Discharge Issues

10.9 - Discharge Issues (Rev. 12382; Issued: 11-28-23; Effective: 01-01-24; Implementation:01-02-24) A. Hospice Election Mid-Period If a patient elects hospice before the end of the 30-day period and there was no partial payment adjustment or LUPA adjustment, the HHA will receive a full 30-day period payment. The 30-day period with visits less than the LUPA threshold for the payment group would be paid at the low utilization payment adjusted amount. B. Patient's Death The documented event of a patient's death would result in a full 30-day period payment, unless the death occurred in a low utilization payment adjusted 30-day period. Consistent with all episodes in which a patient receives four or fewer visits, if the patient's death occurred during a low utilization adjusted 30-day payment period, the period would be paid at the low utilization payment adjusted amount. In the event of a patient's death during an adjusted 30-day period, the total adjusted period would constitute the full 30- day period payment. C. Patient is No Longer Eligible for Home Health (e.g., no longer homebound, no skilled need) If the patient is discharged because he or she is no longer eligible for the Medicare home health benefit and has received visits meeting the LUPA threshold for the payment group, then the HHA would receive the full 30- day period payment. However, if the patient becomes subsequently eligible for the Medicare home health benefit during the same 30- day period and transferred to another HHA or returned to the same HHA, then this would result in a partial payment adjustment. D. Discharge Due to Patient Refusal of Services or is a Documented Safety Threat, Abuse Threat or is Noncompliant If the patient is discharged because he or she refuses services or becomes a documented safety, abuse, or noncompliance discharge and has received visits meeting the LUPA threshold for the payment group, then the HHA would receive full period payment unless the patient becomes subsequently eligible for the Medicare home health benefit during the same 30-day period and transferred to another HHA or returned to the same HHA, then this would result in a partial payment adjustment. E. Patient Enrolls in Managed Care Mid-Period If a patient's enrollment in a Medicare Advantage (MA) plan becomes effective mid period, the 30-day period payment will be proportionally adjusted with a partial payment adjustment since the patient is receiving coverage under MA. Beginning with the effective date of enrollment, the MA plan will receive a capitation payment for covered services. F. Submission of Final Claims Prior to the End of the 30-day Period The claim may be submitted upon discharge before the end of the 30-day period. However, subsequent adjustments to any payments based on the claim may be made due to an intervening event resulting in a partial payment adjustment or other adjustment. G. Patient Discharge and Financial Responsibility for Part B Bundled Medical Supplies and Services As discussed in detail under §10.11, below, the law governing the Medicare HH PPS requires the HHA to provide all bundled home health services (except DME) either directly or under arrangement while a patient is under an open home health plan of care during an open episode. Once the patient is discharged, the HHA is no longer responsible for providing home health services including the bundled Part B medical supplies and therapy services. H. Discharge Issues Associated With Inpatient Admission Overlapping Into Subsequent 60-Day Recertifications 1. If a patient is admitted to an inpatient facility and the inpatient stay overlaps into what would have been the subsequent 60-day recertification and there is no recertification assessment of the patient, then the new certification begins with the new start of care date after inpatient discharge. 2. If a patient is admitted to an inpatient facility and the inpatient stay overlaps into what would have been the subsequent 60-day recertification and there was a recertification assessment of the patient during days 56-60 and the patient returns home from the inpatient stay on day 61, if the home health resource group (HHRG) remains the same then the 30-day period of care following the inpatient stay would be considered continuous and thus be considered a recertification. However, if the HHRG is different, this would result in a new start of care OASIS and thus be considered a new certification and begins with the new start of care date after inpatient discharge. 3. If a patient is admitted to an inpatient facility and the inpatient stay overlaps into what would have been the subsequent 60-day recertification and there was a recertification assessment of the patient during days 56-60 and the patient returns home from the inpatient stay after day 61 (after the first day of the next 60-day recertification of care), then a new certification begins with the new start of care date after inpatient discharge.