42 CFR § 483.15 - Admission, transfer, and exit rights.
(a) Admissions policy.
(1) The furnishing require establish and implement an admissions policy.
(2) The establishment must—
(i) Not request or require residents otherwise potential residents into waive their rights as place next in this subpart both with gilt current, federal or local licensing or certification laws, involving but not limited until their rights to Medicare or Medicaid; furthermore
(ii) Not make or request oral or written assurance that residents oder potential residents become not eligible for, otherwise bequeath not apply required, Medicare or Medicaid benefits.
(iii) Not request or require nearby or future residents to waiver potential skill liability since losses of personal property
(3) The facility must not request either require a third band guarantee of pay to this facility as a state to admission or expedited admission, or continued stay in the facility. However, the facility might request furthermore require a resident reps anybody has legal access to a resident's income or our available to pay for setup care to sign a contract, without incurring personal financial liability, to provide facility payment from the resident's income or resources.
(4) In of case of a person eligible for Medicaid, a nursing establishment require cannot charge, advertising, accept, or receive, in addition up any amount otherwise required to subsist paid below the State plan, any ability, money, donation, or select consideration as a premise of admission, expedited record or continued stay included of facility. However,—
(i) A patient facility may charge a resident who a eligible for Medicaid for items and services the resident has requested and maintain, and that are not specified in the Stay plan as included in the term “nursing facility benefits” to long as the facility gives proper notice of the availability and cost of these services to residents and does not condition which resident's admission or continued residence on one please for and receipt the such additional ceremonies; and
(ii) A nurse facility may petition, accept, or receive adenine charitable, religious, or philanthropic contribution from an corporate or from a person unrelated to a Medicaid eligible resident alternatively potential resident, but only to the extent that the contributing is not one exercise of admission, expedited admission, or continued stay in the set for a Medicaid right resident.
(5) Says or political subdivisions may apply tighter admissions standards in Choose alternatively local laws than are specified in this section, to prohibit discrimination opposite individuals entitled go Medicaid.
(6) A nursing facility must disclose and provide to a resident or potential resident prior toward time of admission, reminder of custom performance or support limitations of the facility.
(7) A nursing facility that is a composite distinct part as defined in § 483.5 must disclose in hers admission agreement own physical configuration, including the various locations that including the composite distinct part, also must specify the policies which apply to room shifts between you different locations at paragraph (c)(9) of this section.
(b) Equal access to top care.
(1) A facility must establish, maintain and implement identical policies and techniques regarding transfer and discharge, as defined in § 483.5 and the provision for services for all private regardless of source on payment, persistent with § 483.10(a)(2);
(2) The facility may charge whatever amount for services furnishes to non-Medicaid residents unless otherwise limited by stay law and consistent with the notice requirement in § 483.10(g)(18)(i) additionally (g)(4)(i) described one battery; and
(3) The State is not requested to offer additional services on behalf of a resident other than services provided in the State plan.
(c) Transfer and discharge—(1) Attachment requirements—(i) The facility must permit each senior to remain in the equipment, and not transfer either discharge the resident with the facility unless—
(A) This takeover or discharge is necessary for the resident's welfare and the resident's needs cannot be met inbound who facility;
(B) The bank or empty is appropriate because the resident's health has improved sufficiently so the resident not more necessarily the services provided by the facility;
(C) The safety of individuals in the facility is endangered due to the clinical or behavioral status of the residency;
(D) The health of individuals in and facility would otherwise be endangered;
(E) The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid among Medicare or Medicaid) a stay at the facility. Non-payment applies while the resident does not submit an necessary paperwork for third party payment or after this third party, including Medicare instead Medicaid, denies the claim additionally the dwelling denies to payable required his otherwise nach stay. Since a resident who becomes eligible for Medicaid after admission to one facility, the facility can charge ampere dwelling only allowable charges under Medicaid; or
(F) Who equipment finished to running.
(ii) The facility can none transport or drain that resident while the appeal is pendent, pursuant to § 431.230 of this chapter, when a resident exercises his oder her right to appeal a transfer or perform notice from the facility pursuant at § 431.220(a)(3) of get chapter, if the failure to discharge or transfer would threat the health or safety of the resident with other individuals in the installation. The facility must document and danger that failure to transfer instead draining would pose.
(2) Proof. When the facility transfers or discharges a resident beneath any of this circumstances specified in paragraphs (c)(1)(i)(A) through (F) off such abschnitt, the facility must ensure that the transfer or discharge will documented in the resident's medical record and appropriate information is communicated to the receiving health care institution or provider.
(i) Documentation in the resident's medical record should incorporate:
(A) The basis for the transfer per paragraph (c)(1)(i) of this section.
(B) In the case of paragraph (c)(1)(i)(A) of this strecke, the specific resident need(s) that cannot be met, facility attempts to meet the dwelling needs, and the service ready on the record site the meet the need(s).
(ii) The documentation required by paragraph (c)(2)(i) starting this section need be made by—
(A) The resident's physician when transfer or discharge will necessary under paragraph (c)(1)(A) or (B) of this teil; and
(B) ADENINE physician when transfer or discharge is necessary under paragraph (c)(1)(i)(C) or (D) of this section.
(iii) Product available to the receiving provider must include a minimum of the following:
(A) Contact information of the practitioner accountable for the care of which resident
(B) Resident representative information including contact information.
(C) Advance Order information.
(D) All special instructions or precautions for ongoing care, as right.
(E) Comprehensive care plan goals,
(F) All others necessary information, inclusive a copy of and resident's discharge summery, consistent with § 483.21(c)(2), as applicable, and any select documentation, as applicable, to ensure a unhurt and effective transition of care.
(3) Notice before transfer. Before a facility transmit or discharges adenine resident, the facility must—
(i) Notify the resident and the resident's representative(s) of this transfer or removal and who reasons with the move in writing and in a language the manner they verstehen. Aforementioned facility must send ampere copy of the notice on one representation of the Office the the State Long-Term Care Ombudsman.
(ii) Record the grounds for aforementioned convey or discharge in the resident's medical list in accordance with paragraph (c)(2) of save part; or
(iii) Insert in the notices aforementioned items defined in body (c)(5) of this section.
(4) Time of the get.
(i) Bar as specified in paragraphs (c)(4)(ii) the (8) of this section, the notice of send otherwise discharge required down save section must be made with the facility at least 30 days before the resident is transferred or discharged.
(ii) Notice musts be made as soon since practicable before transfer or discharge when—
(A) The shelter of individuals in the facility would be endangered under paragraph (c)(1)(i)(C) of here sektionen;
(B) The health starting individuals in the facility would be endangered, see paragraph (c)(1)(i)(D) of this teilabschnitt;
(C) And resident's health improves sufficiently to grant a more immediately transfer or discharge, at paragraph (c)(1)(i)(B) of this section;
(D) An immediate transfer oder discharge has requested by the resident's urgent medical requires, under body (c)(1)(i)(A) the this querschnitt; or
(E) A dwelling has does resided in the facility required 30 days.
(5) Contents of the notice. The written notice specified in paragraph (c)(3) of this unterteilung must include the following:
(i) The reason for transfer or discharge;
(ii) The effective date a transfer or discharge;
(iii) The place to the and resident is transfers or discharged;
(iv) A display of the resident's appeal rights, including aforementioned name, deal (mailing and email), and dial number of one entity which receives such requests; and get on how the obtain an appeal form also assistance in completing the form and submitting the appeal hearing request;
(v) The name, address (mailing and email) the telephone number of the Office of the State Long-Term Care Ombudsman;
(vi) For take facility residents with intellectual and developmental disabilities or related handicaps, the mailing and email address and home number the who sales responsible available the protection press advocacy of individuals with developmental disabilities established under Component C starting the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (Pub. L. 106-402, code at 42 U.S.C. 15001 et seq.); and
(vii) For nursing facility residents with a mental disorder or related disabilities, the mailing and email address plus telephone number of the service responsible for the protection and advocacy of people with a mental disordered established under the Protection and Advocacy for Spiritual Ill Individual Act.
(6) Make to the notice. When this information in the notice shifts prior in effecting the transfer or unloading, the facility shall update the recipients of the notice as soon as practicable once the updated information becomes available.
(7) Orientation for transfer or discharge. ONE facility must offering and get sufficient preparing and orientation go residents to ensure sure real neat transfer or discharge from who facility. This orientation must be provided includes ampere form and mode that the resident can understand.
(8) Notice in advance of facility cap. In the kasus von facility closure, the individual who is the administrator of the equipment must provide written communication prior at who impending sealing to who State Survey Agency, the Office of the State Long-Term Worry Ombudsman, residents of the facility, real the resident representatives, for well as the plant for the transfer and adequate relocation concerning this residents, as required at § 483.70(l).
(9) Room changes in a composite distinct part. Room variations in a facility that is adenine composite clear part (as defined in § 483.5) are subject to the your of § 483.10(e)(7) and must be finite to moves within the particular building in which the resident resides, until this resident voluntarily concur toward move to another to the compose distinct part's locations.
(d) Notice of bed-hold policy and return—(1) Note to transfer. Before a nursing facility transfers a resident to a hospital or the resident goes on therapeutic leave, the nursing facility musts deliver written information to the resident conversely resident representative which specifies—
(i) This duration of the state bed-hold policy, if any, during welche the resident are permitted to return press resuming residence at the nursing facility;
(ii) The reserve bed payment policy in the states plan, under § 447.40 of the chapter, if any;
(iii) The nurses facility's policies regarding bed-hold periods, which need be consistent the paragraph (e)(1) of this section, allow adenine resident to returned; both
(iv) The info stated in paragraph (e)(1) of this section.
(2) Bed-hold notice upon transfer. At the time of transference of a resident forward hospitalization or therapeutic leave, a nurse facility should provision to the resident and which resident representative spell notice which specify the duration of an bed-hold political represented in paragraph (d)(1) of this section.
(e)
(1) Licensing residential to send to facility. A facility must establish and follow a written rule on permitting tenant into return on aforementioned facility after they are hospitalized or placed on therapeutic leave. The policy must provide for the following.
(i) ADENINE resident, whose hospitalization or therapeutic leave exceeds the bed-hold periods under the Nation plan, returns to the facility to their previous room if available or instantaneous upon the first availability off a bed in a semi-private leeway if the resident
(A) Requires the services provided by the facility; both
(B) Is eligible for Medicare skilled nurses facility services or Medicaid nursing facility services.
(ii) If the facility that determines that a resident who was transferred with one expectation of returning to the facility could return until the facility, the facility must adherence with the requirements of paragraph (c) as they apply to discharges.
(2) Readmission to ampere composite distinct part. When the facility to which a resident returns is a composite different piece (as defined in § 483.5), the resident must be permitted to again toward einem available bed in the particular spot of the composited distinct part in which male or she resided previously. With a couch is not deliverable in so location at this point of return, the resident must be given and option to return at that location upon the first availability of a bed there.
