FEDERAL LAW DICTATES ADMISSION, TRANSFER, AND DISCHARGE RIGHTS

A nursing facility must permit each resident to remain in the facility, and not transfer or discharge the resident from the facility unless -

1. The transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the facility;
2. The transfer or discharge is appropriate because the resident's health has improved sufficiently so the resident no longer needs the services provided by the facility;
3. The safety of individuals in the facility is endangered;
4. The health of individuals in the facility would otherwise be endangered;
5. The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility. For a resident who becomes eligible for Medicaid after admission to a facility, the facility may charge a resident only allowable charges under Medicaid; or
6. The facility ceases to operate.

When the facility transfers or discharges a resident, the resident's clinical record must be documented. The documentation must be made by the resident's physician or another physician, depending on the reason for discharge.

Before a facility transfers or discharges a resident, the facility must notify the resident and, if known, a family member or legal representative of the resident of the transfer or discharge and the reasons, and record the reasons in the resident's clinical record based on specified format.

The notice of transfer or discharge required must be made by the facility at least four (4) days before the resident is transferred or discharged.(or is it 30 days before the resident is transferred or discharged?)

The notice may be made as soon as practicable before transfer or discharge when the safety of individuals in the facility would be endangered; the health of individuals in the facility would be endangered; the resident's health improves sufficiently to allow a more immediate transfer or discharge; an immediate transfer or discharge is required by the resident's urgent medical needs; or a resident has not resided in the facility for 30 days.

For nursing facilities, the written notice must include the reason for transfer or discharge; the effective date of transfer or discharge; the location to which the resident is transferred or discharged; a statement that the resident has the right to appeal the action to the State agency designated by the State for such appeals; and the name, address and telephone number of the State long term care ombudsman.

For nursing facility residents with developmental disabilities, the mailing address and telephone number of the agency responsible for the protection and advocacy of developmentally disabled individuals and for nursing facility residents who are mentally ill, the mailing address and telephone number of the agency responsible for the protection and advocacy of mentally ill individuals.

A facility must provide sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility.

Before a facility transfers a resident to a hospital or allows a resident to go on therapeutic leave, the facility must provide written information to the resident and a family member or legal representative that specifies the duration of the bed-hold policy under the State plan, if any, during which the resident is permitted to return and resume residence in the facility; and the facility's policies regarding bed hold periods, which must be consistent with federal law which permits a resident to return.

At the time of transfer of a resident to a hospital or for therapeutic leave, a nursing facility must provide written notice to the resident and a family member or legal representative, which specifies the duration of the bed hold policy. A nursing facility must establish and follow a written policy under which a resident whose hospitalization or therapeutic leave exceeds the bed-hold period under the State plan, is readmitted to the facility immediately upon the first availability of a bed in a semi-private room if the resident requires the services provided by the facility; and is eligible for Medicaid nursing facility services.

A facility must establish and maintain identical policies and practices regarding transfer, discharge, and the provision of services under the State plan for all individuals regardless of source of payment.

The facility may charge any amount for services furnished to non-Medicaid residents consistent with the notice requirement describing the charges; and the State is not required to offer additional services on behalf of a resident other than services provided in the State plan.

The facility must not require a third party guarantee of payment to the facility as a condition of admission, or expedited admission, or continued stay in the facility; not charge, solicit, accept, or receive, in addition to any amount otherwise required to be paid under the State plan, any gift, money, donation or other consideration as a precondition of admission, expedited admission or continued stay in the facility.

A facility must not require residents or potential residents to waive their rights to Medicare or Medicaid; not require oral or written assurance that residents or potential residents are not eligible for, or will not apply for, Medicare or Medicaid benefits.

States or political subdivisions may apply stricter admissions standards under State or local laws than specified by federal law to prohibit discrimination against individuals entitled to Medicaid benefits.

A facility may require an individual who has legal access to a resident's income or resources available to pay for facility care, to sign a contract, without incurring personal financial liability, to provide facility payment from the resident's income or resources. A nursing facility may charge a resident who is eligible for Medicaid for items and services the resident has requested and received, and that are not specified in the State plan as included in the term 'nursing facility services.' A nursing facility may solicit, accept or receive a charitable, religious or philanthropic contribution from an organization or from a person unrelated to the resident, or potential resident, but only to the extent that the contribution is not a condition of admission, expedited admission, or continued stay in the facility.