Lauren Meeker State Long Term Care Ombudsman Laurenmeekertngov Applicable Rules 42 CFR 48315 Admission transfer and discharge rights Tenn Comp R amp Regs 1200130106 ID: 811287
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Slide1
Involuntary Discharge Procedures and FAQ’s
Lauren
MeekerState Long Term Care OmbudsmanLauren.meeker@tn.gov
Slide2Applicable Rules
42 C.F.R. § 483.15
Admission, transfer, and discharge rights.
Tenn. Comp. R. & Regs. 1200-13-01-.06Special Federal Requirements Pertaining to Nursing Facilities
Slide3Transfer and Discharge
Grounds For Involuntary Transfer or Discharge:
Necessary for resident’s welfare and resident’s needs cannot be met in the facility;Resident’s health has improved;
Safety of individuals in facility is endangered due to clinical or behavioral status of the resident;Health of individuals in the facility would otherwise be endangered;Resident has failed, after reasonable and appropriate notice, to pay for a stay at the facility; orFacility ceases to operate.42 C.F.R. 483.15(c); Tenn. Comp. R. & Regs. 1200-13-01-.06(2)(d)(1)(i)
Slide4Burden of Proof
The
nursing home carries the burden of proving by a preponderance of evidence that it has a legal basis for involuntary transfer or discharge of a resident. Tenn. Comp. R. &
Regs. 1360-04-01-.02(7)
Slide5Documentation Requirement
Look to documentation requirements of
Tenn. Comp. Rules & Regs.
1200-13-01-.06(2)(d)(1)(ii)“The basis for the transfer or discharge must be documented in the resident’s clinical record. In the cases described in items (I) [welfare/needs] and (II) [health improved] above, the documentation must be made by the resident’s physician, and in the case described in item (IV) [safety issue to others] above, the documentation must be made by a physician.”
Slide6The Resident’s Health has Improved
This can come in the form of:
No longer meets the Nursing Home Level of Care on PAENo longer meets the Nursing Home Level of Care on PASRR
Medical Director or Physician states resident has gotten better.When any of these reasons occur please make sure that this is documented in the residents clinical record and is accompanied with the supporting documents. Tip: When sending the Notice of 30 day Involuntary Discharge attach the supporting document.
Slide7The Facility Ceases to Operate
When this is the case please notify the District and State Long Term Care Ombudsman and the Regional Supervisor at the Department of Health before you give the notices to the residents.
Slide8R
esident’s
Needs Cannot be Met in the FacilityWhen using this reason for discharge you must have the following documented in the residents clinical record, and be able to provide it to all of the agencies notified:
Why the residents needs cannot be met in your facility.Supporting documents such as doctors orders and nurses notes. Where the resident is being transferred to and what that facility can do to meet their needs that you facility cannot.
Slide9Safety of Individuals in Facility is Endangered due to Clinical or Behavioral Status
When using this reason for discharge you must have the following documented in the residents clinical record, and be able to provide it to all of the agencies notified:
Why the residents needs cannot be met in your facility.
Supporting documents such as doctors orders and nurses notes. Show what steps the facility has taken to reduce/eliminate the dangerous behavior.Change of Status PASRRWhere the resident is being transferred to and what that facility can do to meet their needs that your facility cannot.
Slide10Health of Individuals in the Facility
W
ould Otherwise be EndangeredWhen using this reason for discharge you must have the following documented in the residents clinical record, and be able to provide it to all of the agencies notified:
Why the residents needs cannot be met in your facility.Supporting documents such as doctors orders and nurses notes. Where the resident is being transferred to and what that facility can do to meet their needs that your facility cannot.
Slide11Failure to Pay
Failure to pay basis:
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.
Slide12Failure to Pay
FAQ’s
Q: What should we do when the family refuses to give documents to assist with the Medicaid application?
A: Contact your District LTC OmbudsmanUndue Hardship WaiverSafety LetterQ: What should we do when the failure to pay is a result of the family (POA) misusing the residents funds to pay for things other than the residents care? A: You may send a letter or request a meeting with the family. If that does not resolve the issue, contact your District LTC Ombudsman.LetterCare PlanAssistance with Legal resources for the resident
Slide13Financial Exploitation
Slide14Financial ExploitationKeep an eye on the TCAD website
A resource page that you can give to families who are allegedly misappropriating funds.When to pursue Involuntary Discharge.
Slide1530 Day Notice Before Transfer
Nursing home is required to provide a resident and the resident’s representative with notice of the
reason for discharge, effective date, location of transfer, appeal rights
, contact information for State Long-Term Care Ombudsman and Advocacy Protection Groups. 42 C.F.R. 483.15(3) and (5); Tenn. Comp. R. & Regs. 1200-13-01-.06(2)(d)(4).A copy must be sent to the State Long-Term care Ombudsman, District Ombudsman, HCFA Commissioners Designee and the Department of Health Regional Supervisor.Excluding exceptions, the Notice must be made at least 30 days before transfer. 42 C.F.R. 483.15(4).
Slide16Discharge Notice: Page 1Available on the TCAD website https://www.tn.gov/content/dam/tn/aging/documents/NFDischargeTransferNotice.pdf
All highlighted sections are required to be filled out.
Where the resident is going must be filled in and this must be a safe and appropriate location.
Please also add a contact email. Please note the 4 reasons that require a doctors signature.
This form may also be used for 5 (business) day emergency discharges-please be aware that this section must be filled out correctly.
Slide17Discharge Notice: Page 2Available on the TCAD website https://www.tn.gov/content/dam/tn/aging/documents/NFDischargeTransferNotice.pdf
All highlighted sections are required to be filled out.
Please make sure that this section is signed-especially if your reason requires a doctors signature.
It is required that this section be filled out. For most reasons, it would be best to also state that your supporting documents (PAE/PASRR/Doctors Order) are attached.
Slide18Discharge Notice: Page 3Available on the TCAD website https://www.tn.gov/content/dam/tn/aging/documents/NFDischargeTransferNotice.pdf
All highlighted sections are required to be filled out.
The State Long Term Care Ombudsman must receive the notice on the same day as the resident. Please email it, so that it will arrive the same day. Do NOT fax the notice.
If the resident refuses to sign or is incompetent-Please note this here and have a witness sign off. Additionally, make sure that it is noted that the Representative was given the notice.
Slide19Department of Health Regional SupervisorsEASTTamra Tuberville
865-594-0736Tamra.tuberville@tn.govMIDDLE
Donna Smith615-532-6883Donna.smith@tn.govWESTPaula Tipton731-984-9712Paula.tipton@tn.gov
State LTC OmbudsmanLauren Meeker615-837-5112Lauren.meeker@tn.gov*Must receive at the same time as the resident. District LTC OmbudsmanSee next slide for all contact info.HCFA’s Commissioner’s DesigneeAdministrative Law Judge(Appeal Officer) Audrey Seamon866-797-9469cd.appeals.tenncare@tn.gov
Contact Sheet for Involuntary
Discharges
Please send the notice to all required parties for your area.
Slide20District 1-First TennesseeDebby Morrell 423-794-2488 dmorrell@laet.org
Counties Served: Carter, Greene, Hancock, Hawkins, Johnson, Sullivan, Unicoi & Washington District 2-East TennesseeThomas Kahler
865-691-2551 x4223tkahler@ethra.org Counties Served: Anderson, Blount, Campbell, Claiborne, Cocke, Grainger, Hamblen, Jefferson, Knox, Loudon, Monroe, Morgan, Roane, Scott, Sevier & Union District 3-Southeast TennesseeKaitlyn Goffin
423-755-2877 kgoffin@partnershipfca.comCounties Served: Bledsoe, Bradley, Grundy, Hamilton, McMinn, Marion, Meigs, Polk, Rhea & Sequatchie District 4-Upper CumberlandKim Fowlerombud@twlakes.netCounties Served: Cannon, Clay, Cumberland, DeKalb, Fentress, Jackson, Macon, Overton, Pickett, Putnam, Smith, Van Buren, Warren & WhiteDistrict 5-Greater NashvilleRichard Robinson, Melinda Lunday and Marchell Gardner615.850.3918 Richard Robinsonrrobinson@mchra.comCounties Served: Rutherford & Williamson Melinda Lundaymlunday@mchra.comCounties Served: Davidson, Sumner, Trousdale, & Wilson Marchell Gardnermgardner@mchra.comCounties Served: Cheatham, Davidson, Dickson, Houston, Humphreys, Montgomery, Robertson & Stewart
District 6-South Central Andrea Morrow931-379-2926 amorrow@sctdd.orgCounties served: Bedford, Coffee, Franklin, Giles, Hickman, Lawrence, Lewis, Lincoln, Marshall, Maury, Moore, Perry & Wayne District 7-Northwest Tennessee Kim Boyd731-694-1835kboyd@wtls.orgCounties Served: Benton, Carroll, Crockett, Dyer, Gibson, Henry, Lake, Obion & Weakley District 8-Southwest TennesseeNorma Bell731-668-6411 nbell@swtdd.orgCounties Served: Chester, Decatur, Hardeman, Hardin, Haywood, Henderson, McNairy & Madison
District 9-Memphis-Delta Zev Samuels & Carlos Royston
Counties
Served: Fayette, Lauderdale, Shelby & Tipton
Zev Samuels
901-529-4565
zsamuels@mifa.org
Carlos Royston
901-529-4562
croyston@mifa.org
Tennessee Long Term Care Ombudsman Contact Sheet
Slide21How to Appeal an Involuntary Discharge
An IVD can be appealed
by any of the following methods:Mail: TennCare’s Commissioner’s Designee Unit, ATTN: Involuntary NF Discharge Appeals, 310 Great Circle Road- 3W, Nashville, TN
37243Fax: 615-734-5317Email: cd.appeals.tenncare@tn.govPhone: 866-797-9649Required information:Nursing Facility NameResident Contact Information (and Representative)Indication of intent to appeal
Slide22Discharge During an Appeal
Nursing homes may not transfer or discharge the resident while the appeal is pending,
unless the failure to discharge or transfer would endanger the health and safety of the resident or other individuals in the facility.
42 C.F.R. 483.15(c)(1)(ii); Tenn. Comp. R. & Regs. 1200-13-01-.06(2)(d)(2)(iv) and (2)(d)(3)(i).Further, the nursing home must document the danger that failure to transfer would pose. 42 C.F.R. 483.15(c)(1)(ii).
Slide23Pre-Transfer Nursing Homes Must
Consider
Traumatic effect on the resident.
Proximity of the proposed location to the present nursing home and to family and friends of resident.Availability of necessary medical and social services at the proposed nursing home.Compliance by the proposed nursing home with all applicable federal and state regulations.Tenn. Comp. R. & Regs. 1200-13-01-.06(2)(d)(1)(v)
Slide24RETURNING FROM HOSPITALIZATION AND THERAPEUTIC LEAVE
42 C.F.R. § 483.15(e)(1)(ii
)
Permitting residents to return to facility. A facility must establish and follow a written policy on permitting residents to return to the facility after they are hospitalized or placed on therapeutic leave. The policy must provide for the following:(1) A resident, whose hospitalization or therapeutic leave exceeds the bed-hold period under the State plan, returns to the facility to their previous room if available or immediately upon the first availability of a bed in a semi-private room if the resident(a) Requires the services provided by the facility; and(b) Is eligible for Medicare skilled nursing facility services or Medicaid nursing facility services.(2) If the facility that determines that a resident who was transferred with an expectation of returning to the facility cannot return to the facility, the facility must comply with the requirements of paragraph (c) as they apply to discharges.
Slide25ORIENTATION
42 C.F.R. § 483.15(c)(7)
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.
Slide26Review
of TCAD Website
https://www.tn.gov/aging.html
Slide27Lauren MeekerState Long Term Care Ombudsman615-837-5112
Lauren.meeker@tn.gov