CMS SOM App. U, Tag R150

(a) Discharge planning and instructions. The RNHCI must have in effect a discharge

planning process that applies to all patients. The process must assure that

appropriate post-institution services are obtained for each patient, as necessary. The

RNHCI must assess the need for a discharge plan for any patient identified as likely

to suffer adverse consequences if there is no planning.

Interpretive Guidelines: §403.736

The RNHCI must have a discharge planning process in place to assure appropriate post-institution services are obtained for each patient, as necessary, and to ensure RNHCIs

provide discharge instructions to the patient and/or the patient’s caregiver when the

patient is discharged home.

The RNHCI should have a discharge planning process which involves the RNCHI staff,

patients and his or her caregivers/legal representatives in determining the appropriate

post-discharge plan for the patient. The patient and his or her caregiver/legal

representative have the right to participate in the development and implementation of

his/her plan of care, and to make informed decisions regarding his/her care

(§403.730(b)).

The discharge planning process should begin upon the patient entering the RNCHI for

care. While RNCHIs only furnish nonmedical nursing care and provide services to

beneficiaries who choose to rely solely upon a religious method of healing, and for whom

the acceptance of medical services would be inconsistent with their religious beliefs, the

RNCHI should begin to assess each patient for the need of a discharge plan upon entry

into the RNCHI for care. Additionally, RNHCIs should also ensure reassessment of its

discharge planning on an ongoing basis as required under §403.736(c). For patients

that may not have been initially identified as in need of a discharge plan, there may be

changes in the patient’s condition to warrant development of a discharge plan.

RNHCIs only furnish nonmedical nursing items and services to beneficiaries who choose

to rely solely upon a religious method of healing, and for whom the acceptance of

medical services would be inconsistent with their religious beliefs. RNHCIs only perform

nonmedical services through nonmedical nursing personnel who are experienced in

caring for the physical needs of nonmedical patients. For example, caring for the

physical needs such as assistance with activities of daily living; assistance in moving,

positioning, and ambulation; nutritional needs; and comfort and support measures.

Due to the nature of RNHCI services, this standard does not require the organization to

develop a plan for the patient after the patient is discharged or due to changes in the

patient’s condition. The discharge plan is not based on whether the patient’s condition

improves or worsens as the RNHCI only provides nonmedical nursing. Patients sign the

election statement that identifies understanding that they will receive nonmedical

services. Essentially, a patient would be provided routine care of daily needs, and

assistance as needed for eating, ambulating, etc. For example, if a patient had a cut, a

RNHCI Nurse Practitioner would wash it with soap and water and bandage it as routine

first aide. As a result, there would be no prescribed care/treatment to prevent possible

adverse outcomes after discharge. RNHCI patients are not determined by these facilities

to have a “condition”. RNHCI care is not about treatment of medical diagnoses,

therefore the discharge plan provides instructions primarily based on self-care at home

or information related to potential medical treatment that could be rendered at a medical

facility, not within the RNHCI setting.

The RNHCI discharge plan should include instructions for self-care. Additionally, if the

patient was transferred from a different healthcare setting such as a nursing facility,

home health care or other, then the discharge plan may include aspects provided by the

other healthcare settings, as applicable.

Survey Procedures:

• Review the RNHCI policies and verify the RNCHI has identified patients which

may suffer post-discharge complications due to a lack of a discharge plan. (Note:

The discharge plan is a non-medical plan and may only provide resources to

connect a patient to a healthcare setting which provides medical services.)

• Verify patients who have been categorized into the potential for adverse outcomes

have a discharge plan post-discharge.