Repisodic is providing a road map to hospital leaders in care management to prepare for the end of the COVID-19 waivers and to begin moving forward to reestablishing previous health and safety standards in care transitions and hospital discharge planning.
Throughout the COVID-19 public health emergency (PHE), The Centers for Medicare and Medicaid Services (CMS) has used a combination of emergency authority waivers, regulations, enforcement discretion, and sub-regulatory guidance to ensure access to care and give health care providers the flexibilities needed to respond to COVID-19 and help keep people safer. Many of these waivers and broad flexibilities will terminate at the eventual end of the PHE, as they were intended to address the acute and extraordinary circumstances of a rapidly evolving pandemic and not replace existing requirements.
The current end date of the PHE is October 15, 2022. However, another 90-day extension is expected as the HHS Secretary Xavier Becerra said he would give hospitals at least a 60-day notice before ending the PHE. Even though the PHE is likely to last into early 2023, CMS is encouraging healthcare systems to prepare for the return to pre-pandemic health and safety standards and regulatory processes.
With the end of the PHE in sight, Medicare has developed a roadmap that details all of the PHE blanket waivers that will terminate once the PHE is over. The agency has also released a series of fact sheets to help providers prepare for the end of the PHE. The fact sheets summarize the status of Medicare blanket waivers and flexibilities by provider type.
What Waivers are Ending for Case Management and Hospital Discharge Planning
Our team at Repisodic has reviewed the materials provided by CMS to assess the impact of the end of the PHE blanket waivers on hospital case management departments. Below we highlight the two waivers that are ending related to case management and hospital discharge planning:
Limit Discharge Planning for Hospitals
To allow hospitals more time to focus on increasing care demands, discharge planning has been focusing on ensuring that patients are discharged to an appropriate setting with the necessary medical information and goals of care. CMS has been waiving detailed regulatory requirements to provide information regarding discharge planning, as outlined in 42 CFR §482.43(a)(8), §482.61(e), and 485.642(a)(8). After the expiration of the PHE hospital, and CAH assists patients, their families, or the patient’s representative in selecting a post-acute care provider by using and sharing data that includes, but is not limited to, home health agency (HHA), skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), and long-term care hospital (LTCH) data on quality measures and data on resource use measures. These hospital types must ensure that the post-acute care data on quality measures and data on resource use measures is relevant and applicable to the patient’s goals of care and treatment preferences. During this public health emergency, a hospital may not be able to assist patients in using quality measures and data to select a nursing home or home health agency, but must still work with families to ensure that the patient discharge is to a post-acute care provider that is able to meet the patient’s care needs. CMS will end this waiver at the conclusion of the PHE.
Modify Discharge Planning for Hospitals
Patients must continue to be discharged to an appropriate setting with the necessary medical information and goals of care. To address the COVID-19 pandemic, CMS has been waiving certain, more detailed, requirements related to hospital discharge planning for post-acute care services at 42 CFR §482.43(c), so as to expedite the safe discharge and movement of patients among care settings, and to be responsive to fluid situations in various areas of the country. CMS has been waiving certain requirements for those patients discharged home and referred for HHA services, or for those patients transferred to a SNF for post-hospital extended care services, or transferred to an IRF or LTCH for specialized hospital services. For example, a patient may not be able to receive a comprehensive list of nursing homes in the geographic area, but must still be discharged to a nursing home that is available to provide the care that is needed by the patient. CMS will end this waiver at the conclusion of the PHE.
What this Means for Case Management and How Should Health Systems Prepare
Many leaders in case management will recall that in October 2019, CMS made significant changes to the Medicare Discharge Planning Regulations as part of the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). These rules were only in effect for a few months before the PHE provided blanket waivers for discharge planning, so it’s likely that many health systems never fully implemented policies and procedures to ensure compliance with the new regulations.
Now is the time for hospitals to start reviewing and updating their processes for discharge planning to prepare the end the PHE. Below are some of the questions that case management and compliance leaders should be asking about their current process for generating and presenting post-acute care options to patients as part of the discharge planning process:
– Does our list include those Medicare participating providers that serve the geographic area in which the patient resides (for HHAs) or (in the case of SNFs, IRFs, and LTCHs) the geographic area requested by the patient?
– Are accurate and up-to-date PAC quality and resource measures being shared with the patient?
– For patients enrolled in Medicare Advantage, does the hospital ensure that the patient is aware of a need to verify in-network coverage?
– If the hospital has the information on in-network providers, does the hospital share this information with the patient?
– Does the list identify any PAC in which the hospital has a disclosable financial interest?
The below infographic is a helpful roadmap for case management departments to set up compliant processes for Medicare Discharge Planning Regulations as the waivers expire:
If your hospital is looking for review and update their Medicare Discharge Planning processes, Repisodic offers an EHR-integrated platform that automates compliance with many of these requirements. See here or contact us to learn more.