FutureFocus June 27, 2018 Discharge Planning: CMS Guidance Needed

Lisa Remington

In this week's FutureFocus, are new discussions about discharge planning practices. The June MedPAC report urges CMS to provide more guidance.  CMS’s current regulatory guidance, reflects “the prohibitions” of a law more than two decades old, the Balanced Budget Act (BBA) of 1997, which states “a hospital ‘may not specify or otherwise limit the PAC providers made available to beneficiaries. (Medicare Advantage allows plans to establish their own networks; these plans’ enrollees must select a provider that is in their plan’s network.)” The BBA also requires “that hospitals provide a list of HHAs or SNFs that are near the beneficiary’s residence for patients identified as needing these services.” We provide updates and insights.

Lisa Remington, President, Remington Health Strategy Group

By: Ronald M. Schwartz, Contributing Writer, The Remington Report 

Medicare should allow hospital discharge planners to recommend specific post-acute care providers based on the quality of care. That’s a key takeaway in the Medicare Payment Advisory Commission (MedPAC) June 2018 Report to the Congress: Medicare and the Health Care Delivery System.

Publicly available quality data is rarely a factor in Medicare beneficiary choice of a post-acute care (PAC) provider, according to Medicare Senior Policy Analyst Evan Christman.

“In practice, beneficiaries report relying on information from trusted sources like health care providers, families, or others that may have experience with PAC,” Christman told the Medicare Payment Advisory Commission (MedPAC) March meeting in Washington.

 By: Elizabeth Hogue, Attorney

The U.S. Court of Appeals for the 5th Circuit issued an opinion on March 27, 2018, in Family Rehabilitation, Inc. v. Azar, No. 17-11337 (5th Cir. Mar. 27, 2018), that says that monies cannot be recouped from a home health agency until after hearings have been conducted by an administrative law judge (ALJ). The Appellate Court reversed the decision of the lower court and remanded the case back to the lower court.

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