FROM: Theodore O. Will, Chief Executive Officer
DATE: Oct 16, 2006
SUBJECT: IPRA Discharge Review Criteria
Doreen Walz, RN, Assistant Director, Ext. 444
IPRO has served as the New York State Department of Health Medicaid Independent Professional Review Agent (IPRA) since December 17, 1987. At this time, IPRO is issuing this memorandum to restate the IPRO IPRA Discharge Review Process.
The following is attached to this memorandum:
- IPRO/IPRA Discharge Review Procedures – The procedures are based on three (3) potential scenarios, based on who initiates the review, i.e., the hospitalized patient or patient representative, the discharged patient or patient representative or the hospital when the attending physician disagrees with the discharge, the discharge plan or notice.
- Sample Documents:
Discharge Notices – There are three New York State Hospital Review and Planning Council approved notices:
- For patients reimbursed under the case payment system (including patients on ALC),
- For patients reimbursed on a per diem basis, i.e. patients in exempt units,
- For cases where the hospital indicates the patient is ready for discharge and the attending physician disagrees.
- Department of Health letter to Greater New York Hospital Association which contains the list of all IPRA Agents, a Question and Answer document on discharge reviews, Dear Administrator Letter dated December 30, 1987, Timing of Discharge Notice-5 Examples. (Attachment A).
- Department of Health Memorandum 87-96 dated December 17, 1987 on Discharge Review Program. (Attachment B)
The IPRA Discharge regulations can be found on the New York State Department of Health Website
http://www.health.state.ny.us/nysdoh/phforum/nycrr10.htm click on “Search Title 10” and type in 405.9.