The Centers for Medicare & Medicaid Services (CMS) released a final rule Thursday that makes changes to discharge planning requirements for home health providers. Broadly, the changes are part of CMS’s efforts to make patients a more active part of their care transitions out of the hospital and into other settings.
“This delivers on President Trump’s executive order on promoting health care choice and competition,” CMS Administrator Seema Verma said during a Thursday press call. “It represents a step forward in interoperability and the MyHealthEData Initiative.”
Home health providers have long called for policymakers to clarify the ins and outs of discharge planning, and some in the industry had expected CMS to update guidelines last year.
In November 2018, however, CMS said it was delaying taking that step. Thursday’s news comes a few months shy of CMS’s November 2019 target for an updated final rule on discharge planning.
Under CMS’s newly announced discharge planning rule, patients and their families are required to have access to information that will support them in making informed decisions about their post-acute care (PAC) options, including data on quality measures and data on resource use measures.
The rule also requires home health agencies to provide relevant data on quality measures and resource use measures to the patient and caregiver about their goals of care and treatment preferences.
Additionally, CMS will now require the evaluation of a patient’s discharge needs and discharge plan to be documented in a timely manner. The evaluation must be included in the clinical record and discussed with the patient or their representative — and all relevant patient information from the provider will also need to be incorporated into the discharge plan to avoid delays.
“Care transitions are a vulnerable time in a patient’s care,” Verma said. “If they aren’t handled properly, the unwelcome result is often a costly readmission or poor patient outcome. Patients who are discharged from an acute care setting need and deserve to know how they’re transition will be handled. This rule makes that reality.”
Although CMS is calling for patients to be given more information about post-acute care options following a hospital stay, it is still maintaining its commitment to anti-steering regulations.
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. Many planners have traditionally been wary of crossing that line, sometimes leaving patients in the dark.
“I don’t think that this impacts [anti-steering],” Verma said. “This is about making sure that the patients have information about what happened in the hospital so that when they go to a post-acute provider, they are able to have that information for the provider.”
Officials from the National Association for Home Care & Hospice (NAHC) called the rule “expected,” adding that it implements requirements outlined in the IMPACT Act.
“CMS did not finalize some of the more burdensome requirements that were proposed, such as prescribing when the home health discharge plan is to be re-evaluated and prescribing what information must be sent to the receiving provider,” Mary Carr, vice president for regulatory affairs at NAHC, said in an emailed statement to Home Health Care News. “Concepts related to patient preference, goals and needs of each patient along with patient participation in discharge planning are key concepts that are already part of the [home health Conditions of Participation] in overall care planning.”
In some ways, the final rule addresses the Medicare Payment Advisory Commission (MedPAC) findings surrounding home health referrals.
Last year, MedPAC found that home health patients rarely choose the highest quality providers in their neighborhood after being discharged from the hospital.
“Concern about protecting patient choice … makes some discharge planners cautious in the assistance they provide, even when patients ask for their opinion,” stated MedPAC in its June 2018 report. “Hospital and health system representatives have been concerned that [CMS’s CoPs] do not adequately define permissible educational activities that respect the beneficiary’s freedom to select a PAC provider.”
Overall, more than 94% of beneficiaries who use home health agency services after being discharged from the hospital have at least one provider within a 15-mile radius with a higher quality score than the provider they ultimately end up choosing, according to MedPAC.
On top of that, 70% of beneficiaries have five or more home health agencies in their area known to provide better quality care.
“Medicare statute provides beneficiaries with the freedom to choose their PAC provider, and the laws state that hospitals may not recommend providers,” MedPAC senior analyst Evan Christman noted in a March 2018 public meeting. “The IMPACT Act created a new requirement that hospitals use quality data during the discharge planning process and provide it to beneficiaries. But regulations implementing this new requirement have not been finalized.”
Read the full text of the final discharge rule here.