Guideline text:
(Rev. 200, Issued: 02-21-20; Effective: 02-21-20, Implementation: 02-21-20)

§482.43(a)(5) - Any discharge planning evaluation or discharge plan under this paragraph must be developed by or under the supervision of a registered nurse, social worker, or other appropriately qualified personnel.

## Interpretive Guidelines §482.43(a)(5)

Guidance is pending and will be updated in future release.

(Rev. 87, Issued: 07-19-13, Effective: 07-19-13, Implementation: 07-19-13)

§482.43(b)(5) - The hospital personnel must complete the evaluation on a timely basis so that appropriate arrangements for post-hospital care are made before discharge, and to avoid unnecessary delays in discharge.

## Interpretive Guidelines §482.43(b)(5)

After a patient has been identified as needing an evaluation, or after a request for an evaluation has been made by the physician, patient and/or patient's representative, the evaluation must be completed timely.  This means there must be sufficient time after completion to allow arrangements for post-hospital care to be made, without having to delay the patient's discharge in order to do so, or requiring the patient to transfer to a different setting from where he/she was admitted from primarily due to the delay in making appropriate arrangements.  The comparatively short average length of stay of a short term acute care hospital inpatient necessitates prompt attention to patients' discharge planning needs in that type of hospital.  Failure to complete the evaluation in a timely manner could make it more difficult to implement the patient's final discharge plan, and/or may cause an unnecessary delay in the patient's discharge from the hospital.  While other types of hospitals with a longer average length of stay may be able to complete the evaluation at a later point after admission, they too must complete it on a timely basis to avoid delays in discharge.

Where a team approach is utilized by the hospital in developing the discharge planning evaluation, there must be a process to promote efficient collaboration among team members to complete the evaluation in a timely manner.  Changes in patient condition throughout the hospitalization warrant adjustments to the discharge plan.

## Survey Procedures §482.43(b)(5)

- Review a sample of cases to determine if the discharge planning evaluation was completed on a timely basis to allow for appropriate arrangements to be made for posthospital care and to avoid delays in discharge.  In order to assess this:
- Determine when the discharge planning evaluation was initiated.  If the evaluation was not begun within 24 hours of the request or identification of the need for an evaluation, ask why.
- Is there a pattern of delayed start or completion of the evaluation?  If so, is the delay due to circumstances beyond the hospital's control (e.g., inability to reach the beneficiary's support person(s), continuing changes in the patient's condition) and/or is the delay due to the hospital's failure to develop timely discharge planning evaluations?

Structured rule (JSON):
{"intent_tags": ["safety", "quality", "compliance"], "logic_config": {"anchor": "patient discharge", "max_delay_minutes": 0, "target": "discharge planning evaluation completion"}, "rule_type": "temporal", "scope_tags": ["clinical", "facility", "legal"]}