CMS Updates LTC Surveyor Guidance – LeadingAge NY Analysis: Segment 2: Transfer/Discharge
(Dec. 10, 2024) LeadingAge NY continues to analyze the Centers for Medicare and Medicaid Services (CMS) Requirements of Participation (RoP) guideline updates recently announced in memorandum QSO-25-07-NH. These changes will take effect on Feb. 24, 2025, leaving providers a few short months to prepare. This article will review the transfer/discharge modifications and major updates facilities should be aware of.
In CMS Admission, Transfer, and Discharge existing rule, a nursing home cannot require third-party guarantee of payment as part of admission or continued stay. While residents are responsible for their financial obligations, and resident representatives with access to and responsibility for residents’ finances must ensure that residents’ bills are paid and/or participate in applications for medical assistance, the nursing home cannot require payment from third parties’ personal finances. This was further clarified in the updated guidelines. As this relates to community-dwelling spouses, nursing homes should check spousal impoverishment provisions and clearly communicate financial responsibilities to the community-dwelling spouse or individual responsible for the nursing home resident’s finances.
CMS has significantly streamlined survey processes related to transfer and discharge, although regulations remain unchanged. Distinctions of facility-initiated versus resident-initiated discharges have been eliminated. CMS will now shift focus to appropriate versus inappropriate (noncompliant) discharges. As a provider, you must continue to follow discharge requirements, including discharging only for allowable reasons and only to locations that can meet the resident’s needs. This includes providing supporting documentation in the medical record to justify discharge and following requirements for appropriate notice and transition of care.
New F-tags F627 and F628 cover all transfer/discharge regulatory guidelines. Surveyors are also instructed to consider psychosocial harm in findings of noncompliance, and CMS notes that inappropriate discharges are likely to be cited at severity level 3 (actual harm) or level 4 (immediate jeopardy) due to psychosocial outcomes and likelihood of physical harm that could result from unsafe discharge. The psychosocial severity outcome guide that surveyors use can be found here. CMS critical element pathways for both hospitalization and discharge have been updated and are a great way to help prepare for the updated guidelines. More information on the RoP guidelines can be found here.
Contact: Carrie Mosley, cmosley@leadingageny.org, 518-867-8383 ext. 147