A new California law requiring hospitals to involve caregivers in discharge planning became effective January 1, 2016. Existing state law and Medicare rules require hospitals to arrange for appropriate post-hospital care for patients “who are likely to suffer adverse health consequences upon discharge if there is no adequate discharge planning.” For Medicare patients and their family caregivers, the new law increases the opportunity to participate in the discharge planning process.
This law, SB 675, mandates hospitals to give patients an opportunity to identify a family caregiver, notify the caregiver when the patient is to be discharged, and inform and instruct the caregiver about care that the patient needs after discharge. One subsection states: “The hospital shall provide an opportunity for the patient and his or her designated family caregiver to engage in the discharge planning process, which shall include information and, where appropriate, instruction regarding the post-hospital care needs of the patient.”
An opportunity to engage in the discharge planning process allows the patient and family caregiver to have a say in when the patient would be discharged. In the Medicare program, beneficiaries have the right to appeal the hospital’s discharge decision. Many beneficiaries request a later date of discharge and, if the hospital does not agree, exercise the right to appeal. Information about a Medicare beneficiary’s right to appeal a hospital discharge is in the notice “An Important Message From Medicare About Your Rights,” given to Medicare patients within 2 days of admission.
The new law applies to patients who have been admitted to the hospital as an inpatient. Many people receive outpatient services in a hospital and may not be admitted as an inpatient even if they stay overnight. In the Medicare program, a beneficiary’s status as inpatient or outpatient affects how services are paid, which affects a beneficiary’s payment liability. Furthermore, if a beneficiary needs care in a skilled nursing facility (SNF) after leaving the hospital, Medicare pays for the SNF stay only if the beneficiary had been admitted as an inpatient and stayed in the hospital for at least 3 consecutive days, but not if the beneficiary was an outpatient. For more information, please read “Are You An Inpatient or Outpatient? If You Have Medicare – Ask!”
A prior inpatient hospital stay is one criterion for Medicare to cover subsequent SNF care and affects beneficiaries who have Original Medicare, which is fee-for-service. Beneficiaries in a Medicare Advantage plan may have different rules; many Medicare Advantage plans cover SNF care without requiring a prior hospital stay.
In summary, SB 675 affords patients and their family caregivers an opportunity to participate in the discharge planning process and receive information and instruction on care the patient may need after discharge. Patients and family caregivers should take advantage of this opportunity to have a say in when the patient is discharged. For Medicare patients, if the hospital does not grant a patient’s request for a different discharge date, they have a right to appeal the hospital’s discharge decision. Medicare patients and their caregivers should ask if the patient is an inpatient or outpatient because a Medicare patient’s status affects his/her payment liability for the hospital’s services and SNF care, if the patient needs subsequent SNF care.