Page 143 - Ombudsman Participant Manual Optimized_Neat
P. 143
1
“clinical or behavioral status.” It’s unclear whether ■ Contact information for the Long-
this change is particularly meaningful: whenever Term Care Ombudsman program and
a facility claims a threat to safety, the allegations (if applicable) the agencies responsible
generally concern the resident’s clinical conditions for advocacy on behalf of persons with
or behavior. intellectual and developmental disabilities,
In a more useful change, the revised regulations or persons with mental disorders.
now state that a resident cannot be transferred Notice generally must be given at least 30 days
or discharged for nonpayment if he or she has before the proposed transfer/discharge. Notice can
“submit[ted] the necessary paperwork for third be made “as soon as practicable before transfer or
party payment.” This provision is particularly discharge,” however, if the resident has resided in
2
relevant for a resident applying for Medicaid the facility for less than 30 days, if the resident’s
coverage. While the Medicaid program is improved condition allows for a “more immediate
considering the resident’s application, the facility transfer or discharge,” or if prompt transfer or
cannot initiate a nonpayment transfer/discharge discharge is needed to protect the safety or health
action. This protection previously had been set of others at the facility, or to respond to the
5
forth in the surveyor’s guidelines, but now CMS resident’s “urgent medical needs.” The term “as
3
has elevated that protection to the regulations. soon as practicable” is not defined but, in any case,
the resident cannot be transferred or discharged
Required Notice while an appeal is pending, unless delay will
Consistent with the statute and the previous endanger the health or safety of the resident or
regulations, the revised regulations require that others in the facility.
the facility provide written notice of the proposed If the information in the notice changes,
transfer/discharge to the resident and the resident’s the facility must let the resident and resident
representative(s). A new provision requires that representative(s) know of that change as soon as
notice also be sent to the Long-Term Care practicable. This is a regulatory change that is
Ombudsman program. both good and bad for residents. It is good because
The revised regulations specify that the notice be now the facility has a clear obligation to update
written in a “language and manner” understood by information. It is bad because the regulations
the resident and representative(s). The notice must now seem to allow a notice to be updated without
4
include: restarting the notice period. Regardless, a resident
or representative should demand more time if he or
■ The reason for the transfer/discharge, she is prejudiced by a facility “update” made close
■ The proposed effective date, to the scheduled hearing date.
■ The location to which the resident will be Required Documentation
transferred or discharged,
Most of the documentation requirements
■ Information on the resident’s appeal rights, are consistent with the statute and the previous
and regulations. If a proposed transfer/discharge is
based on an alleged danger to safety or health,
1 42 C.F.R. §483.15(c)(1)(i)(C).
the need for the transfer/discharge must be
2 42 C.F.R. §483.15(c)(1)(i)(E).
documented by a physician. If transfer/discharge is
3 CMS’s Surveyor’s Guidelines are found in Appendix PP to the
CMS State Operations Manual. based upon the resident’s needs —either needing
4 42 C.F.R. §483.15(c)(3)(i). 5 42 C.F.R. §483.15(c)(4).
Office of the LTC Ombudsman Justice in Aging • www.justiceinaging.org • ISSUE BRIEF • 3
Version 1.0 September 2020
137
