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Independent Living News & Policy from the National Council on Independent Living

Urgent Action Alert: Nursing Homes Are Not Community Living!

In proposed rules regarding payment for inpatient rehabilitation facilities and skilled nursing facilities, the Centers for Medicare and Medicaid Services (CMS) has proposed a quality measure for “discharge to community”.

Unfortunately, this measure would count transfer to a nursing home as a community discharge. This is most dangerous for people in a skilled nursing facility who could be transferred to the Medicaid-funded section of the nursing home on paperwork only, remain in the same facility, and then be counted as a “discharge to community.”

Obviously, placement in a nursing home is not the community, and facilities should not be rewarded based on quality measures that pretend it is.

We have a very tight timeline and very few comments have been submitted so far. Comments are due Monday, June 20. 

Take Action

  1. Submit your comments online. Sample text is available below for use. Feel free to edit as needed.
  1. Sign on to the Coalition to Preserve Rehabilitation letter (Word) by emailing Steve Postal at by 5:00 p.m. on Monday, June 20.

Sample Comment

Discharge to Community Should Measure Transitions to Home and Community-Based Settings, not Institutions

Discharge to community is a critical measure to assess the ability of a post-acute care provider to rehabilitate patients to enable them to return to the home and community based setting, rather than remaining in an institution. This measure will be determined based on the code used for the “Patient Discharge Status Code” on the Medicare claim form. A beneficiary will be considered discharged to community if their Patient Discharge Status Code on Medicare claims is one of the following:

  • 01 – Discharged to home/self-care
  • 06 – Discharged/transferred to home under care of organized home health service organization
  • 81 – Discharged to home or self-care with a planned acute care hospital readmission
  • 86 – Discharged/transferred to home under care of organized home health service organization with a planned acute care hospital inpatient readmission.

A nursing home is not one’s own home in one’s own community. We believe that discharging a beneficiary to a “residential” nursing home (i.e., long-term care setting), especially if the patient is admitted from a Medicare-certified part of the same facility, should not be counted as a discharge to community. Unfortunately, the measure specifications as proposed would permit such a discharge to count as a community discharge. For instance, if a beneficiary in a skilled nursing facility (SNF) is discharged to a non-Medicare certified area within that same facility, the discharge may be interpreted as a discharge to a “group home,” “foster care,” or “other residential care arrangement.” Such discharges are nevertheless included under guidance for Patient Status Discharge Code 01, one of the codes that counts as a community discharge (see footnote). If such a discharge from a Medicare skilled nursing facility to another part of the same facility would indeed count as a community discharge, this would likely artificially improve the community discharge rates for SNFs with accompanying residential nursing home beds while holding other PAC providers to a different and potentially more stringent standard. As such, counting a discharge from a SNF to the residential/long-term care portion within the same facility as a discharge to community would not only negate the value of the measure itself, but would miscommunicate the actual discharge to community performance to the average Medicare beneficiary on any public reporting mechanism.

Footnote 1: CMS Medicare Learning Network, Clarification of Patient Discharge Status Codes and Hospital Transfer Policies, MLN MATTERS NO. SE0801, (updated Mar. 6, 2014).

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