Hospital Discharge Rights in New Hampshire

What RSA 151:21 Actually Guarantees

New Hampshire's Patients' Bill of Rights, codified under RSA 151:21, says that a patient may be transferred or discharged only after appropriate discharge planning, subject to the statute's listed exceptions. Federal Conditions of Participation require hospitals to identify your parent's post-acute care needs, arrange appropriate follow-up services, and document the discharge plan before executing the discharge.

Federal Conditions of Participation layer additional requirements on top of the state law. Under CMS rules, the hospital must evaluate whether your parent needs home health services, durable medical equipment, prescription coordination, medical transportation, and follow-up appointments. The discharge plan should address each of these categories before your parent is moved out of their hospital bed.

One protection families consistently overlook: the right to freedom of choice among post-acute providers. Hospitals cannot steer your parent toward a specific skilled nursing facility or home health agency. They must provide a list of certified local providers and help you compare quality metrics, staffing ratios, and state inspection records through the Medicare Care Compare database.

The Caregiver's Right to Notification Under SB 187

New Hampshire's CARE Act (Senate Bill 187) requires hospitals to offer the patient or, if applicable, the patient's legally designated health care decision maker an opportunity to designate a caregiver after entry and before discharge or transfer. If a caregiver is designated, the hospital must record that designation. With the patient's or decision maker's written consent to release information, the hospital must also:

• Record the designation in the patient's medical record
• Notify that caregiver as soon as possible and, at the latest, when the physician or APRN issues the discharge or transfer order. The CARE Act itself does not delay discharge or transfer.
• Provide instruction on the after-care tasks described in the discharge plan, including a live demonstration and an opportunity for questions

If you're the designated caregiver and the hospital hasn't walked you through the specific tasks described in the discharge plan, document that gap in writing to the case manager. The CARE Act does not itself delay a discharge or transfer, but the record may help you request corrective training or support a subsequent appeal.

When the Hospital Pushes Back

Hospital case managers operate under administrative pressure to reduce length of stay and maximize bed turnover. This means discharge timelines often reflect DRG reimbursement structures rather than clinical readiness. When you feel your parent isn't stable enough to leave, you have two concrete options.

First, request a formal meeting with the attending physician — not just the case manager. The physician has clinical authority to extend the stay if medical instability can be documented. Ask specifically whether the discharge meets the criteria for a safe transition given your parent's functional status.

Second, exercise your federal appeal rights. Every Medicare inpatient receives the "Important Message from Medicare" (Form CMS-10065) within two days of admission. When a follow-up copy is required, the hospital must deliver the signed copy no more than two calendar days before the planned discharge. If you believe the discharge is premature, contact Acentra Health — New Hampshire's BFCC-QIO — at 1-888-319-8452 before your parent leaves the hospital and before midnight on the planned discharge date. Filing this appeal legally halts the discharge, and the hospital cannot remove your parent or charge for continued care during the review.

What a Complete Discharge Plan Includes

Before signing off on any discharge, verify that the plan addresses:

• Home health referral with a confirmed start date and agency name
• Durable medical equipment ordered, delivered, and set up before arrival
• Medication reconciliation completed, with a written list of every current medication, dosage, and schedule
• Follow-up appointments scheduled with dates and provider names
• Transportation arranged for the day of discharge and subsequent medical visits
• Emergency contacts documented, including the primary care physician's after-hours line

If any of these elements are missing or vague, put your concerns in writing to the hospital's patient advocate or patient-relations office. That written record creates an official trail that protects your parent's rights if complications arise after discharge.

Building a Stronger Foundation

The discharge window moves fast — often faster than families expect. Having a structured system to track deadlines, ask the right questions, and document every interaction with hospital staff makes the difference between a safe transition and a preventable readmission. The New Hampshire Hospital Discharge Guide walks through each step with worksheets and appeal templates built specifically around New Hampshire's regulatory framework.

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