DISCHARGE PLANNING BY STATE

Transcription

1 DISCHARGE PLANNING BY STATE Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington State West Virginia Wisconsin Wyoming

2 Alabama Common Discharge Provisions at a Glance Alabama Detailed Discharge Planning Alabama Common Discharge Provision at a Glance Applies to Nursing and Similar Facilities Applies to Assisted Living Facilities Applies to Hospice Applies to Hospitals Requires notice to patient prior to 30 Days discharge Limits reason for transfer or discharge: If necessary for resident s welfare and needs cannot be met in the facility Resident s health has improved and he or she no longer needs the services provided by the facility The safety of individuals in the facility are endangered The health of individuals in the facility are endangered The resident has failed to pay after reasonable and appropriate notice given The facility ceases to operate For medical reasons It is essential to meet the facility s reasonable administrative needs and no practicable alternative is available If the patient is a Medicare/Medicaid beneficiary and the home no longer participates in the program Has process for appeal of discharge or transfer decisions Requires Discharge Plan Provides for residents or their advocates to participate in development of care plan or discharge planning Discharge plan/reasons for discharge must be documented in patient s record Requires that patients receive orally or in writing their discharge care plan or reasons for discharge Requires each facility to develop is own discharge policy

3 Alabama Detailed Discharge Planning Nursing Facilities (Ala. Admin. Code Division of Licensure and Certification, Nursing Facilities) (Adapted from Ala. Admin. Code , -.05, -.06, -.09) When a facility anticipates discharge, they must notify the resident, consult the resident s physician, and notify the legal representative or interested family member IMMEDIATELY when the facility decides to discharge a resident. ( ) When discharged, a resident must have a discharge summary Requirements for Discharge Summary A brief review or summary of the resident s stay 2. A final summary of the resident s status including at least: a. Medically defined conditions and prior medical history; b. Medical status measurement; c. Physical and mental functional status; d. Sensory and physical impairments; e. Nutritional status and requirements; f. Special treatments or procedures; g. Mental and psychosocial status; h. Discharge potential; i. Dental condition; j. Activities potential; k. Rehabilitation potential; l. Cognitive status; and m. Drug therapy 3. This final summary must be available for release to authorized persons and agencies with the consent of the resident or legal representative at the time of resident s discharge 4. A post-discharge plan of care, developed with the participation of the resident and his or her family, to assist the resident in adjusting to his or her new living environment The facility may only discharge you if: The transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the facility; 2. 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; 3. The safety of individuals in the facility is endangered; 4. The health of individuals in the facility would otherwise be endangered; 5. 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. For a resident who becomes eligible for Medicaid after admission to a nursing facility, the nursing facility may charge a resident only allowable charges under Medicaid; or 6. The facility ceases to operate. The facility must give 30 days notice of the discharge unless: (i) The safety of individuals in the facility would be endangered, under paragraph (1) (b)3 of this section. (ii) The health of individuals in the facility would be endangered, under (1)(b)4 of this section. (iii) The resident's health improves sufficiently to allow a more immediate transfer or discharge, under paragraph (1)(b)2 of this section;

4 (iv) (v) An immediate transfer or discharge is required by the resident's urgent medical needs, under paragraph (1)(b)1 of this section; or A resident has not resided in the facility for 30 days. The Notice of Discharge or Transfer Must Include: 1. The reason for transfer or discharge; 2. The effective date of transfer or discharge; 3. The location to which the resident is transferred or discharged; 4. A statement that the resident has the right to appeal the action to the State; 5. The name, address and telephone number of the State long term care ombudsman; 6. For nursing facility residents with developmental disabilities, or are mentally ill, the mailing address and telephone number of the Alabama Developmental Disabilities Advocacy Program (ADDAP) at the University of Alabama School of Law; and 7. Orientation for transfer or discharge. A facility must provide sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility. There is a basic grievances process outlined ( ) Grievances. A resident has the right to: 1. Voice grievances without discrimination or reprisal. Such grievances include those with respect to treatment which has been furnished as well as that which has not been furnished; and 2. Prompt efforts by the facility to resolve grievances the resident may have, including those with respect to the behavior of other residents. Source: Alabama State Board Of Health Alabama Department Of Public Health Chapter pdf -Page Up- -Discharge Planning Main-

5 Alaska Common Discharge Provisions at a Glance Alaska Detailed Discharge Planning Alaska Common Discharge Provisions at a Glance Applies to Nursing and Similar Facilities Applies to Assisted Living Facilities Applies to Hospice Applies to Hospitals Requires notice to patient prior to discharge Limits reason for transfer or discharge: If necessary for resident s welfare and needs cannot be met in the facility Resident s health has improved and he or she no longer needs the services provided by the facility The safety of individuals in the facility are endangered The health of individuals in the facility are endangered The resident has failed to pay after reasonable and appropriate notice given The facility ceases to operate For medical reasons It is essential to meet the facility s reasonable administrative needs and no practicable alternative is available If the patient is a Medicare/Medicaid beneficiary and the home no longer participates in the program Has process for appeal of discharge or transfer decisions Requires Discharge Plan Provides for residents or their advocates to participate in development of care plan or discharge planning Discharge plan/reasons for discharge must be documented in patient s record Requires that patients receive orally or in writing their discharge care plan or reasons for discharge Requires each facility to develop is own discharge policy

6 Detailed Alaska Discharge Planning 7 Alaska Admin. Code Patient s Rights 7 Alaska Admin. Code Facilities and Local Units, General Provisions A patient, client, or nursing facility resident has rights that include the following: (13) to participate in the development of a plan of care, or discharge plan, and to receive instructions for self-care and treatment that include explanation of adverse symptoms and necessary precautions, as appropriate; This applies to patients, clients, or residents in: 1. Acute Care Hospitals 2. Rural Primary Care Hospitals 3. Long-term Acute Care Hospitals 4. Critical Access Hospitals 5. Specialized hospitals 6. Nursing Facilities 7. Ambulatory Surgical Facilities 8. Free Standing Birth Centers 9. Frontier Extended Stay Clinics (7 AAC b, d, e, h) Source: Alaska Patient s Rights -Page Up- -Discharge Planning Main-

7 Arkansas Common Discharge Provisions at a Glance Detailed Arkansas Discharge Planning Arkansas Common Discharge Provisions at a Glance Applies to Nursing and Similar Facilities Applies to Hospitals Applies to Assisted Living Facilities Applies to Hospice Requires notice to patient prior to discharge Limits reason for transfer or discharge: If necessary for resident s welfare and needs cannot be met in the facility Resident s health has improved and he or she no longer needs the services provided by the facility The safety of individuals in the facility are endangered The health of individuals in the facility are endangered The resident has failed to pay after reasonable and appropriate notice given The facility ceases to operate For medical reasons It is essential to meet the facility s reasonable administrative needs and no practicable alternative is available If the patient is a Medicare/Medicaid beneficiary and the home no longer participates in the program Has process for appeal of discharge or transfer decisions Requires Discharge Plan Provides for residents or their advocates to participate in development of care plan or discharge planning Discharge plan/reasons for discharge must be documented in patient s record Requires that patients receive orally or in writing their discharge care plan or reasons for discharge Requires each facility to develop is own discharge policy Arkansas Detailed Discharge Planning

8 CARR 007 Code of Arkansas Rules and Regulations, Hospitals and Related Institutions CARR 002 Code of Arkansas Rules and Regulations, Critical Access Hospitals Applies to: ( CARR Definitions) Alcohol/Drug Abuse Inpatient Treatment Centers Emergency Services Facility General Hospital Maternity and General Medical Care Hospital Maternity Hospital Psychiatric Hospital Recuperation Center Rehabilitation Facility Surgery and General Medical Care Hospital Outpatient Psychiatric Center Outpatient Surgery Center Discharge Planning Generally: ( CARR 007 6(E) Medical Staff) There shall (mandatory) be an ongoing plan, consistent with available community and hospital resources to provide or make available social work, psychological and educational services to meet the medically-related needs of the patients and to facilitate the provision of follow up care. Discharge planning shall be started at the time of the patient s admission There shall be a policy and procedure developed for discharge planning ( CARR 002 Code of Arkansas Rules and Regulations, Critical Access Hospitals contains the same language as above Sources: Code of Arkansas Rules and Regulations, Hospitals and Related Institutions Code of Arkansas Rules and Regulations, Critical Access Hospitals -Page Up- -Discharge Planning Main-

9 Arizona Common Discharge Provisions at a Glance Detailed Arizona Discharge Planning Arizona Common Discharge Provisions at a Glance Applies to Nursing and Similar Facilities Applies to Assisted Living Facilities Applies to Hospice Applies to Hospitals Requires notice to patient prior to discharge Limits reason for transfer or discharge: If necessary for resident s welfare and needs cannot be met in the facility Resident s health has improved and he or she no longer needs the services provided by the facility The safety of individuals in the facility are endangered The health of individuals in the facility are endangered The resident has failed to pay after reasonable and appropriate notice given The facility ceases to operate For medical reasons It is essential to meet the facility s reasonable administrative needs and no practicable alternative is available If the patient is a Medicare/Medicaid beneficiary and the home no longer participates in the program Has process for appeal of discharge or transfer decisions Requires Discharge Plan Provides for residents or their advocates to participate in development of care plan or discharge planning Discharge plan/reasons for discharge must be documented in patient s record Requires that patients receive orally or in writing their discharge care plan or reasons for discharge Requires each facility to develop is own discharge policy

10 Detailed Arizona Discharge Planning CHAPTER 10. DEPARTMENT OF HEALTH SERVICES HEALTH CARE INSTITUTIONS: LICENSING, ARTICLE 2. HOSPITALS, R Discharge Planning; Discharge Applies to Hospitals Hospitals are defined as: [A] class of health care institution that provides, through an organized medical staff, inpatient beds, medical services, and continuous nursing services for the diagnosis and treatment of patients. The Discharge Plan for inpatients 1. Identifies the specific needs of the patient after discharge, if applicable 2. Include participation of the patient or patient s representative 3. Must be completed before discharge occurs 4. Provides the patient or representative with written information identifying classes or subclasses of health care institutions and the level of care that the health care institutions provide that may meet the patient s assessed and anticipated needs after discharge, if applicable 5. Is documented in the patient s medical record The Discharge Plan for Outpatients Receiving Emergency Services Discharge instructions are documented and provided to the patient or the patient s representative before the patient is discharged unless the patient leaves the hospital against a medical staff member s advice Transfers fall under R Source: Code of Arizona Rules and Regulations -Page Up- -Discharge Planning Main-

11 California Common Discharge Provisions at a Glance Detailed California Discharge Planning California Common Discharge Provisions at a Glance Applies to Nursing and Similar Facilities Applies to Hospitals Applies to Assisted Living Facilities Applies to Hospice Requires notice to patient prior to discharge Limits reason for transfer or discharge: If necessary for resident s welfare and needs cannot be met in the facility Resident s health has improved and he or she no longer needs the services provided by the facility The safety of individuals in the facility are endangered The health of individuals in the facility are endangered The resident has failed to pay after reasonable and appropriate notice given The facility ceases to operate For medical reasons It is essential to meet the facility s reasonable administrative needs and no practicable alternative is available If the patient is a Medicare/Medicaid beneficiary and the home no longer participates in the program Has process for appeal of discharge or transfer decisions Requires Discharge Plan Provides for residents or their advocates to participate in development of care plan or discharge planning Discharge plan/reasons for discharge must be documented in patient s record Requires that patients receive orally or in writing their discharge care plan or reasons for discharge Requires each facility to develop is own discharge policy Detailed California Discharge Planning

12 California Health and Safety Code Division 2 Licensing Provisions Chapter 2 Health Facilities Article 1 General Written discharge policy and process; Transfer summary; Contract restrictions (a) (f) Applies to Hospitals Discharge Each hospital must have a written discharge planning policy and process requiring that appropriate arrangements for post-hospital care are made prior to discharge for those patients who are likely to suffer adverse health consequences upon discharge if there is no adequate discharge planning. The hospital shall also provide counseling for post-hospital care if the hospital determines that the patient and family members or interested persons need it. The patient must be informed orally or in writing of their continuing health care requirements following discharge from the hospital. Each patient should receive at the time of discharge information regarding the medications dispensed. If the patient is anticipated to need long-term care at the time of discharge with contact information for at least one public or non-profit agency or organization dedicated to providing information or referral services relating to community-based long-term care options in the patient s county of residence and appropriate to the needs and characteristics of the patient Transfers to a skilled-nursing home or intermediate care facility inside or outside of the hospital A transfer summary shall accompany the patient and will include information relative to the patient s diagnosis, hospital course, pain treatment and management, medications, treatments, dietary requirement, rehabilitation potential, known allergies, and treatment plan. A copy of the transfer summary shall be given to the patient or their legal representative prior to transfer Source: California Health and Safety Code -Page Up- -Discharge Planning Main-

13 Colorado Common Colorado Discharge Provisions at a Glance Detailed Colorado Discharge Planning Colorado Common Discharge Provisions at a Glance Applies to Nursing and Similar Facilities Applies to Hospitals Applies to Assisted Living Facilities Applies to Hospice Requires notice to patient prior to discharge Limits reason for transfer or discharge: If necessary for resident s welfare and needs cannot be met in the facility Resident s health has improved and he or she no longer needs the services provided by the facility The safety of individuals in the facility are endangered The health of individuals in the facility are endangered The resident has failed to pay after reasonable and appropriate notice given The facility ceases to operate For medical reasons It is essential to meet the facility s reasonable administrative needs and no practicable alternative is available If the patient is a Medicare/Medicaid beneficiary and the home no longer participates in the program Has process for appeal of discharge or transfer decisions Requires Discharge Plan Provides for residents or their advocates to participate in development of care plan or discharge planning Discharge plan/reasons for discharge must be documented in patient s record Requires that patients receive orally or in writing their discharge care plan or reasons for discharge Requires each facility to develop is own discharge policy

14 Detailed Colorado Discharge Planning 10 CCR Applies to Day Treatment by Hospices under CO s Medical Assistance Program A Hospice can only discharge a client if: 1. The client moves out of the Hospice s service area or transfers to another Hospice 2. The Hospice determines that the client is no longer Terminally Ill This situation requires a planning process that includes planning for any necessary family counseling, patient education, or other services before discharge. 3. The Hospice determines, under 42 C.F.R , that the client s behavior is disruptive, abusive, or uncooperative to the extent that delivery of care or the Hospice s ability to operate effectively is seriously impaired. The Hospice must advise the client discharge is being considered, make a serious effort to resolve the problem, ascertain that the proposed discharge is not due to the client s use of necessary Hospice services, document the problem and the effort made to resolve the problem, and enter this documentation in the client s medical record The Hospice Medical Director must give the Hospice a written discharge order prior to discharging a client The Hospice Medical Director shall document that the attending physician has been consulted about the discharge, include the physician s review and decision in the discharge note Source: Code of Colorado Regulation Titles -Page Up- -Discharge Planning Main-

15 Connecticut Common Discharge Provisions at a Glance Detailed Connecticut Discharge Planning Connecticut Common Discharge Provisions at a Glance Applies to Nursing and Similar Facilities Applies to Hospitals Applies to Assisted Living Facilities Applies to Hospice Requires notice to patient prior to 30 Days discharge Limits reason for transfer or discharge: If necessary for resident s welfare and needs cannot be met in the facility Resident s health has improved and he or she no longer needs the services provided by the facility The safety of individuals in the facility are endangered The health of individuals in the facility are endangered The resident has failed to pay after reasonable and appropriate notice given The facility ceases to operate For medical reasons It is essential to meet the facility s reasonable administrative needs and no practicable alternative is available If the patient is a Medicare/Medicaid beneficiary and the home no longer participates in the program Has process for appeal of discharge or transfer decisions Requires Discharge Plan Provides for residents or their advocates to participate in development of care plan or discharge planning Discharge plan/reasons for discharge must be documented in patient s record Requires that patients receive orally or in writing their discharge care plan or reasons for discharge Requires each facility to develop is own discharge policy

16 Connecticut Detailed Discharge Planning General Statutes of Connecticut, Title 19a Public Health and Well Being, Chapter 368v, Section 19a-504d Hospital discharge plans, Section 19a-535 Transfer or discharge of patients, Section 19a-535a Residential care home, and Section 19a-535b Chronic disease hospital Hospital Discharge (Sec 19a-504d) If a hospital recommends home health care to a patient, the hospital discharge plan shall include at least two options of home health care agencies. The hospital must disclose any ownership, investment interest, or compensation/remuneration with the home health agency to the patient prior to including the agency as an option in the discharge plan. This information must be verbally disclosed or posted in a conspicuous place visible to patients. Nursing Home Discharge Applies to a certified nursing facility under the Medicare program, a skilled nursing facility under the Medicare program, or a chronic and convalescent nursing home or a rest home with supervision (known collectively as facilities ) A facility cannot transfer or discharge a patient unless: 1. The welfare of the patient cannot be met in the facility 2. The patient no longer needs the services of the facility due to improved health 3. The health or safety of individuals in the facility is endangered 4. A self-pay patient s nonpayment or arrearage of more than 15 days the per diem facility room rate 5. The facility ceases to operate The basis for discharge must be documented by a physician in the patient s medical record. If the basis is the endangerment of the health or safety of individuals, the documentation shall be by the patient s physician A facility cannot transfer or discharge a patient as a result of a change in status from selfpay or Medicare to Medicaid provided the facility offers services to both categories of patients. A facility cannot involuntarily transfer or discharge a patient if it is medically contraindicated A patient who wishes to be transferred to another facility which has agreed to accept him may do so upon giving at least fifteen days written notice to the administrator of the facility from which he is to be transferred and a copy to the appropriate advocate of such patient A continuing care facility which guarantees life care for its residents may transfer or discharge a resident if: 1. A resident self-pay patient has intentionally transferred assets in a sum which will render the patient unable to pay the costs of the facility care in accordance with the contract 2. A non-resident self-pay patient who has intentionally transferred assets in a sum which will render the patient unable to pay the costs of a total of 42 months from the date of initial admission to the facility

17 Before effecting transfer or discharge: 1. The facility must notify in writing the patient and the patient s guardian or conservator, or legally liable relative or other responsible party if known, of the proposed transfer or discharge at least 30 days and no more than 60 days in advance of the transfer or discharge. 2. If the transfer or discharge is due to the endangerment of the health or safety of individuals in the facility, or the patient s health improves sufficiently to allow a more immediate transfer or discharge, or when immediate transfer or discharge is necessitated by urgent medical needs, or if the patient has not resided in the facility for 30 days, notice shall be given as many days before the transfer or discharge as possible. Included in the Notice must be: 1. The reasons for the transfer or discharge 2. The effective date of the proposed transfer or discharge 3. The location to which the patient is to be transferred or discharged 4. The right to appeal the proposed transfer or discharge 5. The procedures for initiating such an appeal as determined by the Department of Social Services 6. The date by which an appeal must be initiated to stay transfer or discharge (10 days from the receipt of notice of transfer or discharge from the facility) 7. That the patient may represent himself or herself or be represented by legal counsel, a relative, a friend, or other spokesman 8. Information as to bed hold and hospital readmission policy when appropriate 9. The name, mailing address, and telephone number of the State Long-Term Care Ombudsman The Discharge Plan These rules apply unless the transfer or discharge is an emergency, the patient is transferred to a hospital, or transfer in or out of a Medicare distinct part within the same institution 1. The patient cannot be discharged without a discharge plan developed by the personal physician of the patient or the medical director in conjunction with the nursing director, social worker, or other health care provider. 2. The person in charge of developing the plan shall consider: a. The feasibility of placement near the patient s relatives b. The acceptability of the placement to the patient and his guardian or conservator, if any, or his legally liable relative or other responsible party, if known c. Any other relevant factors which affect the patient s adjustment to the move 3. The plan shall contain: a. A written evaluation of the effects of the transfer or discharge on the patient and a statement of the action taken to minimize such effects b. An outline of the care and kinds of services which the patient shall receive upon transfer or discharge The discharge plan must be presented to the patient s personal physician (if developed by the medical director) and to the patient and his guardian or conservator, if any, or his legally liable relative or other responsible party, if known, LESS THAN 30 DAYS PRIOR TO INVOLUNTARY TRANSFER OR DISCHARGE.

18 Appeals The Commissioner of Social Services or his designee must hold a hearing no less than 10 but no more than 30 days from the receipt of a request for a hearing to appeal any proposed transfer or discharge. A written decision made by the commissioner or his designee will be made within 60 days of the termination of the hearing or 90 days within the date of the hearing request, which ever is sooner. The patient, his guardian, conservator, legally liable relative or other responsible party shall have an opportunity to examine the contents of the patient s file maintained by the facility and all documents and records to be used by the commissioner or his designee or the facility at the hearing AT LEAST 3 BUSINESS DAYS, DURING RMAL BUSINESS HOURS, PRIOR TO THE HEARING. An involuntary discharge shall be stayed pending the decision of the commissioner or his designee If the commissioner or his designee determines that the transfer or discharge is being effected properly, the facility may not transfer or discharge the patient prior to 15 days from the receipt of the decision by the patient and his guardian or conservator, if any, or his legally liable relative or other responsible party, if known Appeals of Emergency Transfer or Discharge A patient who is transferred or discharged on an emergency basis or a patient ho receives notice of such a transfer or discharge may contest the action by requesting a hearing in writing within 10 days of receipt of notice or within 10 days of the transfer or discharge, which ever is later. A hearing shall be held within 7 business days of receipt of the request Residential Home Care Discharge A facility cannot transfer or discharge a resident unless: 1. The transfer or discharge is necessary to meet the resident s welfare and the resident s welfare cannot be met in the facility 2. 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 3. The health or safety of individuals in the facility is endangered 4. The resident has failed, after reasonable and appropriate notice, to pay for a stay or a requested service at the facility 5. The facility ceases to operate Involuntary Transfer or Discharge Resident and, if known, his legally liable relative, guardian, or conservator shall be given a 30 day written notification which includes: 1. The reason for transfer or discharge 2. Notice of the right of the resident to appeal a transfer or discharge by the facility The facility is responsible for assisting the resident in finding appropriate placement. A discharge plan, prepared by the facility, which indicates the resident s individual needs, shall accompany the patient. Appeals

19 A request for a hearing to appeal a transfer or discharge must be filed with the Commissioner of Public Health within 10 days of receipt of the notice of transfer or discharge The hearing shall be held within 7 business days of receipt of such a request A determination must be made within 20 days of the termination of the hearing by the commissioner or their designee Any involuntary transfer or discharge shall be stayed pending a determination by the commissioner or his designee Chronic Disease Hospital Transfer or Discharge A facility shall not transfer or discharge a patient from the facility except: 1. For medical reasons, for the patient s welfare or the welfare of other patients as documented in the patient s medical records 2. Or, in the case of a self-pay patient, for nonpayment or arrearage of more than 15 days of the per diem chronic disease hospital room rates for the patient s stay, except as prohibited by the SSA Involuntary Transfer or Discharge Notice The patient and, if know, the patient s legally liable relative, guardian or conservator and the patient s personal physician, if the discharge plan is prepared by the medical director of the chronic disease hospital, shall be given AT LEAST 30 DAYS WRITTEN TICE of the proposed action to ensure orderly transfer or discharge. Source: Connecticut Elder Law -Page Up- -Discharge Planning Main-

20 Delaware Common Discharge Provisions at a Glance Detailed Discharge Planning Delaware Common Discharge Provision at a Glance Applies to Nursing and Similar Facilities Applies to Hospitals Applies to Assisted Living Facilities Applies to Hospice Requires notice to patient prior to 30 Days discharge Limits reason for transfer or discharge: If necessary for resident s welfare and needs cannot be met in the facility Resident s health has improved and he or she no longer needs the services provided by the facility The safety of individuals in the facility are endangered The health of individuals in the facility are endangered The resident has failed to pay after reasonable and appropriate notice given The facility ceases to operate For medical reasons It is essential to meet the facility s reasonable administrative needs and no practicable alternative is available If the patient is a Medicare/Medicaid beneficiary and the home no longer participates in the program Has process for appeal of discharge or transfer decisions Requires Discharge Plan Provides for residents or their advocates to participate in development of care plan or discharge planning Discharge plan/reasons for discharge must be documented in patient s record Requires that patients receive orally or in writing their discharge care plan or reasons for discharge Requires each facility to develop is own discharge policy

21 Delaware Detailed Discharge Planning TITLE 16 Health and Safety Regulatory Provisions Concerning Public Health Chapter 11. Nursing Facilities and Similar Facilities Subchapter II. Rights of Patients Patient's rights. Applies to Nursing and Similar Facilities Each patient shall receive from the attending physician or the resident physician of the facility complete and current information concerning the patient's diagnosis, treatment and prognosis in terms and language the patient can reasonably be expected to understand, unless medically inadvisable. The patient or resident shall participate in the planning of the patient's or resident's medical treatment, including attendance at care plan meetings. No patient or resident shall be transferred or discharged out of a facility except for medical reasons; the patient's or resident's own welfare or the welfare of the other patients; or for nonpayment of justified charges. If good cause for transferal is reasonably believed to exist, the patient or resident shall be given at least 30 days' advance notice of the proposed action, together with the reasons for the decision, and the patient or resident shall have the opportunity for an impartial hearing to challenge such action if the patient or resident so desires. In emergency situations such notice need not be given. If a patient or resident is transferred out of a facility to an acute care facility, the facility must accept the patient or resident back into the facility when the resident no longer needs acute care and there is space available in the facility. If no space is available, the resident shall be accepted into the next available bed. Every patient and resident shall have the right to inspect all records pertaining to the patient or resident, upon oral or written request within 24 hours of notice to the facility. Source: DEPARTMENT OF HEALTH AND SOCIAL SERVICES: Division of Long Term Care Residents Protection -Page Up- -Discharge Planning Main-

22 District of Columbia Common Discharge Provisions at a Glance Detailed District of Columbia Discharge Planning District of Columbia Common Discharge Provisions at a Glance Applies to Nursing and Similar Facilities Applies to Hospitals Applies to Assisted Living Facilities Applies to Hospice Requires notice to patient prior to 21 Days discharge Limits reason for transfer or discharge: If necessary for resident s welfare and needs cannot be met in the facility Resident s health has improved and he or she no longer needs the services provided by the facility The safety of individuals in the facility are endangered The health of individuals in the facility are endangered The resident has failed to pay after reasonable and appropriate notice given The facility ceases to operate For medical reasons It is essential to meet the facility s reasonable administrative needs and no practicable alternative is available If the patient is a Medicare/Medicaid beneficiary and the home no longer participates in the program Has process for appeal of discharge or transfer decisions Requires Discharge Plan Provides for residents or their advocates to participate in development of care plan or discharge planning Discharge plan/reasons for discharge must be documented in patient s record Requires that patients receive orally or in writing their discharge care plan or reasons for discharge Requires each facility to develop is own discharge policy

23 District of Columbia Detailed Discharge Planning D.C. Code Grounds for involuntary discharge, transfer, or relocation by facility Notice to resident and resident's representative Hearing Discussion and counseling Applies to: NURSING HOMES AND COMMUNITY RESIDENCE FACILITIES A facility can discharge, transfer to another facility, or transfer from one part of facility or room to another if: 1. It is essential to meet the resident s documented health care needs or to be in accordance with the prescribed level of care 2. It is essential to safeguard that resident or other residents from physical or emotional injury 3. Non payment for maintenance except for: a. No facility that is a District Medicaid provider may discharge, transfer, or relocate a resident on account of his or her conversion from private-pay or Medicare to Medicaid status, or on account of a temporary hospitalization if payment or reimbursement for his or her bed continues to be made available. b. 42 U.S.C.S et seq. and 42 U.S.C.S et seq. 4. It is essential to meet the facility s reasonable administrative needs and no practicable alternative is available 5. The facility is closing or officially reducing its licensed capacity Notice A facility representative shall give the resident and their representative oral and written notice of the reasons for, procedures for contesting, and proposed effective date of the discharge, transfer, or relocation. Notice shall be given at least 21 calendar days before discharge or transfer and at least 07 calendar days before relocation unless: 1. A more immediate discharge, transfer, or relocation is necessitated by resident s urgent medical needs explicitly stated in the signed, written orders of an attending physician 2. Long-Term Care Ombudsman determines that emergency or other compelling circumstances necessitate a more immediate discharge, transfer, or relocation and the basis for this is documented in the clinical records of the resident Consent by the resident and representative is only valid if knowingly and voluntarily given at the time the move is proposed The notice must contain: 1. The specific reasons, in detail and not in conclusory language, for the proposed discharge, transfer, or relocation 2. The proposed effective date of the discharge, transfer, or relocation 3. A statement in at least 12-pt type that reads: "You have a right to challenge this facility's decision to discharge, transfer, or relocate you. If the decision is to discharge you from the facility or to transfer you to another facility and you think you should not have to leave, you or your representative have 7 days from the day you receive this notice to inform the Administrator [Residence Director, if a community residence facility] or a member of the staff that you are requesting a hearing and to complete the enclosed hearing request form and mail it in the preaddressed envelope provided. If you are mailing the hearing request form from the

24 facility, the day you place it in the facility's outgoing mail or give it to a member of the staff for mailing shall be considered the date of mailing for purposes of the time limit. In all other cases, the postmark date shall be considered the date of mailing. If, instead, the decision is to relocate you within the facility and you think you should not have to move to another room, you or your representative have only 5 days to do the above. "If you or your representative request a hearing, it will be held no later than 5 days after the request is received in the mail, and, in the absence of emergency or other compelling circumstances, you will not be moved before a hearing decision is rendered. If the decision is against you, in the absence of an emergency or other compelling circumstances you will have at least 5 days to prepare for your move if you are being discharge or transferred to another facility, and at least 3 days to prepare for your move if you are being relocated to another room within the facility. "To help you in your move, you will be offered counseling services by the staff, assistance by the District government if you are being discharged or transferred from the facility, and, at your request, additional support from the Long-Term Care Ombudsman program. If you have any questions at all, please do not hesitate to call one of the phone numbers listed below for assistance." 4. A hearing request form, with a postage paid envelope preaddressed to the appropriate District official or agency 5. The name, address, and telephone number of the person charged with the responsibility of supervising the discharge, transfer, or relocation 6. The names, addresses, and telephone numbers of the Long-Term Care Ombudsman program and local legal services organizations Whenever non-payment is the ground for involuntary discharge or transfer, the resident shall have the right to redeem up to the time that the discharge or transfer is to be effected and, if full payment is made, shall have the right to remain in the facility Hearing The resident, their representative, or Long-Term Care Ombudsman may contest the decision to transfer, discharge or relocate the resident by mailing a written hearing request to the Mayor and notifying the administrator or facility staff of the request Request must be mailed and given within 7 calendar days of receiving notice of proposed discharge or transfer and within 5 calendar days of receiving notice of relocation within the facility Date of mailing shall be the postmarked date unless resident or resident s representative mails the request from the facility. In that case, the mailing date is the day it is placed in the facility s outgoing mail or given to a member of the facility staff for mailing. A timely hearing will stay the discharge, transfer, or relocation unless an urgent medical need for discharge, transfer, or relocation develops The major shall hold a hearing at the resident s facility within 5 calendar days and render a judgment within 7 calendar days after receipt of hearing request The facility holds the burden of proof unless the reason for transfer, discharge, or relocation is a change in the prescribed level of care. If this is the case, the person responsible for prescribing that change shall have the burden of proof. The resident shall have the right to challenge the level of care determination at the hearing

25 Mayor must find that one of the conditions for discharge, transfer, or relocation has been proven by clear and convincing evidence. If this is found, the resident shall not be: 1. discharged or transferred from the facility before the 22 nd calendar day following his or her receipt of notice or the 5 th calendar day following the notification of the hearing decision, whichever is later, unless an urgent medical need develops 2. Relocated before the 8 th calendar day following receipt of the notice or the 3 rd calendar day following notification of the hearing decision, whichever is later, unless an urgent medical need develops Discussion and counseling Before transfer, discharge, or relocation, a facility representative shall discus the reasons for the move with the resident and their representative and shall answer any questions they must have about the move or the written notice. The discussion shall be summarized in writing, include the names of the individuals involved in the discussion, and be placed in the resident s clinical record. The facility representative shall strongly recommend and offer to provide counseling services to the resident and their representative before the move. If a hearing has been requested, the staff shall attempt to prepare the resident for moving on 3 or 5 day notice if the hearing decision is not in the resident s favor. Source: District of Columbia Code -Page Up- -Discharge Planning Main-

26 Florida Common Discharge Provisions at a Glance Florida Detailed Discharge Planning Florida Common Discharge Provisions at a Glance Applies to Nursing and Similar Facilities Applies to Hospitals Applies to Assisted Living Facilities Applies to Hospice Requires notice to patient prior to 30 Days discharge Limits reason for transfer or discharge: If necessary for resident s welfare and needs cannot be met in the facility Resident s health has improved and he or she no longer needs the services provided by the facility The safety of individuals in the facility are endangered The health of individuals in the facility are endangered The resident has failed to pay after reasonable and appropriate notice given The facility ceases to operate For medical reasons It is essential to meet the facility s reasonable administrative needs and no practicable alternative is available If the patient is a Medicare/Medicaid beneficiary and the home no longer participates in the program Has process for appeal of discharge or transfer decisions Requires Discharge Plan Provides for residents or their advocates to participate in development of care plan or discharge planning Discharge plan/reasons for discharge must be documented in patient s record Requires that patients receive orally or in writing their discharge care plan or reasons for discharge Requires each facility to develop is own discharge policy

27 Detailed Florida Discharge Planning Florida Statutes, Chapter 400, Nursing Homes and Related Health Care Facilities, Part II Nursing Homes (Ss ) Applies to Transfers and Discharges Initiated by the Nursing Home Facility Notice of Discharge or Transfer Notice of proposed discharge or transfer must be given to the resident and a family member or the resident s legal guardian or representative at least 30 days prior to transfer or discharge except: 1. The transfer or discharge is necessary for the resident s welfare and the resident s needs cannot be met in the facility, and the circumstances are documented in the resident s medical records by the resident s physician 2. The health or safety of other residents or facility employees would be endangered, and the circumstances are documented in the resident s medical records by the resident s physician or the medical director if the resident s physician is not available Notice must be in writing and contain all information required by state and federal law, rules, or regulations applicable to Medicaid or Medicare cases. The notice shall contain: 1. Means for a resident to request the local long-term care ombudsman council to review the notice and request information or assistance with initiating a fair hearing with the department s Office of Appeals Hearings. 2. The reason allowed under federal or state law that the resident is being discharged or transferred, with an explanation to support this action 3. The effective date of discharge or transfer and the location to which the resident is being moved 4. The resident s appeal rights and the procedures for filing an appeal A copy of the notice must be placed in the resident s clinical record, and a copy must be transmitted to the resident s legal guardian or representative and to the local ombudsman council within 5 business days after signature by the resident or resident designee. When initiated by nursing home, the administrator or designee must sign the notice of discharge or transfer. If the notice indicates a medical reason for discharge or transfer, it must be signed by the resident s attending physician or the medical director of the facility or include an attached written order for the discharge or transfer. The notice or the order must be signed by the resident s physician, medical director, treating physician, nurse practitioner, or physician assistant. Reviews and Hearings A resident of any Medicaid or Medicare certified facility may challenge a decision by the facility to discharge or transfer the resident. The local long-term care ombudsman council must review a request by a resident to review notice of discharge within 7 days after receipt of request.

28 The nursing home administrator or designee must forward the request for review contained in the notice to the local ombudsman council within 24 hours after such a request is submitted. Failure to forward the request within this time will toll the running of the 30-day advance notice period until the request has been forwarded. A resident is entitled to a fair hearing to challenge a facility s proposed transfer or discharge and may request the hearing any time within 90 days of the resident s receipt of the facility s notice If the hearing is requested within 10 days after receiving the notice of transfer or discharge, the request shall stay the proposed transfer or discharge pending a hearing decision. If the hearing is requested beyond 10 days after receiving the notice of transfer or discharge, the facility may transfer or discharge the resident after 30 days from the date the resident received notice. Initial fair hearing must be completed within 90 days after receipt of request for a hearing An emergency discharge or transfer may be implemented as necessary pursuant to state or federal law during the period of time after the notice is given and before the time a hearing decision is rendered. Notice of this must be given to the resident, the resident s legal guardian or representative, and the local ombudsman council if a request for review was submitted, by telephone or in person before the transfer or as soon thereafter as practicable. The ombudsman shall conduct review within 24 hours of receipt of request. The resident s file must be documented to show who was contacted, whether the contact was by telephone or in person, and the date and time of the contact. If the notice is not given in writing, written notice as laid out above must be give the next business day. After receipt of notice, the local ombudsman council may request a private informal conversation with the resident, a family member, or the resident s legal guardian or designee, to ensure the facility is in accordance with this section. If requested, the local ombudsman shall assist the resident with filing an appeal of the proposed discharge or transfer These persons must be present at all hearings: 1. The resident, or their legal representative or designee 2. The facility administrator, or the legal representative or designee A representative of the local long-term care ombudsman council may be present at all hearings Hearings shall be conducted by the department s Office of Appeals Hearings. The office shall notify the facility of a resident s request for a hearing Burden of Proof Clear and Convincing Evidence Hearing decision must be rendered within 90 days after receipt of request for hearing If the hearing decision is favorable to the resident, the resident must be readmitted to the facility s first available bed. The decision of the hearing officer is final and aggrieved parties may appeal the decision to the district court of appeal in the appellate district where the facility is located Source: 2009 Florida Statutes -Page Up- -Discharge Planning Main-