Discharge Planning, Transfer and Discharge Summaries

Sets out the Agency's discharge planning process from admission onward, how it helps patients who transfer to another home health agency or are discharged to a skilled nursing facility, inpatient rehabilitation facility or long-term care hospital choose a provider using quality and resource use data, what information it sends to the receiving facility or practitioner, and the deadlines for the discharge summary (within 5 business days of discharge) and the transfer summary (within 2 business days of a planned transfer, or of learning of an unplanned transfer). It adds the Michigan Medicaid duty to develop a transfer or discharge plan at admission and to ensure continuity with Home Help and MI Choice.