What is the Exempted Hospital Discharge?

According to 42 CFR 483.106(a)(2), Basic Rule, the only true exemption from PASRR is the Exempted Hospital Discharge (EHD). The EHD may be applied for an individual who (a) is admitted to any nursing facility (NF) directly from a hospital after receiving acute inpatient care at the hospital, (b) requires NF services for the condition for which he or she received care in the hospital, and (c) has been certified by an attending physician before admission to the NF to likely to require fewer than 30 days NF services.

If the State program permits the use of EHD, and the individual remains in the facility longer than 30 days, the CMS State Operations Manual Appendix PP requires the NF to screen the individual using the State’s Level I screening process and refer any resident who has or may have MD, ID or a related condition to the appropriate state-designated authority for Level II PASRR evaluation and determination. Under 42 CFR 483.106(b)(2)(ii), if an individual who enters a NF under an EHD is later found to require more than 30 days of NF care, the State mental health or intellectual disability authority must conduct a Level II resident review within 40 calendar days of admission.

While not required, states may choose to perform a Level I screen for individuals being admitted to a NF under the EHD as a way to track individuals who might later require a Level II.