Home Health & Hospice Week

Step 1: Decide on your definition of ‘all necessary medical information.’

If you are complying with the Home Health Conditions of Participation on discharge planning that took effect last year, you’re already mostly covered on the discharge planning front. But you will need to take on a few new tasks in the wake of a newly published final rule on the topic.

Back in 2015, the Centers for Medicare & Medicaid Services proposed a wide-ranging discharge planning rule for hospitals and post-acute care providers. The final rule was due in 2018, but CMS delayed publication for a year.

Then: Two of the proposed provisions that drew the most fire from home health agencies were a lengthy list of required elements for the discharge/transfer summary, and a requirement to involve the physician in the HHA discharge planning process, CMS notes in the final rule published in the Sept. 30 Federal Register.

Now: Home care providers are happy to see that the final rule omits both of those provisions. CMS scraps the detailed list of 22 items in the discharge/transfer summary as overly burdensome without proof that it is useful (see Eli’s HCW, Vol. XXVIII, No. 34).

Instead, the discharge planning rule now simply requires that “the HHA must send all necessary medical information pertaining to the patient’s current course of illness and treatment, post-discharge goals of care, and treatment preferences, to the receiving facility or health care practitioner to ensure the safe and effective transition of care.”

The rule explains that “the impracticality and potential ineffectiveness of such a list of mandatory discharge or transfer summary elements developed in the absence of public consensus and evidence-based practices would not improve patient care and safety, nor would it assure the efficient use of HHA resour- ces.” Implementing the broader, more flexible “all necessary medical information” standard instead “allows HHAs to tailor the exchange of information to the exact circumstances and needs of the care transition in order to support the patient’s post- discharge goals,” CMS says.

Remember: HHAs should use the golden rule when crafting their discharge summaries, CMS exhorts. “It is just as important for the receiving health care practitioner to be sent the discharge information as it is for the HHA to receive such information from the patient’s previous care provider,” the rule says. “For continuity of care and a smooth transition from the HHA, we believe the discharge summary will provide invaluable information to the receiving practitioner/facility to continue to meet the patient’s care needs.”

Your duties aren’t quite done with the discharge summary, however. The CoP on discharge planning at 484.58 will now read “the HHA must comply with requests for additional clinical information as may be necessary for treatment of the patient made by the receiving facility or health care practitioner,” the rule finalizes.

“This change will assure that receiving facilities and practitioners have access to this information as needed, while not overburdening HHAs to preemptively provide such a potentially large volume of information that may not be helpful to receiving practitioners and facilities,” CMS explains

As for the contentious requirement to involve the physician in discharge planning, that topic was already addressed by the CoP changes that took effect last year, CMS notes in the new final rule. The “HHA CoP final rule requires HHAs to communicate with all relevant parties, including physicians who are involved in the patient’s HHA plan of care, whenever there are revisions related to the plan for patient discharge. We believe that this requirement … accomplishes the goal of HHA- physician communication regarding discharge. As such, we believe that this separate discharge planning requirement is no longer necessary.”

But watch out: CMS may not have given up the idea for good. “It was … not our intent to potentially strain HHA-physician relationships,” the discharge planning final rule acknowledges. But “this issue warrants further study and a better developed evidence base before we proceed further with rulemaking.”

CMS also lets go of proposed requirements for providers “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,”

notes attorney Debra McCurdy with Reed Smith in Washington, D.C., in online analysis of the rule. CMS also won’t “require providers to use or access PDMPs during the medication reconciliation process,” McCurdy says.

Rule Costs HHAs The Most

While HHAs’ discharge planning burdens are significantly lifted compared to the proposed rule, it’s still the home care industry that will shoulder most of the cost of the rule’s changes, McCurdy points out.

The new discharge planning process will cost $214 million annually, with another $1.5 million to respond to requests for further information, CMS estimates in the rule. In contrast, hospitals have no additional costs due to the rule.

HHAs will also see one-time costs of $10.8 million in implementing the rule, compared to $17.7 million for hospitals and $1.9 million for critical access hospitals, CMS estimates.

Note: The final rule is at www.govinfo.gov/content/pkg/FR-2019-09-30/pdf/2019-20732.pdf.