CMS Pub. 100-04, ch. 10, § 20.1.3

to Home Health Care

(Rev. 635, Issued: 08-05-05; Effective: 10-01-00; Implementation: 11-03-05)

A hospital discharging a Medicare beneficiary to home health care can also play an

important role in alerting the beneficiary to their potential liability under home health

consolidated billing. Under the Medicare Conditions of Participation (COP) for

Hospitals: Discharge planning, (42 CFR, §482.43 (b) (3) and (6)), hospitals must have in

effect a discharge planning process that applies to all patients, and the discharge planning

evaluation must include an evaluation of the likelihood of a patient needing post-hospital

services and of the availability of the services. The hospital must include the discharge

planning evaluation in the patient’s medical record for use in establishing an appropriate

discharge plan and the hospital must discuss the results of the evaluation with the patient

or individual acting on his or her behalf. In addition, under 42 CFR, §482.43 (c) (5), the

patient and family members must be counseled to prepare them for post-hospital care and

under 42 CFR, §482.43 (d) Transfer or referral, the hospital must transfer or refer

patients, along with necessary medical information, to appropriate facilities, agencies, or

outpatient services, as needed, for followup or ancillary care.

Hospitals, therefore, should counsel beneficiaries being discharged to receive home

health services, that his/her “primary” home health agency; i.e., the agency establishing

his/her plan of care, will provide all home health services. Hospitals should provide a list

of home health agencies for beneficiaries to choose from; in addition, when referring the

beneficiary to his/her chosen home health agency, the hospital should notify the agency

and include any counseling notes, which should serve as a reminder to the home health

agency to also notify the beneficiary that all home health services will be provided by

them as the “primary” home health agency. Hospitals play a key role in making

beneficiaries, and/or their caregivers, aware of Medicare home health coverage policies

to help ensure that those services are provided appropriately.