Burden Reduction and Discharge Planning Final Rules Guidance and Process

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

On Friday, December 20, 2019, CMS posted QSO-20-07-ALL.  This 680-page addresses two (2) final rules for various provider and supplier types.  These final rules were published back on September 30, 2019.


Medicare and Medicaid Programs; Regulatory Provisions to Promote Efficiency, Transparency, and Burden Reduction (CMS 3346-F) Program and Medicare and Medicaid Programs; Revisions to Requirements for Discharge Planning for Hospitals, Critical Access Hospitals, and Home Health Agencies (CMS 3317-F) have implementation dates a year apart.  CMS 3317-F revises requirements for Hospitals, HHA and CAHs.  CMS 3346-F revises requirements for:

  • Religious Nonmedical Healthcare Institutions (RNHCIs) at §403
  • Ambulatory Surgical Centers (ASCs) at §416
  • Hospices at §418
  • Hospitals and Transplant at §482
  • Home Health Agencies (HHAs) at §484
  • Critical Access Hospitals (CAHs) & Comprehensive Outpatient Rehabilitation Facilities (CORFs) at §485
  • Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) at §491
  • Portable X-ray (PXR) at §486
  • End Stage Renal Disease (ESRD) Facilities at §494 and
  • Emergency Preparedness

CMS has updated the SOM to reflect the regulatory changes as a result of these two final rules.  The regulation changes are effective on November 29, 2019, with the exception of the following:

  • The regulations at §482.42(b) and §485.640(b) regarding antibiotic stewardship programs for hospitals and CAHs, respectively, will be effective on March 30, 2020.
  • The regulations at §485.641 regarding Quality Assessment and Performance Improvement Programs (QAPI) for CAHs will be effective on March 30, 2021.

The requirements that have delayed effective dates have been indicated accordingly within the attached updated SOM. CMS is aiming to subsequently release the SOM after this first release to provide the Interpretive Guidelines for these regulations in the Spring of 2020. Additional guidance will be forthcoming, and crosswalks will be available for some provider/supplier types accessible via the specific websites at: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/index.

Changes are found in these SOM (State Operations Manual) Appendices:

  • CAH – Appendix W
  • Hospital/CAH/RHC/FQHC – Appendices A, G and W
  • Psych Hospitals – Appendix A (Appendix AA is being deleted)
  • ESRD Facilities – Appendix H
  • RHC/FQHC – Appendix G

Program mailboxes are found on page 4 of the QSO document.

Starting on page 5 and continuing through page 680 of this QSO, you’ll find the Advanced Copy of the SOM Appendix revisions.  Note there is no date on this document.  The revisions are displayed in red ink.  Interpretive Guidance and Survey Procedures are included in this advanced copy.


Changes to Appendix Z (starting on page 641) – Emergency Preparedness – includes review and updating the facility’s/entity’s emergency preparedness plan at least every two (2) years now with the exception of LTC facilities.  LTC facilities must continue their annual review and update.

Take time to review this QSO as well as both rules.  Also, keep in mind that LTC providers are still awaiting the posting of the updated Appendix PP which is scheduled for second quarter of 2020.  There will definitely be critical information for LTC in that Appendix posting.