The CMS Conditions of Participation for Discharge Planning: What’s New for 2020
  • CODE : TONI-0012
  • Duration : 60 Minutes
  • Level : Beginner
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Toni G. Cesta, Ph.D., RN, FAAN is Partner and Health Care Consultant in Case Management Concepts, LLC, a consulting company which assists institutions in designing, implementing and evaluating acute care and community case management models, educating case management professionals and assisting in the implementation of case management departmental changes. The author of nine books and a frequently sought after speaker, lecturer, and consultant, Dr. Cesta is considered one of the primary thought leaders in the field of case management. Dr. Cesta writes a monthly column called “Case Management Insider” in the Hospital Case Management journal in which she shares insights and information on current issues and trends in case management.

Prior to her current work as a case management consultant, Dr. Cesta was Senior Vice President – Operational Efficiency and Capacity Management at Lutheran Medical Center in Brooklyn, New York. She was responsible for case management, social work, discharge planning, utilization management, denial management, bed management, the patient navigator program, the clinical documentation improvement program, and systems process improvement. Dr. Cesta has also held positions as Corporate Vice President for Patient Flow Optimization and Director of Case Management. She also designed and implemented a Master’s of Nursing in Case Management  Program and Post-Master’s Certificate Program in Case Management at Pace University in Pleasantville, New York.  Dr. Cesta completed seven years as a Commissioner for the Commission for Case Manager Certification.

This program will review the current rules and regulations from the Conditions of Participation (CoP) for Discharge Planning. The CoP is the legal and regulatory requirements that hospitals and case management professionals must follow in order to be compliant in their role as discharge planners. This will be followed by a review of the changes to the Conditions of Participation for Discharge Planning that were announced in October 2019 for Federal Fiscal Year 2020. From here we will then discuss these most recent changes from the Medicare program and how they will impact the roles of the RN case manager and the social worker. Learn how to be sure that your processes address the complexities of the new healthcare environment and that your role as a case manager or social worker is designed and staffed to meet the changes ahead!

The Centers for Medicare and Medicaid Services (CMS) have recently added more “teeth” to the discharge planning process as it is outlined in the Conditions of Participation for Discharge Planning. Discharge planning is no longer a destination but a process that starts before the patient is admitted to the hospital and continues after they are discharged.

The proposed and actual changes to the Conditions of Participation for Discharge Planning will likely have profound effects on how case management departments organize their work. It will also affect the workloads of RN case managers and social workers. Patients in ambulatory settings such as out-patient surgery, outpatient procedures, and emergency departments may need to be assessed for the purpose of creating a discharge plan. Family caregivers and physicians will be expected to be much more involved than they have in the past.

Areas Covered    

  • Conditions of Participation (CoP) for Medicare
  • Current CoP for Discharge Planning
  • Proposed rules for discharge planning
  • New rules for 2020
  • Strategies for managing the Discharge Planning CoP
  • How to maintain compliance

Course Level - Fundamental

Who Should Attend

  • RN Case Managers
  • Social Work Case Managers
  • Compliance Officers
  • Hospital Director of Case Management
  • Hospital Director of Finance
  • Vice President of Case Management
  • Directors of Nursing 

Why Should Attent

  • Understand what the CMS Conditions of Participation are and how they guide the practice of the RN case manager and social worker
  • Review the current Conditions of Participation Discharge Planning rules
  • Learn the new CMS rules for discharge planning
  • Be able to identify any gaps in your discharge planning process related to the current versus the proposed rules
  • Ensure that you are current and compliant with the current rules for discharge planning
  • Understand any misconceptions that are in the field related to discharge planning, especially related to the ‘choice list’
  • $149.00



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