CMS SOM App. A, Tag A-1564

definition of transfer and discharge, §483.15(c)(1), (c)(2)(i), (c)(2)(ii),

(c)(3), (c)(4), (c)(5), and (c)(7))

• §483.5: definition of transfer and discharge: Transfer and discharge

includes movement of a resident to a bed outside of the certified facility

whether that bed is in the same physical plant or not. Transfer and discharge

does not refer to movement of a resident to a bed within the same certified

facility.

• §483.15(c)(1): Facility requirements—

(i) The facility must permit each resident to remain in the facility, and

not transfer or discharge the resident from the facility unless—

(A) The transfer or discharge is necessary for the resident's

welfare and the resident's needs cannot be met in the

facility;

(B) 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;

(C) The safety of individuals in the facility is endangered due

to the clinical or behavioral status of the resident;

(D) The health of individuals in the facility would otherwise be

endangered;

(E) 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. Non-payment applies if the

resident does not submit the necessary paperwork for

third party payment or after the third party, including

Medicare or Medicaid, denies the claim and the resident

refuses to pay for his or her stay. 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

(F) The facility ceases to operate.

(ii)The facility may not transfer or discharge the resident while the

appeal is pending, pursuant to §431.230 of this chapter, when a

resident exercises his or her right to appeal a transfer or discharge

notice from the facility pursuant to §431.220(a)(3) of this chapter,

unless the failure to discharge or transfer 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.

• §483.15(c)(2)(i) Documentation in the resident's medical record must

include:

(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 section, the specific

resident need(s) that cannot be met, facility attempts to meet

the resident needs, and the service available at the receiving

facility to meet the need(s).

• §483.15(c)(2)(ii) The documentation required by paragraph (c)(2)(i) of this

section must be made by—

(A) The resident's physician when transfer or discharge is

necessary under paragraph (c)(1)(A) or (B) of this section; and

(B) A physician when transfer or discharge is necessary under

paragraph (c)(1)(i)(C) or (D) of this section.

• §483.15(c)(3): Notice before transfer. Before a facility transfers or discharges

a resident, the facility must—

(i) 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. The facility must send

a copy of the notice to a representative of the Office of the State

Long-Term Care Ombudsman.

(ii) Record the reasons for the transfer or discharge in the resident's

medical record in accordance with paragraph (c)(2) of this section;

and

(iii) Include in the notice the items described in paragraph (c)(5) of

this section.

• §483.15(c)(4): Timing of the notice. (i) Except as specified in paragraphs

(c)(4)(ii) and (8) of this section, the notice of transfer or discharge required

under this section must be made by the facility at least 30 days before the

resident is transferred or discharged.

(ii) Notice must be made as soon as practicable before transfer or

discharge when—

(A) The safety of individuals in the facility would be endangered

under paragraph (c)(1)(i)(C) of this section;

(B) The health of individuals in the facility would be endangered,

under paragraph (c)(1)(i)(D) of this section;

(C) The resident's health improves sufficiently to allow a more

immediate transfer or discharge, under paragraph (c)(1)(i)(B)

of this section;

(D) An immediate transfer or discharge is required by the

resident's urgent medical needs, under paragraph (c)(1)(i)(A)

of this section; or

(E) A resident has not resided in the facility for 30 days.

• §483.15(c)(5): Contents of the notice. The written notice specified in

paragraph (c)(3) of this section must include the following:

(i) The reason for transfer or discharge;

(ii) The effective date of transfer or discharge;

(iii)The location to which the resident is transferred or discharged;

(iv) A statement of the resident's appeal rights, including the name,

address (mailing and email), and telephone number of the entity

which receives such requests; and information on how to obtain an

appeal form and assistance in completing the form and submitting

the appeal hearing request;

(v) The name, address (mailing and email) and telephone number of

the Office of the State Long-Term Care Ombudsman;

(vi) For nursing facility residents with intellectual and developmental

disabilities or related disabilities, the mailing and email address

and telephone number of the agency responsible for the protection

and advocacy of individuals with developmental disabilities

established under Part C of the Developmental Disabilities

Assistance and Bill of Rights Act of 2000 (Pub. L. 106-402, codified

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 and telephone number

of the agency responsible for the protection and advocacy of

individuals with a mental disorder established under the

Protection and Advocacy for Mentally Ill Individuals Act.

• §483.15(c)(7): Orientation for transfer or discharge. A facility must provide

and document sufficient preparation and orientation to residents to ensure

safe and orderly transfer or discharge from the facility. This orientation

must be provided in a form and manner that the resident can understand.

Interpretive Guidelines §482.58(b)(2)

Refer to Appendix PP of the State Operations Manual (SOM) for interpretive guidelines.

Survey Procedures §482.58(b)(2)

Refer to Appendix PP of the State Operations Manual (SOM) for survey procedures.