On June 6, 2023, the Center for Medicare and Medicaid Services (“CMS”) released a Quality Safety & Oversight memorandum (“QSO Memo”) reminding state survey agencies, accrediting organizations, and hospitals of the requirements for discharges and transfers to post-acute care (“PAC”) providers. 

The standard for hospital discharge planning is set forth in 42 CFR 482.43, which requires a hospital to have “an effective discharge planning process that focuses on the patient’s goals and treatment preferences and includes the patient and his or her caregivers/support person(s) as active partners in the discharge planning for post-discharge care.”  Moreover, the hospital “must discharge the patient, and also transfer or refer the patient where applicable, along with all necessary medical information pertaining to the patient’s current course of illness and treatment, post-discharge goals of care, and treatment preferences, at the time of discharge, to the appropriate post-acute care service providers and suppliers, facilities, agencies, and other outpatient service providers and practitioners responsible for the patient’s follow-up or ancillary care.”  42 C.F.R. 482.43(b). 

PAC providers may not be equipped or trained to care for certain conditions that apply to patients whose information they were not previously informed of by the hospital and have accepted for transfer and admission.  As a result, CMS finds these situations can cause avoidable readmissions, complications, and other adverse events.  Specifically, CMS identifies a concern regarding the information PAC providers, including skilled nursing facilities and home health agencies, receive from hospitals.  In the QSO Memo, CMS specifically identifies certain areas of concern relating to missing or inaccurate patient information, including the following:

  • A comprehensive list of all medications that have been prescribed to a patient during, and prior to, their hospital stay.
  • Information about skin condition, including pressure ulcers, bruising or lacerations, as well as instructions or treatments or dressings.
  • Durable medical equipment, such as high-flow oxygen used for respiratory treatments.
  • The patient’s preferences and goals for care, including any advance directives for end-of-life care; and
  • The patient’s needs at home or home environment.

CMS advises state agencies and accrediting organizations, when conducting surveys, to be alert to the common issues identified above and ensure these discharges are occurring in a compliant and safe manner.

In order to protect patients’ health and safety, CMS has issued recommendations that hospitals can leverage to improve their discharge policies and procedures.  Hospitals have discretion to develop their own policies and procedures to meet the requirements – but should consider the following recommendations set forth by CMS:

  • Collaborate with PAC providers on standardized processes or forms that are used during discharges, such as the InterACT hospital to post-acute care transfer form.
  • Conduct case reviews of previous discharges to improve the outcomes of future discharges.
  • Use resources to improve policies and procedures, such as the Agency for Healthcare Research and Quality’s Re-Engineered Discharge Toolkit

Notably, CMS recommends policies and procedures that enable access to patient information in electronic health records across hospitals and PAC providers; this way providers can access the necessary information to improve transitions.  Under conditions of participation, a hospital is required to demonstrate it has made “a reasonable effort to ensure that the system [electronic medical records system or other electronic administrative system] sends the notifications to all applicable post-acute care services providers and suppliers…” 42 C.F.R. 482.24(d)(5).

The QSO Memo is effective as of June 6, 2023. 

Reed Smith will continue to follow developments related to hospital and post-acute care regulations. If you have questions about compliance with the QSO Memo or anything related to hospital discharge, please contact the health care lawyers at Reed Smith.