Medicaid Transfer Notices Expectations

Numerous DSHS case managers have recently advised assisted livings to not send Medicaid resident transfer notices when residents are temporarily transferred to other care settings, such as a hospital.  Rather, these case managers have urged facilities to send notice of discharge only – when a resident will not be returning to the facility. WHCA staff worked with Home and Community Services leadership to inform the accurate interpretation of the new regulation; as a result case managers should now accept transfer notices.

Per WAC 388-78A-2661 and RCW 70.129.110, transfer or discharge notices must be given to the resident “as soon as practicable” when “an immediate transfer or discharge is required by the resident’s urgent medical needs.”  WHCA staff and legal counsel agree that a transfer notice, then, would be sent along with a resident or shortly thereafter when leaving the facility urgently for medical care.

What may have confused DSHS staff, as well as others, is the glaring fact that current regulations and laws do not include the definition of the word “transfer.” And so, some people consider the words “transfer” and “discharge” to mean the same thing – a permanent move from the facility, while others view a transfer as only taking place if the resident is temporarily admitted to a hospital or other care setting.

During the stakeholder process when writing these new regulations, WHCA advocated for adding the definitions of transfer and discharge to the new regulations; these suggestions were not accepted.

And so, WHCA staff referenced the Centers for Medicare and Medicaid Services (CMS) definition of transfer and discharge. The wording in RCW 70.129.110 mimics federal law related to transfer and discharge notice language and is applicable to all long-term care settings; it made sense, then, to use existing definitions from CMS to apply here.

WHCA met with DSHS headquarters staff in late February and again in early April to clarify expectations on notice of transfer – specifically, what constitutes a transfer, not to whom transfer notices must be sent.  On Friday, April 17, DSHS issued a Management Bulletin updating directions to their case managers, effectively notifying them that, per regulation, they shall accept transfer notices from assisted living providers who are notifying the resident’s case manager of a temporary transfer to the hospital. In addition, DSHS amended its Frequently Asked Questions document regarding transfer and discharge notices to extend the same expectations for transfer notices as were expected for discharge notices.

For questions about the new Medicaid resident transfer and discharge regulations, please email Vicki McNealley.