CMS SOM App. B, Tag G460

[…The HHA may only transfer or discharge the patient from the HHA if:]

(4) The patient refuses services, or elects to be transferred or discharged;

Interpretive Guidelines §484.50(d)(4)

A patient who occasionally declines a service is distinguished from a patient who refuses

services altogether, or who habitually declines skilled care visits. It is the patient’s right

to refuse services. It is the agency’s responsibility to educate the patient on the risks and

potential adverse outcomes that can result from refusing services. In the case of patient

refusals of skilled care, the HHA must document its communication with the physician or

allowed practitioner who is responsible for the patient’s home health plan of care, as well

as the measures the HHA took to investigate the patient’s refusal and the interventions

the HHA attempted in order to obtain patient participation with the plan of care.

The HHA may consider discharge if the patient’s decision to decline services

compromises the agency’s ability to safely and effectively deliver care to the extent that

the agency can no longer meet the patient’s needs.