Feb 3 2022 | Transfer/Discharge Notice Requirements – Notification of the Ombuds

With the adoption of the Centers for Medicare & Medicaid Services (CMS) Requirements of Participation (RoP), several rules were written to address resident transfers and discharges in CFR 483.15, F622 through F626. While a number of the requirements mirror the Washington statute (RCW 70.129.110), there are some key additional requirements to ensure compliance. It is important to remember that these are federal requirements that pertain to nursing homes, they do not apply to assisted living facilities.

The facility may not transfer or discharge the resident while an appeal is pending, unless not doing so would endanger the health or safety of the resident or other individuals in the facility. The facility must document the danger that failure to transfer or discharge would pose.
The resident’s physician must document in the resident’s record when the transfer or discharge is necessary when identified and according to criteria outlined in the rule.
Information provided to the receiving provider must include a minimum of the outlined information in the rule.
Before a facility transfers or discharges a resident, the facility must notify the resident and the resident’s representative of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand. The facility must send a copy of the notice to a representative of the State LTC Ombuds.
If the information in the notice changes prior to the transfer/discharge, the facility must update the recipients of the notice as soon as practicable.
Orientation for transfer/discharge must be provided in a form and manner the resident can understand.

One of the most misunderstood requirements is that of notification to the State LTC Ombuds. The key to understanding this requirement lies in the CMS definitions of Facility Initiated Discharge and Resident Initiated Discharge. The RCS Dear Administrator Letter #2017-014 clarifies the definitions as well as clarification regarding the notice of transfer and discharge requirements related to Ombuds notification. More information can be found in the CMS S&C Memo here.

Facility-initiated transfer or discharge: A transfer or discharge to which the resident objects, did not originate through the resident’s verbal or written request, and/or is not in alignment with the resident’s stated goals for care and preferences.
Resident-initiated transfer or discharge: Means the resident or, if appropriate, the resident representative has provided verbal or written notice of intent to leave the facility (leaving the facility does not include the general expression of a desire to return home or the elopement of residents with cognitive impairment).

Sending an actual copy of the resident’s transfer or discharge notice to the State LTC Ombuds:

Applies to all facility-initiated discharges
Notice to the State LTC Ombuds is not required for resident-initiated transfers

According to the CFR 483.15(c)(3), F623 Guidance to Surveyors, when a resident is temporarily transferred on an emergency basis to an acute care facility, this type of transfer is considered to be a facility-initiated transfer and a notice of transfer must be provided to the resident and the resident representative as soon as practicable. Notice must also still be sent to the State Ombuds. According to CMS, emergency transfer notification may be done in the form of a list of residents transferred to the hospital on a routine basis, such as monthly or bi-monthly.

Discharge and transfer notification to the Washington State Ombuds can be made electronically via email to [email protected] or fax (253) 815-8173. Please remember to include the name of the facility with your notification to the Ombuds. With emergency transfer list notification, it is helpful to include the following information:

The name of the resident,
Where the resident was transferred,
The main reason or diagnosis they were transferred, and
If the resident has returned to the facility.

If you have questions or would like additional information, please contact Patricia L. Hunter, MSW, State LTC Ombudsman Program via telephone at (253) 838-6810 or email Elena Madrid or call her at (800) 562-6170, extension 105.

Posted in Skilled Nursing Facilities