Discharging a Client: A Guide for Healthcare Providers
DISCHARGING. As you will see below, many requirements must be met to comply with Maryland State law and ACHC regulations. It can be confusing! That's why at Balance Point Wellness, we make discharging as easy as possible. We provide a template in RxNT that walks you through all of the discharge summary requirements. Then therapists simply need to go to their caseload tracker, change "Start Discharge Process?" to "Yes," and provide the information that was just entered into your discharge summary. If you select "Yes" for needing a letter sent, then the CSA's will take care of this for you, and you are done! Some like to send their own letter, which is absolutely fine; the template that meets all of the requirements can be found on SharePoint Resources, and a copy of the letter needs to be placed in the chart. For psychiatry, after the summary is complete, an email needs to be sent to MedicalDischarges@bpointwellness.com, and a Medical Coordinator will assist in sending a letter.
However, why do we need to formally discharge a client when we know the client has already said they aren't returning or we haven't heard from them for a while? There are multiple reasons. From a liability perspective, it is important to close up the chart and document the end. The client is now out there without us knowing their mental state. They are possibly unstable or at risk for harming themselves or others, and on paper, they are still your client, and you are the treatment provider until the discharge is documented and the client informed. You do not want to have an active client who you haven't seen in months or years, who you still hold some responsibility towards and, therefore, liability should something bad happen.
Secondly, Balance Point Wellness is an Outpatient Mental Health Center (OMHC) in the State of Maryland, and as an OMHC, Maryland law (COMAR 10.21.17.10) requires:
Within 10 working days after an individual is discharged from a program, a staff person responsible for coordinating services to the individual shall complete and sign a discharge summary that includes, at a minimum, the: (1) Reason for admission; (2) Reason for discharge; (3) Services provided, including the frequency and duration of services; (4) Progress that was made; (5) Diagnosis at the time of discharge, if appropriate; (6) Current medications, if any; (7) Continuing service recommendations and summary of the transition process; and (8) Extent of the individual's involvement in the discharge plan.
…Provide written notice of the intention to discontinue services and recommend referral for alternative services…at least 30 calendar days before discontinuing services. The notice shall include: (a) The effective date of the action; (b) The reason for the action; and (c) A discharge plan.
Thirdly, our accreditation board, ACHC, requires, per their regulations, that:
The service recipient record reflects discharge planning activities, coordination with other service providers, the service recipient's response and understanding to these activities and service recipient care instructions. Prior notice of discharge is given within timeframes as required by state law, unless there is imminent danger, and then the discharge is processed as soon as possible, to facilitate the service recipient accessing intensive services…Where no timeframes for discharge notice exists, notification is given within 72-hours of discharge. The discharge summary includes, but is not limited to: Date of discharge; Demographic information; Service recipient's physician and phone number, if applicable; Diagnosis; Reason for discharge; A brief description of services provided; Status of service recipient at the time of discharge; Medications, if applicable; Any instructions given to the service recipient/responsible person.
Additionally, Medicaid and private insurance companies have their own requirements when it comes to discharging. Overall, the idea is that we need to document the end of the therapeutic relationship so that the record reflects the trajectory of services to assist future treatment providers, and referrals must be provided for continuity of care.
Should you have questions about discharging, email Hannah Frallicciardi, Director of Compliance, at HFrallicciardi@bpointwellness.com.