DOH Provides Reminders on Hospital Discharges and Nursing Home Admissions

(Jan. 7, 2025) The Department of Health (DOH) recently issued a Dear Administrator Letter (DAL) geared toward both hospital discharge planners and nursing home administrators, reminding them of their responsibilities in the discharge process. This came about after DOH became aware of certain hospitals that failed to disclose the full extent of a patient’s known medical status to the skilled nursing facility (SNF) where the patient requested admission. Pursuant to federal regulations at 42 Code of Federal Regulations (CFR) § 482.43 and NYS regulations at 10 NY Codes, Rules, and Regulations (NYCRR) § 405.9(h), a hospital's effective discharge planning process is patient-centered and designed to reduce the factors that can lead to readmission, and upon transfer to a post-acute setting, hospitals must include all necessary medical information pertaining to the patient’s current course of illness and treatment, post-discharge goals, and treatment preferences.

The DAL goes on to remind SNFs of the expectation to perform a thorough assessment of incoming residents’ functional capabilities via the mandatory clinical assessment process – i.e., the Minimum Data Set (MDS) – and ensure the completion of the Preadmission Screening and Resident Review.

As a measure of precaution, SNFs may want to review their pre- and post-admission practices to uncover any gaps in current practices and provide appropriate adjustment and education as needed. Facilities with questions regarding the content of this DAL may write to nhinfo@health.ny.gov.

Contact: Carrie Mosley, cmosley@leadingageny.org, 518-867-8383 ext. 147