Sending Notice To Other Providers

Question:

We originally attempted to comply system-wide with CMS regulation CMS 432.13(b)(4) Right of Notice of Admission by building the question into the nursing admission assessment, with the intent that when the patient said yes to family, provider, or other notifications, that would trigger a task downstream for those notifications.  

Now, to comply with 42 CFR 482.24(d)(1-5) for hospitals and 42 CFR 485.638(d)(1-5) for CAHs, our HIM and IS teams have set automatic notifications via ADT processes, assuming that the patient’s consent is covered in our general consent language.  

In reading the QSO memo from May 7, 2021, *QSO-21-18-Hospitals/CAHs (cms.gov) which is an advance copy of interpretative guidance for hospitals, including CAH and psych hospital, it appears if I am reading this correctly, that the patient must still consent to having their records sent.  

We want to get your input as likely we need to discontinue the nursing admission question as it is moot in sequence and ensure expressed consent by the patient at the point of admission registration.    Any insights or advisements you can provide would be very helpful.

Answer:

The new QSO (QSO 21-18) memo makes it clear that hospitals have to send notice to other providers for emergency room visits and admissions, external transfers, and discharges if that notice is not “inconsistent with the patients expressed privacy preferences.”  

This new wording is different than the first draft which sounded more like you had to get “consent” from the patient to send the notices.  We have not seen this comfortably implemented yet, but you could consider adding this new communication to either your general consent or some special consent policy.  You can notify the patient of the new communications but give the patient an “opt out” option.  The default would be to communicate (say what?!).  

This is summarized a bit more below:

QSO memo 21-18 for hospitals and critical access hospitals (effective June 30, 2021) requires hospitals to send notice to other providers for emergency room visits and admissions, external transfers, and discharges.  

The three A-tag requirements are discussed below:

1. A-0470:  Requires notice be sent for registration as an inpatient or emergency room patient to external providers.   CMS points out that this may require two notices, one stating that the patient has registered for treatment in the ED, and a second notice stating the patient has been admitted to the hospital.  CMS also makes it clear in their guidance that emergency room notice must be sent regardless of the decision to admit or not.  For acute care hospital patients this notice needs to be sent if the notice is “not inconsistent with the patients expressed privacy preferences.”   We have heard hospitals discuss a change to the general consent that notifies them of the plan to communicate to their PCP and gives them an “opt out” option.  If they don’t opt out, then all of the required notices are sent for acute care patients.  Different rules apply for BH patients.
2. A-0471:  Requires notice be sent to post-acute providers when a patient is discharged from the hospital. So, if your patient has a PCP and a cardiologist or other specialist the patient identifies as primarily responsible for their care, you would want to ensure that both providers receive the aftercare notice.
3. A-1673:  Contains the same registration in the ED or as an inpatient notice be sent but the guidance specifically refers to psychiatric hospitals; a specific consent must be obtained from the patient to send the notice to other providers.  In this case, a specific consent must be obtained from the patient to send the notice to other providers. This contrasts with the general hospital guidance which included obtuse language stating the notice sent should “not be inconsistent with the patients expressed privacy preferences.”