Source: https://www.medicareadvocacy.org/medicare-and-discharge-planning-thinking-through-your-needs/
Timestamp: 2019-04-21 12:19:46+00:00

Document:
Discharge planning is an important tool for reviewing and making arrangements for on-going healthcare needs across healthcare settings, including hospitals, skilled nursing facilities, home health, or hospice. When focusing on discharge planning, beneficiaries and their advocates should carefully read all documents that purport to explain rights to services, including discharge evaluations and discharge planning documents. They should also question treating physicians, nurses, social workers, home health and hospice care providers about necessary services as the beneficiary's condition improves or declines, and voice opinions and concerns about care; and participate fully in all care decisions. They should also be aware of appeal rights should problems arise.
The Centers for Medicare & Medicaid Services (CMS) is in the final stages of developing a checklist called "Planning for Your Discharge."  Focus groups have been meeting throughout the year to review and refine the document. When completed, the checklist will be offered as a tool to be used by beneficiaries and their families to work with their providers in preparation for a discharge from a health care setting. The checklist will be an important starting point for beneficiaries and their advocates in focusing on the specifics of discharge planning.
The checklist re-emphasizes the importance of talking to healthcare providers about where one is to go following care in a particular healthcare setting, as well as the need to consider how, and by whom, care will be provided after such transitions.
the beneficiary's level of understanding of what insurance will cover for prescription drugs, equipment, and services that will be needed, and what the beneficiary will have to pay.
The CMS checklist also states that if the Medicare beneficiary feels that he or she is being asked to leave a hospital or other health care setting too soon, the beneficiary may have appeal rights and should contact the Quality Improvement Organization (QIO)  for an explanation of those rights. Beneficiaries should always be aware of the importance of appeal rights in assuring that proper attention has been given to their care needs as they move through various care settings. Planning issues are often linked to the question of whether a discharge is occurring too soon, or is otherwise inappropriate. In many instances, such needs and concerns are not properly addressed without resorting to an appeal.
Discharge planning discussions should begin on admission. Beneficiaries and their representatives should look for, and carefully review, the "Important Message from Medicare" (IM) which is given to beneficiaries upon admission to a Medicare-participating hospital.  The IM is a general notice that explains a variety of rights, including the right to discharge planning services. The "Medicare Discharge Rights" segment of the IM is on the front of the notice and comprises a significant portion of that initial page.
When a hospital issues a notice of a proposed discharge, it will give the beneficiary a second copy (follow-up) of the "Important Message from Medicare," which contains information about how to appeal the proposed discharge.  If the beneficiary thinks the proposed discharge is inappropriate, the beneficiary or his or her advocate should make that known to the hospital. Once this is done, the hospital is required to issue the beneficiary a "Detailed Notice of Discharge.  This notice includes language that explains that it is a hospital-initiated notice and not an official Medicare decision and that the beneficiary has the right to have the appropriateness of the discharge reviewed by the Quality Improvement Organization for a formal Medicare decision.
The discharge planning check list heightens CMS's emphasis on the importance of discharge planning. In conjunction with the discharge planning rights outlined above, it gives beneficiaries and their advocates more tools to use in assuring that beneficiaries receive the healthcare services they need as they move from care setting to care setting.
 The telephone number for the QIO in each state can be obtained by calling 1-800-MEDICARE (1-800-633-4227) or by visiting www.medicare.gov.
See 42 U.S.C §1395x(ee); 42 C.F.R. §482.43 (Condition of participation: Discharge planning). For a detailed discussion of discharge planning, including transitions, see Chiplin, "Breathing Life into Discharge Planning," The Elder Law Journal, Univ. of Illinois College of Law, Vol. 13, No. 1 (2005). See also https://www.medicareadvocacy.org/Archives/ArchivedPages/Discharge_BreathingLifeIntoDischargePlanning06.22.04.PDF; see also, Alfred J. Chiplin, Jr., Medicare Discharge Planning Regulation: An Advocacy Tool for Beneficiaries, 29 Clearinghouse Rev. 152-152-61 (1995) . Note, some states have discharge planning laws which may provide valuable options and are cited in the articles mentioned above.
See 42 U.S.C §1395x(ee); 42 C.F.R. §482.43.
 See 42 C.F.R. §405.1205 (traditional Medicare) and 42 C.F.R. §422.620 (Medicare Advantage). A copy of the IM can be found in the Medicare agency’s collection of forms which is available at www.cms.gov (for researchers and other professionals).
 42 .C.F.R. §405.1205(c)(1); 42 .C.F.R. §422.620(c)(1). Follow-up notice is not required if the provision of the admission IM falls within 2 calendar days of discharge. 42 .C.F.R. §405.1205(c)(2); 42 .C.F.R. §422.620(c)(2).
See CMS Form No. 10066 (approved 5/2007), available in the CMS collection of forms available through www.cms.gov.
42 C.F.R. §405.1200 et seq.
 42 U.S.C. §1395f(a); 42 C.F.R. §405.1200 et seq. The beneficiary must file an expedited appeal with a QIO by noon of the day of receipt of the notice from the HHA. The QIO has 72 hours in which to make a determination. 42 C.F.R. §405.1202.
 42 U.S.C. §1395bbb (a)(1)(A), 42 C.F.R. §484.10(c)(1) and (2). Notice in this context must be given to the beneficiary at least 2 days before the loss of service is to occur. 42 C.F.R. §1200(b)(1).

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