Before a New York hospital sends you home, it must give you a written discharge plan. If you have Medicare and think you are leaving too soon, you can ask the Quality Improvement Organization (QIO) for a fast review, as long as you call no later than the planned discharge date. For New York that is Commence Health (formerly Livanta) at 1-866-815-5440.
What does a hospital have to do before it sends someone home?
Both federal and New York rules require a planning process. The federal rule is a hospital condition of participation (42 CFR 482.43). New York’s side is in the State Health Department’s booklet Your Rights as a Hospital Patient in New York State.
| What you can expect | Where it comes from |
|---|---|
| A discharge planning evaluation for patients likely to struggle at home, and for anyone when the patient, a representative or the physician asks | 42 CFR 482.43(a) |
| An evaluation of likely needs after discharge (home health, skilled nursing facility, hospice, community providers) and whether those services are available to you | 42 CFR 482.43(a)(2) |
| A list of Medicare-participating home health agencies or skilled nursing facilities near you, freedom to choose among them, and disclosure of any hospital financial interest in one | 42 CFR 482.43(d) |
| A written discharge plan describing the arrangements for care you will need; the services in it must be secured or reasonably available before you leave | NYS Department of Health, Your Rights as a Hospital Patient |
“Reasonably available” is the hospital’s judgment, so ask who is coming to the house, on what day, and what happens if they do not arrive.
Can a family member or friend be part of the plan?
Yes. Under New York’s CARE Act (Public Health Law Article 29-CCCC), a general hospital must give an inpatient at least one chance to name a caregiver, such as a relative, partner, friend or neighbor, before discharge. Naming someone is optional, and the person named is not obligated to do the care.
The State Health Department’s letter to hospitals (DAL 16-06) says the patient must consent to sharing health information with that person. The hospital must consult with the caregiver and patient about after-care needs, if possible 24 hours before discharge, and offer instruction in the after-care tasks, including a demonstration.
What if I think the discharge is too soon?
Medicare gives you a fast appeal, and the steps are short. The hospital must hand an inpatient the Important Message from Medicare at or near admission, no later than two calendar days after admission, and a signed copy again shortly before discharge (42 CFR 405.1205). It names the QIO and its phone number (see the CMS notice form).
- Talk to the care team first. Raise it with the doctor, nurse or discharge planner, and your plan if you have Medicare Advantage.
- Call the QIO. The notice says to contact it no later than your planned discharge date and before you leave. You can ask any day of the week. Speaking to someone or leaving a message starts the appeal.
- Expect a detailed notice. The hospital must explain why it thinks you are ready, no later than noon of the day after the QIO notifies it of your request (42 CFR 405.1206).
- Be available, then wait. The QIO will ask for your view; a written statement is optional. It must decide within one calendar day after it has all the information, and if it finds you are not ready, Medicare keeps covering the stay.
| Situation | What the rules say |
|---|---|
| You call by the deadline | You are not responsible for inpatient charges, other than any coinsurance and deductible, before noon of the day after you are told the QIO’s decision |
| You miss the deadline but are still in the hospital | You can still ask the QIO for a review, but the cost protection does not apply |
| You already left | You can ask for a QIO review within 30 calendar days of discharge, or later for good cause |
The hospital carries the burden of proving the discharge is correct. New York is in Region 2 on Commence Health’s page, and CMS names Commence Health (formerly Livanta) and Acentra Health (formerly Kepro) as the QIO contractors. The State’s booklet lists the same number and a TTY line, 1-866-868-2289. Check the number on your own notice before calling. Patients without Medicare get a written discharge notice naming the review agency for their coverage, per the State booklet.
Does inpatient or observation status change anything?
It can. Medicare.gov says you are an inpatient only once a doctor writes an order and the hospital formally admits you. In observation you are an outpatient even if you stay overnight. After more than 24 hours of observation the hospital must give you a Medicare Outpatient Observation Notice. Ask each day which status you have.
Status affects skilled nursing facility coverage: Medicare requires a qualifying inpatient stay of at least three days in a row, and observation time does not count. Details are in SNF coverage days and appealing a skilled nursing decision.
What are the options after discharge, and how do I ask for each?
| Option | Who generally pays | How to ask |
|---|---|---|
| Home health: nurse or therapist visits | Medicare, if you are homebound and need part-time skilled care | A doctor or nurse practitioner must see you in person and order it; ask for the agency list |
| Skilled nursing facility for rehab | Medicare Part A, only after a qualifying inpatient stay, for a limited time | Ask the discharge planner for a referral and a facility list |
| Private-pay home care (aides, nurses) | You or family, sometimes long-term care insurance | Call a licensed agency yourself; no referral needed |
| Medicaid personal care or CDPAP | Medicaid, if eligible | Assessment by the NY Independent Assessor Program; ask a social worker about immediate need |
Medicare.gov says home health does not cover 24-hour care, home meal delivery, or personal care when it is the only care you need. See the home health benefit, home health versus home care, private home care, costs and choosing an agency.
How do I get home care started fast?
If the person has Medicaid, or would apply, New York has an “immediate need” route for personal care. The State’s Medicaid page says eligibility may be processed faster if the person:
- has no voluntary informal caregiver able and willing to provide or continue care
- is not receiving needed help from a home care agency
- has no third-party insurance or Medicare benefits available to pay for the help, and no equipment that meets the need
The conditions are strict. Someone who can use Medicare home health, or has family at home, may not fit, so ask a hospital social worker or HRA first.
Requests go to the local social services office, HRA in New York City. The State lists a signed Attestation of Immediate Need (DOH-5786) and a physician’s order (DOH-4359 or HCSP-M11Q) or a Practitioner Statement of Need (DOH-5779). A person without Medicaid also sends the Access NY application (DOH-4220). Once HRA has all the necessary information, it has 7 days to say whether the person is eligible for Medicaid and 12 days to decide whether they could get personal care. See our guide to the M11q form and how Medicaid covers home care. Those are decision deadlines, not a start date.
What should be arranged before the first day home?
Medicare’s discharge planning checklist is a good script. Items on it include:
- Names and phone numbers of people to call with questions.
- Whether you need equipment such as a walker, whether Medicare covers it, and who arranges delivery.
- Staff showing you and your caregiver any special task, such as changing a bandage, and then practicing it.
- Written instructions you can understand, plus a summary of your current health.
- A full medicine list, with staff saying which items and doses to continue.
- For a caregiver: getting prescriptions and errands done before discharge, to avoid extra trips.
Never change a dose because a list looks confusing; ask the prescriber or pharmacist (see medication management for seniors). For equipment, see free medical equipment; for rides, senior medical transportation.
What should happen in the first 72 hours at home?
Boston University’s Project RED toolkit, funded by the federal Agency for Healthcare Research and Quality (AHRQ), schedules a hospital follow-up call within 72 hours of discharge to check medicines, appointments and home services.
- Keep the paperwork together. Plan, instructions, medicine list and phone numbers in one folder.
- Check the basics. Equipment delivered, prescriptions filled, a safe path from bed to bathroom and kitchen.
- Match the medicines to the list. If bottles at home and the discharge list differ, call the prescriber or pharmacist.
- Confirm the visits. Confirm the first home health or aide visit. If no agency has called within a day, call the discharge planner or the agency.
- Confirm follow-up appointments and rides, both directions, and who goes along.
- Explain it back. Have the patient or caregiver repeat the instructions in their own words (“teach-back,” used in AHRQ-backed discharge tools). If the hospital does not call to check in, you call.
Which warning signs mean a call or 911?
The hospital’s written instructions should list what to watch for, and Medicare’s checklist tells you to ask about complications. Call the doctor’s office or the number on the discharge papers for anything on that list, or if you cannot take a prescribed medicine, equipment has not come, or planned help does not show up. Call 911 for:
- Stroke signs. The CDC lists sudden trouble walking or seeing, numbness or weakness especially on one side, sudden confusion or trouble speaking, and sudden severe headache.
- Heart attack signs. Per the CDC, these include chest discomfort lasting more than a few minutes, faintness, pain in the jaw, neck, back or arms, and shortness of breath.
- Possible sepsis. The CDC lists confusion, fever or shivering, extreme pain, a high heart rate, clammy skin and shortness of breath, and calls sepsis a life-threatening emergency. Most cases involve an underlying condition or recent hospitalization.
How do hospitals try to prevent a return trip?
Project RED gives each patient an After Hospital Care Plan listing medicines and appointments, plus the 72-hour call; its toolkit page says the process it replicates produced 30 percent fewer readmissions and emergency room visits. AHRQ’s IDEAL approach, summarized by a CMS-contracted quality organization, includes the family and covers five areas: what to expect next, medicines, readmission risk factors, test results and follow-up appointments. Use those as your questions. See also our hospital to home transition guide and post-surgery home care.
Timing and escorts: advice from our nurse director
Anna Klyauzova, RN, MSN, MPA, Director of Patient Services at ProLife Home Care, on what she sees in practice:
For private-pay care, we usually match an HHA or PCA in 24 to 48 hours when staff are available, and care can often start within 48 hours. Those timings apply mainly to private care. With Medicaid, the start date also depends on the assessment and authorization.
Most older New Yorkers get to appointments with a relative, a Medicaid ride or a regular taxi. The ride is rarely the hard part. The hard part is the visit: who helps at the front desk, explains the symptoms to the doctor and remembers what was said? If your father walks slowly or forgets what the doctor said, I would book an escort. Our Medical Escort service sends a trained home health aide who goes with the patient, writes down the doctor’s instructions and brings the patient home. It is private pay.
We are a licensed home care agency in Brooklyn and Queens, licence #2572L001, New York State Department of Health. We can talk through which route fits and what private help could cover while other arrangements are set up. Call (718) 232-2777 or use our contact page.
Rules, QIO contractors and phone numbers change. Everything above was checked on 14 October 2026 against medicare.gov, cms.gov, ecfr.gov, health.ny.gov, bu.edu and cdc.gov. Confirm your own situation with the discharge planner, your plan, 1-800-MEDICARE, or an elder law attorney if there is a dispute. This page is general information, not medical or legal advice.
Frequently asked questions
Can a New York hospital discharge me if nobody is at home?
The State Health Department says a written discharge plan is required for every patient, and the services in it must be secured or reasonably available before you leave. The hospital decides what is reasonably available, so tell the discharge planner who is and is not at home, and use the appeal rights if you disagree.
How do I appeal a hospital discharge if I have Medicare?
Call the QIO named on your Important Message from Medicare no later than your planned discharge date and before you leave. For New York, Commence Health lists 1-866-815-5440. The QIO must decide within one calendar day after it gets the information it needs.
What is the Important Message from Medicare?
It is the standard notice that a hospital must give a Medicare inpatient within two calendar days of admission, with a follow-up copy before discharge. It explains your inpatient rights, your right to a fast appeal, and the QIO contact information.
Does Medicare pay for home care right after a hospital stay?
Only for home health that meets Medicare’s rules: you are homebound, need part-time skilled care, and a provider orders it from a Medicare-certified agency. Medicare does not pay for 24-hour care or personal care when it is the only care you need.
How soon can home care start after discharge?
It depends on the route. Medicare home health begins after a provider’s referral and the agency’s assessment. Private-pay care can often start faster. Medicaid personal care depends on the assessment and authorization, and the immediate need route sets decision deadlines of 7 and 12 days after the office has all the information, not a start date.
Does time in observation count toward the three-day rule?
No. For skilled nursing facility coverage, Medicare counts only days after a doctor orders inpatient admission. Time in the emergency room or observation before the order does not count, even overnight.
Can I name a family member to be part of my discharge plan?
Yes. Under New York’s CARE Act, the hospital must give you at least one chance to name a caregiver. You do not have to, and the person you name does not have to provide care, but the hospital must offer them instruction in the after-care tasks if you are going home.
