CMS releases final discharge planning rule that includes record access requirements

Emergency Department
CMS issued a long-awaited final rule that outlines how hospitals must plan for patient discharges. (Studio 642/Getty Images)

The Trump administration issued a long-awaited final rule on how hospitals must handle discharge planning, introducing new requirements on records access.

The rule released on Thursday by the Centers for Medicare & Medicaid Services requires hospitals, home health agencies and inpatient rehab facilities to also focus on patient goals and treatment preferences when a patient is discharged.

Hospitals are required to provide patients with information on post-acute care provider choices, including quality scores for each provider.

“Patients will no longer be an afterthought; they’ll be in the driver’s seat, playing an active role in their care transitions to ensure seamless coordination of care,” said CMS Administrator Seema Verma in a statement Thursday.

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Hospitals must provide for patients their medical records upon request and in an electronic format if called for. 

The rule also includes new requirements mandated by the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. The law requires long-term care hospitals, skilled nursing facilities, home health agencies and inpatient rehab facilities to submit standardized data to CMS on quality measures related to discharge, hospitalization and Medicare spending per beneficiary.

The law also required hospitals to factor in quality measures when assisting patients and families during discharge planning. The new requirements go into effect within 60 days.

The agency added that hospitals and critical access hospitals are “already conducting most of the revised discharge planning requirements, with the exception of the discharge planning requirements of the IMPACT Act.”

The hospital and home health industries has been waiting a while for the final rule, as CMS had published the proposed rule back in November 2015. In November 2018, CMS extended the timeline for publishing the final rule because public comments raised “significant policy issues that need to be resolved.”

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The rule has some major differences with the proposed version released back in 2015. For one thing, CMS dropped a mandatory requirement for providers to access their state’s prescription drug monitoring program (PDMP) while discharge planning.

The agency said in the rule that some facilities complained in comments that they didn’t have access to their state’s PDMP or their state didn’t have one at all. But CMS said that states should look into strategies such as a PDMP to help reduce prescription drug misuse.

CMS also scrapped a proposal to establish a new standard in discharge planning regulations that would require hospital medical and nursing staff as well as leadership to provide input in the development of discharge planning processes.

However, most comments received on this proposal warned CMS that the new standard would create a burdensome requirement, according to the final rule text. Instead, CMS is encouraging hospitals to include any of the factors they originally proposed.