Case Management

Patient choice is about quality, not quantity

Case Management Monthly, January 1, 2011

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Many discharge planners believe that Medicare requires hospitals to provide the patient with a minimum of three postacute choices, says Jackie Birmingham, RN, BSN, MS, author of Discharge Planning: Tools for Compliance, Third Edition. 

Birmingham found no evidence of Medicare requiring a certain number of discharge options. Some hospitals may require three options to ensure a backup option, and some Medicaid programs may require at least three suggestions, but Medicare does not. 

According to the provision of the Code of Federal Regulations, section 482.43, Conditions of Participation (CoP), Section (6) reads in part: 

The hospital must include in the discharge plan a list of home health agencies or SNFs 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, in the geographic area requested by the patient. 

That same section also states that hospitals can limit choices for patients enrolled in a managed Medicare program to those providers who have contracted with their program—the idea being that patients exercise their choice when they decide to enroll in a managed Medicare program, Birmingham says. 

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