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The Centers for Medicare & Medicaid Services today issued a  revising discharge planning requirements for hospitals (including long-term care hospitals and inpatient rehabilitation facilities), critical access hospitals and home health agencies that participate in the Medicare and Medicaid programs. In the proposed rule, hospitals and CAHs would be required to create discharge plans for all inpatients as well as some outpatients, including observation patients, same-day patients receiving anesthesia or moderate sedation, and emergency department patients whom a practitioner identifies as needing a discharge plan. Among other provisions, the rule would require the discharge planning process to take into account the patient’s goals and preferences, as well as certain quality, resource use and other measures, as required by the Improving Medicare Post-Acute Care Transformation Act of 2014. However, the rule does not propose specific quality measures. Hospitals and CAHs would need to establish a post-discharge follow-up process for at least some patients discharged to home, although CMS does not specify the mechanism, timing, or scope of follow-up programs. Instead, the agency emphasizes the importance of ensuring that hospitals follow up “with their most vulnerable patients, including those with behavioral health conditions.” When transferring patients, hospitals, CAHs and home health agencies would be required to provide specific medical information to the receiving facility. The proposed rule will be published in the Nov. 3 Federal Register with a 60-day comment period.