Patient Discharge Policy

Policy: Patient Discharge

Policy Number: 400 Policy Section: Clinical Care
Owner: Cynthia Grant Approved By: Paul Vogelman, COO
Effective Date: 3/08/2022 Date of Last Review: 3/24/2023

 

SUD Specialty Group -- CA; Mental Health Specialty Group, P.A.; Mental Health Specialty Group NJ, PC; and Mental Health Specialty Group KS, P.A. (collectively, the "Group") contracts with Path CCM, Inc. d/b/a Rula Health ("Rula") for management and administrative support services. This policy applies to the Group and Rula.

 

Policy Statement

This policy ensures that patients are discharged from treatment services appropriately. 

 

Applicability

This policy applies to team members who provide direct care and services to patients. For purposes of this policy, the Group’s and Rula’s team members include individuals who would be considered part of the workforce such as employees, independent contractors, business team members, and other persons whose work performance is under the direct purview of Rula or the Group’s business practices. 

 

Definitions

Discharge: is a discontinuation of services; discharges can be planned or unplanned. 

 

Discharge Note: is a document within the patient’s electronic health record (EHR) that describes the patient’s course of treatment and makes recommendations for continued care, when needed.  

 

Policy

  1. Discharge Criteria: Criteria for discharge listed in this policy are not all inclusive and are meant to serve as a guide to consider a patient for discharge from services. 
  2. Patients will be discharged from services with a provider when:
    1. They no longer meet medical necessity as determined by the Medical Necessity policy (i.e., treatment has been completed). 
    2. They no longer want telehealth services. 
    3. They are unhappy with their services and wish to transfer to another provider. 
    4. The patient has permanently moved out of the state where the provider is licensed to practice and where the Group is not operating. 
    5. They are threatening, hostile, or violent towards their Provider, team member, or others. 
      1. Documentation of the patient's behaviors will occur in the EHR using a non-billable Blank Note. 
      2. Clinical review will be sought in these instances prior to discharge. 
    6. The patient has been recommended for a higher level of care, and does not comply with treatment recommendations. 
      1. Documentation of the need for assessment or higher level of care will occur. 
      2. Clinical review will be sought in these instances prior to discharge. 
    7. The patient does not regularly attend scheduled treatment appointments, or late cancels appointments, or no-shows appointments with their Provider three times or more.
    8. The patient has died.  
  3. Discharges may be completed when the patient does not engage in a therapeutic relationship with the Provider or if the patient no longer regularly schedules appointments 
    1. For providers, this may include a patient who does not schedule a follow-up visit within 90 days after a first appointment or a patient does not schedule a follow up appointment within 30 days of the most recent visit. In these situations, the provider is expected to make a minimum of one documented outreach attempt to the patient by phone or email to inquire if they would like to continue to receive services.  If there is no response from the patient within 10 days, a discharge note should be completed.
    2. For psychiatric nurse practitioners, this may include a patient who is moving out of state or is being transferred to another clinic/HLOC 
  4. For all patients discharging from services, a written Discharge Note will be completed by the patient’s Provider. The Discharge Note includes the following information:
    1. Discharge date
    2. Service being discontinued
    3. Reason for treatment 
    4. Reason for discharge
    5. Documentation of treatment goal achievement
    6. Provider notes, which may include a list of recommendations for services or supports for follow up or return to services (optional) 
    7. Follow up or safety plans (if indicated) 
  5. If the patient’s discharge is planned, a Discharge Note will be entered into the record within seven (7) days of the last visit.
  6. If the patient’s discharge is unplanned, the Discharge Note will be based on the most recent clinical and other information available. 


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