Discharge Planning: Your Right to Choose a Rehab Hospital or Post-Acute Provider
What federal rules say about discharge planning, patient choice and lists of post-acute providers, and how to use them.
When a hospital stay is ending, families often get a short list of rehabilitation or long-term care providers and a deadline. It helps to know what the federal rules say about this process, because patients have more say than many people realize.
What hospitals must do
Medicare's conditions of participation for hospitals include discharge planning requirements (42 CFR 482.43). In general, when a patient is discharged to post-acute care such as home health, a skilled nursing facility, an inpatient rehabilitation facility or a long-term care hospital, the hospital must give the patient a list of available providers that serve the patient's geographic area and are appropriate to the patient's needs. It must respect the patient's and family's goals and preferences, and it must disclose any financial interest it has in a provider on the list. The rules are summarized on the text of 42 CFR 482.43.
What you can ask
- "Can I see the list of facilities that serve my area and fit my needs?"
- "Does this hospital have a financial relationship with any facility on the list?"
- "Which facilities have a bed now, and which have a waiting list?"
- "Why do you recommend this type of facility over the others?"
- "Which of these facilities take my insurance or Medicare Advantage plan?"
Using Care Compare
Medicare Care Compare lets you look up many types of providers, including inpatient rehabilitation facilities and long-term care hospitals, and see quality information that facilities report to Medicare. Use it alongside what you learn from visits and phone calls. On this site, each listing shows the facility's CMS certification number so you can find it on Care Compare.
Visit or call
If you cannot visit before transfer, ask the facility for a phone or video conversation with the admissions staff and a therapist. Ask about daily therapy hours, physician coverage, nurse staffing, how families take part and what the plan is for going home. Ask whether the facility has treated many patients with the same condition. Ask who the contact will be for questions after the transfer.
If you disagree with a discharge
If you think a patient is being discharged too soon, Medicare patients can ask for a fast appeal through the Quality Improvement Organization that handles appeals for the region. The hospital must give a written notice that explains the right to appeal and how. See Medicare's page on appeals and ask the hospital's patient advocate for help. Act quickly, because the appeal deadlines are short.
Medicare Advantage
If the patient has a Medicare Advantage plan, the plan may need to approve the next facility, and may have network rules. Ask the plan and the facility who is responsible for the authorization and what the plan has decided in writing. If the plan denies coverage, you have appeal rights; ask for the denial in writing and the steps to appeal.
Where we fit
This directory lists Medicare-certified facilities from CMS data. We take a flat monthly fee from facilities that choose a featured spot, clearly labelled, and we never take a fee per referral or patient. Featured placement does not change the order of the regular list. We do not rate or recommend any facility.
Written notices and records
Keep every written notice the hospital gives you, including the notice of discharge rights, the list of providers and any statement about financial interests. Ask for a copy of the discharge plan and for the patient's recent records to be sent to the next facility. If a facility accepts the patient, ask for the expected admission date and the name of the person who will receive the patient. A clear handoff makes the first days easier and reduces the risk that medications or therapy goals are lost in the transfer.
Plan for the first week
Before the move, ask what the patient should bring, what clothing is useful for therapy, and how to label belongings. Arrange for a family member to be present on the first day if possible, to meet the team and ask about the schedule. Ask how often you will get updates, and write down a name and number for questions.
General information only, current as of the date above. The information on Inpatient Rehab & LTCH Index is not medical advice and does not replace a doctor, nurse, discharge planner or other qualified professional. Do not use it to make decisions about diagnosis or treatment. If you have a medical emergency, call 911. Rules and programs change; check the official sources linked in this guide.