Discharge Planning Rights For Medicare Beneficiaries

In New York State, all hospital patients must receive a written discharge plan at least 24 hours before leaving the hospital.

A Discharge Plan:

Describes the care and services you may need after you leave the hospital and how those services will be provided.
Helps you to know how to continue recovery or maintain your health status. All health care services must be in place before you go home or to another facility.

You should work with your discharge planning team to develop a plan that meets your needs.

Your Discharge Plan Starts Before Your Hospital Stay.

Talk to your doctor if you are going to the hospital for treatment and ask about expected care needs after discharge.

Early in your hospital stay you, your doctor, family, nurse and social service staff should work to develop a plan if you need services when you leave. Ask about your discharge plan if you are not approached.
Know your discharge rights and use them. Under New York State law, the hospital must give you a copy of "Your Rights as a Hospital Patient in New York State." This includes "An Important Message from Medicare." It explains what to do and how to appeal if you feel you are being discharged too soon. Ask for this information if you don't receive it.

For help with appeals, call IPRO at 1-800-331-7767.

Discharge Plans May Include:

Home care visits (part-time) if you need the services of a registered nurse or licensed therapist.
Skilled care in a nursing home or specialty hospital.
Outpatient care or treatments.
Hospice care if appropriate for your condition.
Information on community resources and transportation issues.
Provision of durable medical equipment as needed.
Attention to your home situation and coverage needs.
Clear direction on medication and treatments and patient or caregiver-teaching necessary for certain care.

Medicare Covered Services Include:

Skilled Nursing Facility (SNF) Care - After a 3-day qualifying hospital stay if you are in traditional Medicare, you pay nothing for the first 20 days at the SNF. From day 21-100 you pay $119.00 per day. If you are enrolled in a Medicare Advantage Plan, it is important to note that Medicare Advantage Plans many offer more than one plan option to persons with Medicare. Different levels of plans have varied costs (deductibles and co-pays) for services like SNF care and hospital care. Costs for co-pays and deductibles may change annually. Call your plan with any questions, call 1-800-Medicare or visit www.Medicare.gov to get current information on plans in your area and associated costs. (This includes in-patient rehabilitation service).

Home Health Care - Part-time skilled nursing care and/ or therapies, needed equipment or supplies. You pay nothing for medically necessary home care. As determined by your doctor and provided by a Medicare Certified home health agency you pay 20% of approved amounts for medical equipment.

Hospice Care - Medical and support services from a Medicare-approved hospice.

Outpatient Rehabilitation Services - Physical, occupational or speech, and/or mental health services. Always ask about any coverage limits. In 2006 there are limits on outpatient physical therapy and speech/ language therapy services.

The 2006 cap for these services is $1,740.00. For more information, visit www.medicare.gov or call 1-800-633-4227

Tips on Discharge Planning

Medicare benefits for extended care are available to all people on Medicare, both in original Medicare and Managed Care.

Always ask about appeal rights if you are denied medical services from Medicare or your Managed Care plan.

If skilled nursing facility care is recommended, be aware that space is limited. If the reason you refuse a bed is not accepted, you could have to pay for days of care while waiting for another facility.

Ask for phone numbers of agencies servicing you in the event you need to contact them.

To learn more about Medicare Rights and Protections or to ask about a quality of care complaint call 1-800-MEDICARE (1-800-633-4227). For the hearing impaired, call TTY/TDD 1-877-486-2048. Or, visit www.Medicare.gov.

A call to 1-800-MEDICARE or a visit to www.Medicare.gov can give you important information about Medicare Benefits and Rights - nursing homes, home health agencies, dialysis facilities and much more.

Helpful Definitions

Medically Necessary Care - Services needed or provided to diagnose and treat your medical condition.
Skilled Care - Care supervised by licensed nurses or therapists under the direction of a doctor.
Acute Care - Services that could only be provided in a hospital or emergency room.
Custodial Care - Personal care like bathing, cooking, and shopping, not covered by Medicare.
Long Term Care Ombudsman A supporter for nursing home patients who works to solve problems between patients and nursing homes.

Additional Resources

Eldercare Locator: 1-800-677-1116 for Eldercare Services information in your community.
IPRO Non-Coverage Department (Hospital Appeals): 1-800-446-2447(New York State only), or 1-800-326-6131(Medicare Advantage Fast Track Appeals): 1-888-696-9561
Medicare Health Now (Durable Medical Equipment): 1-800-633-4227
Palmetto GBA (Railroad Retirement): 1-800-833-4455
Medicare Billing Questions (Empire Medicare Services Part A & B Downstate):(Medicare Health Now Upstate Part B): 1-800-633-4227
New York State Office for Aging: 1-800-342-9871 (Long Term Care)
United Government Services (Home Health or Hospice Questions): 1-800-633-4227
Health Insurance Information Counseling & Assistance Program: 1-800-701-0501 *Callers in the five boroughs of New York City may call 311 for Hiicaps referral.

This material was prepared by IPRO under a contract with the Centers for Medicare & Medicaid Services (CMS). The contents do not necessarily reflect CMS policy.