CMS Delays Revising Hospital Discharge Planning Requirements

Hospitals and home health agencies that wanted policymakers to clear up the dos and don’ts of discharge planning are likely facing a longer wait.

The Centers for Medicare & Medicaid Services (CMS) opted Friday to extend its timeline for revising hospital discharge planning requirements until at least November 2019.

As currently set up, hospital discharge planning policies largely prioritize patient choice. That approach, however, that has led to questions about how much information and direction discharge planners can actually provide.


“I think it’s definitely a good idea to give discharge planners more leeway,” Nataly Koshev, administrator of the Illinois-based home health company Advanta, told Home Health Care News in July. “But, at times, discharge planners may have their own agenda, their own friends and acquaintances, people who they may have known in the past who now work for home health agencies.”

CMS officials originally proposed to revise discharge planning requirements in November 2015.

They did so while also pushing for the implementation of discharge planning requirements of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, an Obama-era piece of legislation that required hospitals, home health agencies, skilled nursing facilities and other post-acute care providers to take into account quality measures while assisting patients and families during discharge panning.


The goal of the IMPACT Act was to encourage individuals to become more active participants in the planning of their transition to the post-acute care setting.

CMS received hundreds of public comments in response to its proposed rule, with commenters including individuals, health care professionals and corporations, national associations and coalitions, state health departments, patient advocacy organizations, and facilities that would potentially be affected by any discharge planning changes.

“Commenters presented procedural and cost information related to their specific circumstances, and the information presented requires additional analysis,” CMS officials wrote in a Friday Federal Register notice on the extension. “Based on both public comments received and stakeholder feedback, we have determined that there are significant policy issues that need to be resolved in order to address all of the issues raised by public comments to the proposed rule and to ensure appropriate coordination with other government agencies.”

Under federal rulemaking procedures, the timeline for publishing final regulation cannot exceed three years from the data of publishing proposed regulation — unless there are exceptional circumstances.

The decision to extend its timeline on clearing up discharge planning requirements should not be viewed as “a diminution” on the agency’s commitment to timely and effective rulemaking in the area, CMS officials noted.

The Medicare Payment Advisory Commission (MedPAC) has been among the groups calling for more clearly defined discharge planning dos and dont’s.

In general, hospital discharge planning and referral patterns have fallen into MedPAC’s spotlight because star ratings on Home Health Compare aren’t steering patients toward the highest quality providers. As a way to possibly address that shortcoming, MedPAC argues that CMS should consider giving discharge planners more authority and flexibility in terms of guiding patients out of hospitals and toward top home health agencies.

Current rules that strongly emphasis patient choice have left some hospital discharge planners worried about overstepping their role, according to MedPAC.

The vast majority of beneficiaries who use home health agency services after a discharge have at least one nearby provider with a higher quality score than the provider from which they ultimately receive services, a MedPAC review of referral patterns found.

Written by Robert Holly

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