Page 113 - Ombudsman Participant Manual Optimized_Neat

Transfer/Discharge §483.15(c)(1)(i)(A-F)
Six (6) allowable reasons for discharge or transfer (nursing facility):
1. The facility is unable to meet the resident’s needs. If a client is assessed as nursing-facility
appropriate and the facility is a licensed nursing facility, this will not be a satisfied standard. Also, a
resident who refuses to authorize or accept medical treatment by a nursing facility cannot be
discharged under this standard. New regulations dictate that specific documentation required if
transfer/discharge “is medically necessary for the resident’s welfare and the resident’s needs cannot
be met in the facility.” The medical record must now include:
a. Specific resident needs that cannot be met
b. Facility attempts to meet the resident’s needs
c. Service available at the receiving facility to meet the need(s).
2. The resident’s health has improved sufficiently so that he/she no longer needs nursing facility care.
Ombudsman report that some facilities have pointed to this improvement, which seems to coincide
with the consumer’s spend-down of assets and impending application for Medical Assistance
benefits.
3. The safety of individuals in the facility is endangered. In the new regulations, the “safety of others”
justification is now limited to endangerment “due to the clinical or behavioral status of the
resident”.
4. The health of individuals in the facility is endangered.
5. The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under
Medicare/Medicaid) his/her stay in the facility. Conversion from private pay to Medical Assistance is
NOT failure to pay. New regulations stipulate that “nonpayment” does not occur if the resident has
submitted the necessary paperwork for third party reimbursement.
6. The facility closes.

Notice Before Transfer §483.15(c)(3)
• Notice must occur 30 days in advance, or as soon as possible if a more immediate transfer is necessary
to meet health needs or if the resident has been in the facility less than 30 days §483.15(c)(4)(i)
• Notice must be given in writing to the resident and their representative in a language and manner
understandable by the consumer and send a copy of the notice to the Office of the State Long-Term
Care Ombudsman §483.15(c)(3)(i)

Information that must be provided to the Receiving Facility or Provider
Information to the receiving provider must include, at a minimum:
• Practitioner contact information
• Resident representative contact information
• Advance Directive information
• Special instructions or precautions for ongoing care
• Comprehensive care plan goals
• Other necessary information, including copy of the discharge summary

Some Key Provisions
• Admission—Prohibiting Pre-Dispute Arbitration Agreements (AHCA has filed challenge; court granted
injunction pending appeal). § 483.70(n)(1) Post-dispute arbitration (with conditions) OK. §483.70(n)(2)

Office of the LTC Ombudsman
Version 1.0 September 2020
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