The CMS Conditions of Participation for Discharge Planning: What’s New for 2020

Presented by Toni G. Cesta

This program will review the current rules and regulations from the Conditions of Participation (CoP) for Discharge Planning. The CoP is the legal and regulatory requirements that hospitals and case management professionals must follow in order to be compliant in their role as discharge planners. This will be followed by a review of the changes to the Conditions of Participation for Discharge Planning that were announced in October 2019 for Federal Fiscal Year 2020. From here we will then discuss these most recent changes from the Medicare program and how they will impact the roles of the RN case manager and the social worker. Learn how to be sure that your processes address the complexities of the new healthcare environment and that your role as a case manager or social worker is designed and staffed to meet the changes ahead!

The Centers for Medicare and Medicaid Services (CMS) have recently added more “teeth” to the discharge planning process as it is outlined in the Conditions of Participation for Discharge Planning. Discharge planning is no longer a destination but a process that starts before the patient is admitted to the hospital and continues after they are discharged.

The proposed and actual changes to the Conditions of Participation for Discharge Planning will likely have profound effects on how case management departments organize their work. It will also affect the workloads of RN case managers and social workers. Patients in ambulatory settings such as out-patient surgery, outpatient procedures, and emergency departments may need to be assessed for the purpose of creating a discharge plan. Family caregivers and physicians will be expected to be much more involved than they have in the past.

The CMS Discharge Planning Rules and Regulations for 2018

Presented by Toni G. Cesta

This program will review the current rules and regulations from the Conditions of Participation for discharge planning. We will then discuss the most recent changes to the Medicare program and how they will impact the roles of the RN case manager and the social worker. We will review strategies for safely transitioning your patients across the continuum of care. In addition, we will review how to engage other members of the interdisciplinary care team in the process of planning for the patient’s movement across the continuum including verbal and written hand-off communication. We will also discuss the positive impact that effective discharge planning processes can have on hospitals, post-acute providers and patients!

The proposed changes to the Conditions of Participation for Discharge Planning will likely have profound effects on how case management departments organize their work. It will also affect the workloads of RN case managers and social workers. Patients in ambulatory settings such as outpatient surgery, outpatient procedures, and emergency departments will all need to be assessed for the purpose of creating a discharge plan. Family caregivers and physicians will be expected to be much more involved than they have in the past. Case management departments will be expected to follow patients via phone calls as they transition out into the community.

Toni G. Cesta, Ph.D., RN, FAAN is Partner and Health Care Consultant in Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing and evaluating acute care and community case management models, educating case management professionals and assisting in the implementation of case management departmental changes. The author of nine books and a frequently sought-after speaker, lecturer and consultant, Dr. Cesta is considered one of the primary thought leaders in the field of case management. Dr. Cesta writes a monthly column called “Case Management Insider” in the Hospital Case Management journal in which she shares insights and information on current issues and trends in case management.

Prior to her current work as a case management consultant, Dr. Cesta was Senior Vice President – Operational Efficiency and Capacity Management at Lutheran Medical Center in Brooklyn, New York. She was responsible for case management, social work, discharge planning, utilization management, denial management, bed management, the patient navigator program, the clinical documentation improvement program, and systems process improvement. Dr Cesta has also held positions as Corporate Vice President for Patient Flow Optimization and Director of Case Management.  She also designed and implemented a Master’s of Nursing in Case Management  Program and Post-Master’s Certificate Program in Case Management at Pace University in Pleasantville, New York.  Dr. Cesta completed seven years as a Commissioner for the Commission for Case Manager Certification.