House File 2460 H-8240 Amend House File 2460 as follows: 1 1. By striking page 105, line 4, through page 109, 2 line 19, and inserting: 3 < DIVISION ___ 4 HOSPITAL DISCHARGE PLANNING 5 Sec. ___. HOSPITAL DISCHARGE PLANNING. A hospital 6 licensed pursuant to chapter 135B shall comply with 7 the conditions for participation relating to discharge 8 planning specified in 42 C.F.R. §482.43 as follows: 9 The hospital must have in effect a discharge 10 planning process that applies to all patients. The 11 hospital’s policies and procedures must be specified in 12 writing, and include or incorporate as standards the 13 following: 14 1. Standard: Identification of patients in need 15 of discharge planning. The hospital must identify at 16 an early stage of hospitalization all patients who 17 are likely to suffer adverse health consequences upon 18 discharge if there is no adequate discharge planning. 19 2. Standard: Discharge planning evaluation. 20 a. The hospital must provide a discharge planning 21 evaluation to the patients identified in subsection 1, 22 and to other patients upon the patient’s request, the 23 request of a person acting on the patient’s behalf, or 24 the request of the physician. 25 b. A registered nurse, social worker, or other 26 appropriately qualified personnel must develop, or 27 supervise the development of, the evaluation. 28 c. The discharge planning evaluation must include 29 an evaluation of the likelihood of a patient needing 30 post-hospital services and of the availability of the 31 services. 32 d. The discharge planning evaluation must include 33 an evaluation of the likelihood of a patient’s capacity 34 for self-care or of the possibility of the patient 35 -1- HF2460.3520 (3) 86 pf/rn 1/ 4 #1.

being cared for in the environment from which he or she 1 entered the hospital. 2 e. The hospital personnel must complete the 3 evaluation on a timely basis so that appropriate 4 arrangements for post-hospital care are made before 5 discharge, and to avoid unnecessary delays in 6 discharge. 7 f. The hospital must include the discharge planning 8 evaluation in the patient’s medical record for use in 9 establishing an appropriate discharge plan and must 10 discuss the results of the evaluation with the patient 11 or individual acting on his or her behalf. 12 3. Standard: Discharge plan. 13 a. A registered nurse, social worker, or other 14 appropriately qualified personnel must develop, or 15 supervise the development of, a discharge plan if the 16 discharge planning evaluation indicates a need for a 17 discharge plan. 18 b. In the absence of a finding by the hospital 19 that a patient needs a discharge plan, the patient’s 20 physician may request a discharge plan. In such a 21 case, the hospital must develop a discharge plan for 22 the patient. 23 c. The hospital must arrange for the initial 24 implementation of the patient’s discharge plan. 25 d. The hospital must reassess the patient’s 26 discharge plan if there are factors that may affect 27 continuing care needs or the appropriateness of the 28 discharge plan. 29 e. As needed, the patient and family members or 30 interested persons must be counseled to prepare them 31 for post-hospital care. 32 f. The hospital must include in the discharge plan 33 a list of home health agencies or skilled nursing 34 facilities that are available to the patient, that are 35 -2- HF2460.3520 (3) 86 pf/rn 2/ 4

participating in the Medicare program, and that serve 1 the geographic area, as defined by the home health 2 agency, in which the patient resides, or in the case 3 of a skilled nursing facility, in the geographic area 4 requested by the patient. Home health agencies must 5 request to be listed by the hospital as available. 6 (1) This list must only be presented to patients 7 for whom home health care or post-hospital extended 8 care services are indicated and appropriate as 9 determined by the discharge planning evaluation. 10 (2) For patients enrolled in managed care 11 organizations, the hospital must indicate the 12 availability of home health and post-hospital extended 13 care services through individuals and entities that 14 have a contract with the managed care organizations. 15 (3) The hospital must document in the patient’s 16 medical record that the list was presented to the 17 patient or to the individual acting on the patient’s 18 behalf. 19 g. The hospital, as part of the discharge planning 20 process, must inform the patient or the patient’s 21 family of their freedom to choose among participating 22 Medicare providers of post-hospital care services 23 and must, when possible, respect patient and family 24 preferences when they are expressed. The hospital must 25 not specify or otherwise limit the qualified providers 26 that are available to the patient. 27 h. The discharge plan must identify any home health 28 agency or skilled nursing facility to which the patient 29 is referred in which the hospital has a disclosable 30 financial interest, as specified by the secretary of 31 health and human services, and any home health agency 32 or skilled nursing facility that has a disclosable 33 financial interest in a hospital under Medicare. 34 Financial interests that are disclosable under Medicare 35 -3- HF2460.3520 (3) 86 pf/rn 3/ 4

are determined in accordance with the provisions of 42 1 C.F.R. pt. 420, subpt. C. 2 4. Standard: Transfer or referral. The hospital 3 must transfer or refer patients, along with necessary 4 medical information, to appropriate facilities, 5 agencies, or outpatient services, as needed, for 6 follow-up or ancillary care. 7 5. Standard: Reassessment. The hospital must 8 reassess its discharge planning process on an ongoing 9 basis. The reassessment must include a review of 10 discharge plans to ensure that they are responsive to 11 discharge needs. > 12 2. By renumbering as necessary. 13 ______________________________ BYRNES of Mitchell -4- HF2460.3520 (3) 86 pf/rn 4/ 4 #2.