Absence of Hospital Discharge Planning For Community-Based Services; Is CMS Ignoring an Olmstead Violation?

Steve Gold Information Bulletin #310 (4/10) In the previous Information Bulletin, "Want to Save Medicaid Expenditures," one of the suggestions was:

"Pursuant to the federal Medicaid statutes, acute care hospitals as a 'Condition of Participation' must do 'discharge planning.' HHS/CMS must prohibit federal Medicaid reimbursement to hospitals that, as part of their 'discharge planning,' do not notify a state Medicaid office, well in advance of patient discharge, that a patient will require LTC. Timing is critical so that the State Medicaid officials can meet, discuss, and offer community based services."

Why did we make this suggestion? It was made to ensure that people are not dumped from hospitals and become unnecessarily institutionalized in nursing homes. The critical point of diverting people from nursing homes is at the point of hospital discharge. 60.4% of folks going into nursing facilities come directly from acute care hospitals. The lack of any real discharge planning in hospitals today is a scandal that has gotten little public attention nor from HHS/CMS.

Let's look at what HHS/CMS could have been implementing and requiring since 1994 - 6 years before the Olmstead decision. Discharge planning is one "Condition of Participation" required for hospitals which treat all Medicare and Medicaid patients.

According to federal regulations, 42 CFR part 482, which have the force of law, a hospital must:

(1.) Identify, at an "early stage of hospitalization," persons who are "likely to suffer adverse heath consequences upon discharge if there is no adequate discharge planning."

HHS/CMS - Is unnecessary institutionalization and the violation of Olmstead an adverse consequence?

(2.) Include discharge plans with an "evaluation of the likelihood of a patient needing post-hospital services and of the availability of [post hospital] services."

HHS/CMS - "availability" requires hospital have knowledge of MA Home and Community-based services. Why not, by rule, require hospitals to notify the State Medicaid office at the "early stage" of discharge planning, so patients can be offered a real choice, including community-based services.

(3) Discharge plans must be completed "on a timely basis so that appropriate arrangements for post-hospital care are made before discharge."

HHS/CMS - we assume you agree that "appropriate" includes community-based services? So why aren't you, by rule, telling the hospitals and requiring that they must, during the discharge planning process, offer services in the "most integrated setting".

(4) Discharge plans must be recorded in the patient's record.

Hmmm. That should be easy to check. HHS/CMS - here's a suggestion. Use the MDS information, which CMS collects quarterly, which shows 60.4% of the people in nursing homes were admitted directly from an acute care hospital. Randomly pick a few states and, based on the MDS data, identify from which acute care hospitals the greatest number of nursing home residents come from. Then, go back to those hospitals and review the records of those that were placed in nursing homes. See if these hospital records have any reference to any discharge planning for the individual. If there was discharge planning, were community services offered, or were they just sent to nursing homes. Maybe you could even talk to the nursing home residents and ask them what the hospital did, if anything, other than put them in a nursing home.

HHS/CMS - you have the authority to withhold Medicare and Medicaid prospective funds for hospitals that are dumping folks into nursing facilities, instead of providing a choice of services in the community. You have the authority to revoke provider agreements for violating the Condition of Participation to provide real discharge planning.

HHS/CMS - stop the "hear no evil, see no evil, speak no evil." Find out what's really happening with "discharge planning."

WHAT WE CAN DO:
HHS/CMS needs to hear from all the aging and disability advocates when abuses of discharge planning occurs. Let your regional HHS office know when these abuses occur.

CELEBRATE THE 20TH ANNIVERSARY OF THE ADA
RIGHTS WORTH FIGHTING FOR!

Steve Gold,

The Disability Odyssey continues