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Appeals Tip Sheet

Nursing Homes:
• The resident, or representative acting on or behalf of the resident, has 30 days from the date of receipt of a proper
notice to file an appeal.

• Make sure that the notice is a legal discharge that has all the items required on the Transfer Discharge tip sheet.

Appeals should be addressed to:
Office of Hearings and Appeals
Department of Human Services
PO Box 2675
Harrisburg, PA 17105-2675

• An appeal requesting an order to HALT the transfer or discharge must be identified with the words
“INTERVENTION REQUESTED” in large letters on the outside of the envelope and in the appeal letter itself. This will
mean that there will be two hearings held for the individual. One for the “intervention” and one for the discharge.

• Appeal must state reason why discharge is wrong with a copy sent to the facility and physician of record.

Consumer Rights:
• If an MA resident requests a hearing, MA must pay for care until a hearing is held and a decision rendered.

• The consumer/and their representative have a right to examine the records and files that will be used in the hearing.

• Rights to bring witnesses to the hearing and to question evidence provided.

• The hearing decision is based solely on evidence introduced at the hearing.

Intra-Facility Transfers:
• Residents are to be given prior notice for change in room or change in roommate.

• Although residents do not have appeal rights, other rights for choice and self-determination must be met.

• Resident can refuse transfer if the purpose is to relocate the resident into or out of a Medicare bed.

• If possible, legal services or agency solicitor should be involved in the appeal process. These are legal proceedings
and sometimes can be quite overwhelming for the resident or ombudsman. Consultation should be available to the
resident and ombudsman with a legal provider. If that is not available in your county, then consult the Office for
guidance on the issue.

Personal Care Homes:
• The PCH regulations implemented October 2005 have no provision for appealing discharge. The resident would
have the right to contact any community agency for help.

• As the local ombudsman you will want to be sure that the resident is being discharged for one of the legally
allowable reasons, and that the discharge is valid.

• You should also contact the DHS licensing office for assistance in assessing the validity of the discharge notice.

Office of the LTC Ombudsman
Version 1.0 September 2020
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