CMS SOM App. A, Tag A-0814

or the patient’s representative of their freedom to choose among participating Medicare

providers and suppliers of the post-discharge services and must, when possible, respect the

patient’s or the patient’s representative goals of care and treatment preferences, as well as

other preferences they express. The hospital must not specify or otherwise limit the qualified

providers or suppliers that are available to the patients.

Interpretive Guidelines §482.43(d)(2)

During the discharge planning process, the hospital must inform the patient of his/her freedom to

choose among Medicare-participating post-hospital providers and must not direct the patient to

specific provider(s) or otherwise limit which qualified providers the patient may choose among.

When the patient or the patient’s family has expressed a preference, the hospital must attempt to

arrange post-hospital care, as applicable, which meets these preferences. If the hospital is

unable to make the preferred arrangement, e.g., if there is no bed available in the preferred SNF,

IRF or LTCH, it must document the reason the patient’s preference could not be fulfilled and

must explain that reason to the patient.

Survey Procedures §482.43(d)(2)

• Ask the hospital to identify current patients for whom HHA or SNF services are planned.

Interview the patient or the patient’s family to ask them:

o Were they presented with a list of HHAs or SNFs, as applicable, to choose from?

o Did the hospital emphasize the patient’s freedom of choice?

o Did the hospital arrange for their referral/transfer to an HHA or SNF reflecting their

preferences? If not, did the hospital explain why their choice was not feasible?