June 20 2025 | Transfer & Discharge Requirements – Notification of Ombudsman
As most of you are aware by now, the Centers for Medicare and Medicaid Services (CMS) made some key changes to Appendix PP of the State Operations Manual and surveyor guidance related to transfer and discharge requirements for skilled nursing facilities. These changes went into effect on April 28, 2025.
Key changes to the Discharge and Transfer requirements revolved around CMS’s deletion of F-Tags 622 – F626 and F660 – F661 as well as removing the terms “facility-initiated” and “resident-initiated.” The guidance from the deleted tags was reorganized, with revisions added to clarify when a transfer or discharge is noncompliant. The new regulatory requirements are found under F627 for Inappropriate Transfers and Discharges and F628 for Transfer and Discharge Process.
While this is not a change, it is important to clarify and highlight the requirements around Ombudsman notification of resident transfers and discharges. Prior to all transfers or discharges, the facility must notify the resident and the resident’s representative(s) of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand. Additionally, the facility must send a copy of the notice of transfer or discharge to the representative of the Office of the State Long-Term Care (LTC) Ombudsman. This requirement is not new. According to CMS, the intent of sending copies of the notice to a representative of the Office of the State LTC Ombudsman is to provide added protection to residents from being inappropriately transferred or discharged, provide residents with access to an advocate who can inform them of their options and rights, and to ensure that the Office of the State LTC Ombudsman is aware of facility practices and activities related to transfers and discharges.
The facility must maintain evidence that the notice was sent to the Ombudsman. While Ombudsman Programs vary from state to state, CMS goes on to state that it is the facility’s responsibility to know the process for ombudsman notification in their state.
In situations where the facility has decided to discharge the resident while the resident is still hospitalized, the facility must send a notice of discharge to the resident and resident representative before the discharge and must also send a copy of the discharge notice to a representative of the Office of the State LTC Ombudsman. Notice to the Office of the State LTC Ombudsman must occur at the same time the notice of discharge is provided to the resident and resident representative, even though, at the time of initial emergency transfer, sending a copy of the transfer notice to the ombudsman only needed to occur as soon as practicable.
For any other types of discharges, the facility must provide notice of discharge to the resident and resident representative along with a copy of the notice to the Office of the State LTC Ombudsman at least 30 days prior to the discharge or as soon as possible. The copy of the notice to the ombudsman must be sent at the same time notice is provided to the resident and resident representative.
When a resident is temporarily transferred on an emergency basis to an acute care facility (hospital and/or emergency room) a notice of transfer must be provided to the resident and resident representative as soon as practicable before the transfer. Copies of notices for emergency transfers must also still be sent to the ombudsman, but they may be sent when practicable, such as in a list of residents on a monthly basis, as long as the list meets all requirements for content of such notices in the requirements.
During the off-site preparation for surveys, surveyors are directed to contact the local Ombudsman to determine if there have been recent complaints regarding improper discharges.
Key Take Aways regarding sending a copy of transfer/discharge notice to ombudsman:
- Applies to all discharges
- For emergency room transfer, facilities may send notice to ombudsman when practicable such as in a list of residents on a monthly basis
Facilities need to ensure that a copy of all transfer and discharge notices is sent directly to the Office of the Washington LTC Ombuds at the location below. It is preferred that these notices be faxed or emailed promptly.
- Email – [email protected]
- Fax # – (253) 815-8173
- Address – PO Box 23699, Federal Way, WA 98093-0699
In Washington, our LTC Ombudsman is Patricia Hunter. More information can be found at Advocacy for Long-Term Care Residents | Federal Way, WA | Washington State Long-Term Care Ombudsman Program. Resources are also available, LTC Ombudsman Discharge Notification Kit.
For more information, please find Survey Tips- Transfer and Discharge (Part 1 and Part 2) on the AHCA Survey Regulatory page. AHCA’s Transfer and Discharge Action Tool can also assist your facility to understand the changes, documentation requirements for discharges, and a list of action items to ensure your facilities compliance. If you have questions, please contact Elena Madrid, Executive Vice President of Education and Regulatory Affairs.