise, Record and Enable Act. Nursing homes are required to make all reasonable efforts to create a designated unit within the nursing home. Congratulations to the attorneys of the Health Care practice group at Foster Swift Collins & Smith, PC for their inclusion in the Best Lawyers in America 2021 edition. On May 20, 2020, Governor Gretchen Whitmer issued Executive Order 2020-95, which updates precautionary and notification requirements for long-term care facilities to protect residents and employees from the spread of COVID-19. Hospital Discharge Planning Law and Guidance Whether a hospital admission is planned or unexpected, the hospital discharge process can be a worrying time for patients and their families. If a COVID-19 affected resident is not medically stable, a long-term care facility is required to transfer them to a hospital. For further questions concerning this article, contact one of the authors below. (a) Standard: Discharge planning process. If the facility does not have a dedicated unit, the resident should be transferred to a regional hub, an alternate care facility, or an available swing bed at a hospital. (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. The facility must take necessary precautions to ensure adequate disinfecting and cleaning, and provide employees with personal protective equipment (PPE) and hand sanitizer. Talk to the QIO. Financial interests that are disclosable under Medicare are determined in accordance with the provisions of part 420, subpart C, of this chapter. 1262.5. State law requires that every hospital have a written discharge planning policy and process.3Hospitals must: 1. â[make] Arrangements for post-hospital care ⦠including care at home, in a skilled nursing facility, or intermediate care facility ⦠[must be] made prior to discharge for patients who are likely to su⦠Executive Order 2020-95 recognizes that many residents have voluntarily obtained housing outside the facility due to the risk of COVID-19 spreading rapidly through the facility. II. “Long-term care facility” includes a nursing home, home for the aged, adult foster care facility, or assisted living facility. In such a case, the hospital must develop a discharge plan for the patient. If the presence of a COVID-19 affected resident is identified, the facility must inform employees as soon as reasonably possible, and no later than 12 hours after identification. 51 - General Provisions Chap. Employees who test positive or display any of the principal symptoms of COVID-19 must stay home and the facility may not discipline or retaliate against them for doing so. During the length of Executive Order 2020-95, long-term care facilities may not evict or involuntarily discharge a resident due to nonpayment or otherwise deny them access to the facility. Protections for Both Residents and Employees. This care may be self care, care by family members, home health assistance or ⦠discharge planning evaluation indicates a need for a discharge plan.