{Agency Name}

DISCHARGE POLICY

Date:

Approved:

Purpose:

To establish uniform discharge criteria for all patients; to identify conditions under

which a client may be discharged, and to differentiate between routine and non-

routine discharges.

Definitions:

  • Routine discharge - termination of service(s) when goals of care have been met and client no longer requires home health care services (Optional: reference Medicare Denial Notices Policy)
  • Non-Routine Discharges: individual discharge type described below.
  • Emergency discharge - termination of service(s) due to the presence of safety issues which place the client and/or agency staff in immediate jeopardy and prevent the agency from delivering home health care services or due to lack of physician orders.
  • Premature discharge - termination of service(s) when goals of care have not been met and client continues to require home health care services;
  • Financial discharge - termination of service(s) when the client’s insurance benefits and/or financial resources have been exhausted. (Optional: Failure to meet Traditional Medicare’s Face to Face Encounter requirement effective 4/1/2011 meets criteria for financial discharge.)

Policy:

  • Discharge planning will be initiated upon admission to the agency.
  • Clients may be discharged from the agency if at least one of the following discharge criteria has been met. (Optional:For specific payer change processes, see “Guidelines for Discharge and Payer Source Changes.”)
  • Discharge Criteria
  • The established goals and objectives for care have been met.
  • The client/family refuses services or no longer desires services (client self- determination).
  • The client no longer meets admission criteria.
  • The client's condition has changed and/or the agency’s resources are such that the required care or services are beyond the scope, type, or quantity that can be provided by the agency.
  • The client has left the agency’s service area.
  • (Include if provide hospice services: The Hospice Medicare Benefit client has stabilized or is seeking aggressive treatment of his/her disease process.)
  • The client/family is no longer able or willing to cooperate with the established plan of care.
  • The client’s physician will not initiate or renew orders authorizing home care services.
  • The physical safety of the client or agency staff is in jeopardy (see procedure).
  • The client’s home environment will not support the provision of services.
  • Insurance benefits or financial resources have been exhausted.
  • Optional: For non-routine discharges, consider a pre-termination review using a multi-disciplinary approach.

Procedure:

  1. In the case of a routine discharge, the agency shall provide:
  2. Pre-discharge planning and instructions by the case manager, attendingphysician, or dentist and other agency staff involved in client’s care, which shall be documented in client’s clinical record.
  3. Notification to the physician each time one or more services are terminated, and when the client is discharged from the agency.
  4. A discharge summary will be completed and made available to the physician if requested.--***May need to change based on new CoPs***
  1. In the case of an emergency discharge, the agency shall immediately take all measures deemed appropriate to the situation to ensure client safety.
  2. In addition, the agency shall immediately notify the client or client’s representative, the client’s physician, and any other persons or agencies involved in the provision of home health care services.
  3. Written notification of action taken including client’s name, address, date and reason for emergency discharge shall be forwarded to the client and/or family and client’s physician within five (5) calendar days. (Optional: Send written notification by certified mail.)
  1. In the case of a premature discharge, the agency shall document that prior to the decision to discharge an interdisciplinary case conference was conducted (include client care staff, supervisory and administrative staff, client's physician, client and/or client representative, and representation from any other agencies involved in the plan of care.)
  2. Decision to continue service: If the decision of the case review is to continue to provide service, a written agreement shall be developed between the agency and the client or his/her representative to identify the responsibilities of both in the continued delivery of care for the client. This agreement shall be signed by the agency administrator/designee and the client or his representative. A copy shall be placed in the client’s clinical record with copies sent to the client and his or her physician.
  3. Decision to discharge from service: If the case review results in an administrative decision to discharge the patient from agency services, the administrator/designee shall notify the client and/or family and the client’s physician that services shall be discontinued in ten (10) days and the client shall be discharged from the agency.
  4. Services shall continue in accordance with the client’s plan of care to ensure client safety until the effective day of discharge.
  5. The agency shall inform the client in writing of the names of three (3) other home health agencies available to provide health care services.
  1. In the case of a financial discharge, the agency shall conduct:
  2. APre-termination Review whenever one or more home health services are to be terminated because of exhaustion of insurance benefits or financial resources.
  3. At least ten (10) days prior to such termination, there shall be a review of need for continuing home health care by the client, his/her representative, family caregivers, the supervisor of clinical services, the client’s physician or dentist, case manager and other staff involved in the client’s care.
  4. This determination and, when indicated, the plan developed for continuing care shall be documented in the client’s clinical record.
  5. A Post-termination Review: The clinical records of each patient discharged because of exhaustion of insurance benefits or financial resources shall be reviewed by the professional advisory committee or the clinical record review committee at the next regularly scheduled meeting following the discharge. The committee reviewing the record shall ensure that adequate post-discharge plans have been made for any patient with continuing home health care needs.
  1. Optional: The agency shall in the case of an emergency, premature or financial discharge notify the client of their right to appeal this decision within ten (10) calendar days of receiving the initial notification of the discontinuance of service. The agency shall consider all client appeals of discharge within ten (10) calendar days of receipt of the appeal. The agency’s administrator/designee shall make a final decision as to the appropriateness of the discharge.

For Medicaid clients who meet the"Refusal to Serve"criteriaPer Section 17b-262-7 of the Medicaid Home Health Provider Manual (refusal to accept a new client, a termination of service to an existing client, or an interruption of service to an existing client which lasts longer than 48 hours):

  1. All home health care agencies shall record each and every written or oral refusal to serve and suspension of service, including but not limited to discharges, including the date, the name and address of the patient or the reason why the name and address is unavailable, the reason for the refusal to serve, and identifying the support for this reason.
  2. If the stated reason for the refusal to serve is that there is an immediate danger to the health and safety of the home health care agency's personnel, the home health care agency shall, within 48 hours of the refusal to serve or discharge:
  3. Complete a form to be provided by the department (Home Health Agency Refusal to Serve, W-1004) detailing the timely, objective and substantial evidence on which the refusal to serve is based, the reasonable efforts taken to protect the home health care agency personnel, the geographic area covered by the refusal to serve, and the actual or expected duration of the refusal to serve;
  4. If the name and address of the client are known, send the client written notice of the refusal to serve in a form prescribed by the department (Home Health Agency Refusal to Serve (Client Notification), W-1002), which notice shall include the reason for the refusal to serve, the timely, objective and substantial evidence on which the refusal to serve is based, the length of time during which service shall be refused, the right of the client to file a complaint with the department; and informing the client of his or her right to seek legal advice if he or she feels his or her rights have been violated; and Department of Social Services Requirements of Payment for Home Health Services Provider Manual 3;
  5. Send the department a copy of the form with a copy of the notice to the client attached. If the department determines that the agency has failed to comply with these requirements, the home health care agency shall be notified in writing of such determination, and shall be required, within ten days of receipt of the notice, to submit, in writing, justification for its failure to comply based on legitimate non-discriminatory reasons in accordance with section 17b-262-8.
  6. The department shall review and monitor all forms prepared by home health care agencies pursuant to subsection (b) of section 17b-262-7, Refusal to Serve, to determine that the refusal to serve does not evidence a pattern which suggests an intent to avoid, or have the effect of avoiding, areas with a high concentration of minority residents, based on census data and other objective information. If the department determines that such a pattern exists, the home health care agency shall be notified of such determination, and shall be required, within ten days, to submit, in writing, justification for his refusals to serve based on legitimate non-discriminatory reasons in accordance with section 17b-262-8.
  7. The department shall conduct random inspections to ensure compliance with record-keeping requirements.
  8. The department shall respond to all complaints of refusal to serve by conducting a full investigation into the circumstances of the particular case, including but not limited to inspection of the home health care agency's records regarding refusals to serve.
  9. The department shall, in its discretion, conduct investigations into any refusals to serve or discharges which it determines warrant investigation, even in the absence of a specific complaint.
  10. If the department determines that a home health care agency has refused to serve a person located within its designated service areas, the agency shall be notified in writing of such determination and shall be required, within ten days, to submit, in writing, justification for its refusal to serve based upon legitimate non-discriminatory reasons in accordance with section 17b-262-8.
  11. All suspensions of service shall be justified by timely, objective and substantial evidence, and oral or written notice of the suspension shall be given to the client.

References:

Patient Self-Determination Act of 1990

State of Connecticut Licensure Regulations

CT DSS Provider Manual Chapter 7 – Home Health

Discharge Policy/CAHCH/Policy Comm/tpw 03_2017