Hospital Discharge Planning Rights Michigan

Your Parent Has a Legal Right to a Safe Discharge Plan

If a hospital is rushing to discharge your parent before you feel the transition is safe, you are not powerless. Michigan statute and federal Medicare regulations together create a framework of discharge planning rights that hospitals must follow — and that you can invoke when advocating for your parent.

The two pillars are MCL 333.26285–333.26289 (Michigan's Designated Caregiver Act, often described as the CARE Act, effective July 12, 2016) and the federal Medicare Conditions of Participation. Together they require a discharge-planning process, give the patient or authorized representative an opportunity to designate a caregiver, and provide a structured appeal process when Medicare coverage is ending.

The Michigan Designated Caregiver Act (CARE Act): MCL 333.26285–333.26289

The Michigan CARE Act requires hospitals to give your parent (or their patient advocate) the opportunity to designate a family caregiver as soon as practicable after an inpatient admission and before discharge. Once designated, the hospital must:

• Record the caregiver's name and contact information in the patient's medical record
• Notify the designated caregiver before the patient is discharged or transferred
• Attempt to consult with the caregiver about the discharge plan, including instruction on any aftercare tasks the caregiver will need to perform at home

Aftercare tasks include wound care, medication administration, use of medical equipment, and monitoring for warning signs that require emergency intervention. The hospital must provide this instruction in nontechnical language and give the caregiver an opportunity to ask questions. A live or recorded demonstration may be provided if hospital personnel determine it is necessary.

If your parent is admitted through the emergency department and is too disoriented to designate a caregiver themselves, the patient advocate (the person named in a valid Patient Advocate Designation under MCL 700.5506) or court-appointed guardian can make the designation.

What a Complete Discharge Plan Must Include

Under federal Medicare Conditions of Participation, every hospital must have a discharge planning process that evaluates each patient's post-hospital needs. The written discharge plan your family receives should include:

• An updated medication list that clearly marks which pre-hospitalization medications are continued, discontinued, or changed — and why
• Scheduled follow-up appointments with the patient's primary care physician and any specialists
• Durable medical equipment (DME) orders for items like hospital beds, walkers, oxygen concentrators, or wound care supplies — with delivery confirmed before discharge
• Home health referrals if the patient needs skilled nursing visits, physical therapy, or occupational therapy at home
• Warning signs that should trigger an immediate call to 911 or a return to the emergency department

The hospital's discharge planner (typically a social worker or nurse case manager) is required to deliver this plan. If your family has not received a written plan that covers these elements, you have grounds to request one before agreeing to the discharge date.

The Medicare Notice System

Medicare beneficiaries receive specific written notices during a hospital stay that trigger important rights:

The Important Message from Medicare (IM) — Form CMS-10065 — must be delivered within two days of admission and signed again up to two days before discharge. It explains the patient's right to appeal a discharge they believe is premature.

The Medicare Outpatient Observation Notice (MOON) — delivered if the patient is placed under observation status rather than formal inpatient admission. This distinction matters because observation days do not count toward the three-consecutive-inpatient-night requirement for Medicare SNF coverage.

The Medicare Change of Status Notice (MCSN) — issued when a hospital reclassifies a patient from inpatient to outpatient observation. Since February 2025, this notice includes appeal rights that did not previously exist.

If you are managing a parent's hospital stay, request copies of every notice delivered and keep them in a folder. These documents are the foundation for any appeal.

What to Do If the Discharge Plan Is Inadequate

When the hospital's proposed discharge plan does not ensure your parent's safety — the home is not modified, the caregiver has not received instruction, DME has not been ordered, or follow-up appointments are missing — take these steps:

1. Ask the discharge planner to document your concerns in the medical record
2. Request a care conference with the attending physician, the discharge planner, and any therapists involved in your parent's recovery
3. File an appeal with Commence Health (Michigan's BFCC-QIO) before midnight of the scheduled discharge day — this freezes the discharge and keeps Medicare coverage in place during the review

You do not need an attorney to file this appeal. A phone call to Commence Health at 1-888-524-9900 initiates the process, and the hospital cannot discharge your parent while the review is pending.

Protecting Your Parent's Transition

The gap between hospital and home is where things break down — medication errors, falls, missed follow-up appointments. Michigan's discharge planning rights exist specifically to close that gap, but they only work if someone in the family knows to invoke them.

The Hospital-to-Home in Michigan guide walks through each of these rights step by step, with the exact forms, phone numbers, and timelines you need to enforce them during a crisis.

See more Michigan guides →