42 CFR 482.43

42 CFR 482.43 is one of the conditions of participation a hospital meets to be paid by Medicare. Its heading is “Condition of participation: Discharge planning”, and it has two halves that matter to anyone who receives patients from a hospital.

The planning half, paragraph (a). The hospital’s discharge planning process “must identify, at an early stage of hospitalization, those patients who are likely to suffer adverse health consequences upon discharge” without adequate discharge planning, and it “must provide a discharge planning evaluation for those patients so identified as well as for other patients upon the request of the patient, patient’s representative, or patient’s physician”. The evaluation is the hospital’s work, and it is where the choice of post-acute provider is supposed to be made with the patient.

The transfer half, paragraph (b). Its standard is “Discharge of the patient and provision and transmission of the patient’s necessary medical information”. The hospital “must discharge the patient, and also transfer or refer the patient where applicable, along with all necessary medical information pertaining to the patient’s current course of illness and treatment, post-discharge goals of care, and treatment preferences, at the time of discharge” to the practitioner or facility responsible for the patient’s follow-up or ancillary care. That sentence is the legal basis for the referral packet: the hospital owes the receiving agency the course of illness and treatment, the goals of care and the treatment preferences, at discharge.

Three things the section does not do, which decide how useful it is on the receiving end:

• It names categories, not documents. “Necessary medical information” is not defined as a discharge summary, a medication list or a face-to-face note. What arrives is whatever the hospital’s process produces.
• It binds the hospital, not the next provider. The home health agency, PACE organization or practice has no right of action under it. A thin packet is a survey finding against the hospital, and surveys are rare.
• It sets no clock. “At the time of discharge” is the only timing, and the discharge summary itself is often signed days later under a different rule, 42 CFR 482.24.

For the agency that is the practical reading: the rule is why a packet exists at all, and not a reason to wait for one. When the packet is incomplete, the records it should have carried sit in the hospital’s system and can be retrieved for treatment by network query rather than requested again, which is what Vivlio does for home health agencies ahead of the start of care.