[Code of Federal Regulations]

[Title 42, Volume 3]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR482.43]



[Page 497-498]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 482_CONDITIONS OF PARTICIPATION FOR HOSPITALS--Table of Contents

 

                   Subpart C_Basic Hospital Functions

 

Sec. 482.43  Condition of participation: Discharge planning.



    The hospital must have in effect a discharge planning process that 

applies to all patients. The hospital's policies and procedures must be 

specified in writing.

    (a) Standard: Identification of patients in need of discharge 

planning. The hospital must identify at an early stage of 

hospitalization all patients who are likely to suffer adverse health 

consequences upon discharge if there is no adequate discharge planning.

    (b) Standard: Discharge planning evaluation. (1) The hospital must 

provide a discharge planning evaluation to the patients identified in 

paragraph (a) of this section, and to other patients upon the patient's 

request, the request of a person acting on the patient's behalf, or the 

request of the physician.

    (2) A registered nurse, social worker, or other appropriately 

qualified personnel must develop, or supervise the development of, the 

evaluation.

    (3) The discharge planning evaluation must include an evaluation of 

the likelihood of a patient needing post- hospital services and of the 

availability of the services.

    (4) The discharge planning evaluation must include an evaluation of 

the likelihood of a patient's capacity for self-care or of the 

possibility of the patient being cared for in the environment from which 

he or she entered the hospital.

    (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.

    (6) The hospital must include the discharge planning evaluation in 

the patient's medical record for use in establishing an appropriate 

discharge plan and must discuss the results of the evaluation with the 

patient or individual acting on his or her behalf.

    (c) Standard: Discharge plan. (1) A registered nurse, social worker, 

or other appropriately qualified personnel must develop, or supervise 

the development of, a discharge plan if the discharge planning 

evaluation indicates a need for a discharge plan.

    (2) In the absence of a finding by the hospital that a patient needs 

a discharge plan, the patient's physician may request a discharge plan. 

In such a case, the hospital must develop a discharge plan for the 

patient.

    (3) The hospital must arrange for the initial implementation of the 

patient's discharge plan.

    (4) The hospital must reassess the patient's discharge plan if there 

are factors that may affect continuing care needs or the appropriateness 

of the discharge plan.

    (5) As needed, the patient and family members or interested persons 

must be counseled to prepare them for post-hospital care.

    (6) The hospital must include in the discharge plan a list of HHAs 

or SNFs that are available to the patient, that are participating in the 

Medicare program, and that serve the geographic area (as defined by the 

HHA) in which the patient resides, or in the case of a SNF, in the 

geographic area requested by the patient. HHAs must request to be listed 

by the hospital as available.

    (i) This list must only be presented to patients for whom home 

health care or post-hospital extended care services are indicated and 

appropriate as determined by the discharge planning evaluation.

    (ii) For patients enrolled in managed care organizations, the 

hospital must indicate the availability of home health and posthospital 

extended care services through individuals and entities that have a 

contract with the managed care organizations.



[[Page 498]]



    (iii) The hospital must document in the patient's medical record 

that the list was presented to the patient or to the individual acting 

on the patient's behalf.

    (7) The hospital, as part of the discharge planning process, must 

inform the patient or the patient's family of their freedom to choose 

among participating Medicare providers of posthospital care services and 

must, when possible, respect patient and family preferences when they 

are expressed. The hospital must not specify or otherwise limit the 

qualified providers that are available to the patient.

    (8) The discharge plan must identify any HHA or SNF to which the 

patient is referred in which the hospital has a disclosable financial 

interest, as specified by the Secretary, and any HHA or SNF that has a 

disclosable financial interest in a hospital under Medicare. Financial 

interests that are disclosable under Medicare are determined in 

accordance with the provisions of Part 420, Subpart C, of this chapter.

    (d) Standard: Transfer or referral. The hospital must transfer or 

refer patients, along with necessary medical information, to appropriate 

facilities, agencies, or outpatient services, as needed, for followup or 

ancillary care.

    (e) Standard: Reassessment. The hospital must reassess its discharge 

planning process on an on-going basis. The reassessment must include a 

review of discharge plans to ensure that they are responsive to 

discharge needs.



[59 FR 64152, Dec. 13, 1994, as amended at 69 FR 49268, Aug. 11, 2004]