CMS SOM App. A, Tag A-0813

or LTCHs that are available to the patient, that are participating in the Medicare program,

and that serve the geographic area (as defined by the HHA) in which the patient resides, or in

the case of a SNF, IRF, or LTCH, in the geographic area requested by the patient. HHAs

must request to be listed by the hospital as available.

(i) The list must only be presented to patients for whom home health care post

hospital extended care services, SNF, IRF, or LTCH services are indicated and appropriate as

determined by the discharge planning evaluation.

(ii) For patients enrolled in managed care organizations, the hospital must make

the patient aware of the need to verify with their managed care organization which

practitioners, providers or certified suppliers are in the network of the patient’s managed care

organization, it must share this with the patient or the patient’s representative.

(iii) The hospital must document in the patient’s medical record that the list was

presented to the patient or to the patient’s representative.

Interpretive Guidelines §482.43(d)(1)

The hospital must include a list of Medicare-participating HHAs, SNFs, IRFs, or LTCHs in the

discharge plan for those patients for whom the plan indicates home health or post-hospital

extended care services are required and that are available to the patient. The list must be based

on the geographic area in which the patient resides for HHA services, or in the geographic area

requested by the patient for other post-acute care services. Hospitals have the flexibility either to

develop their own lists or to print a list of post-acute care providers and home health agencies in

the applicable geographic areas from the CMS websites.

For home health agencies, the list must consist of Medicare-participating HHAs that have

requested the hospital to be listed and that serve the geographic area where the patient lives.

Hospitals may expect the HHA to define its geographic service area when it submits its request

to be listed.

The list must only be provided to the patient when post-acute care services are identified through

the discharge planning evaluation. The list provided to the patient should be appropriate for the

care and services needed.

There must be documentation in the patient’s medical record that the list was provided to the

patient and/or the patient’s representative.

If the patient is enrolled in a managed care insurance program that utilizes a network of

exclusive or preferred providers, the hospital should make reasonable attempts, based on

information from the insurer, to identify HHAs and SNFs that participate in the insurer’s

network of providers.

Survey Procedures §482.43(d)(1)

• Review a sample of cases of patients discharged to HHAs, SNFs, IRFs, and LTCHs to

determine if, when applicable, the hospital provided the patient with lists of Medicare-participating providers. In making this determination:

o Is there documentation of a list of multiple HHAs or SNFs being provided (including

electronically) to the patient? If not, is there documentation for an acceptable

rationale for providing only one option, e.g., the patient’s home is included in the

service area of only one Medicare-participating HHA that requested to be included

on hospital lists, or there is only one Medicare-participating SNF in the area

preferred by the patient?

o Ask to see examples of lists of HHAs and SNFs provided to patients prior to

discharge.

o Interview staff members involved with the discharge planning process. Ask them to

describe how patient preferences are taken into account in the selection of post-hospital HHA or SNF services.