10115.1 The ALA or Acting Administrator shall determine if the care needs of a resident exceed the resources that can be marshalled by the ALR or third-party services in order to safely support the resident, making transfer to another facility necessary.This determination shall only be made after having consulted with the resident (or surrogate) to identify if the ALR can continue to support the resident safely. An ISP review shall satisfy the requirement for this consultation.
10115.2 Except as provided in § 10115.13, an ALR shall conform to the notices and procedures applicable to involuntary relocation, transfer, or discharge provided by subchapter 3 of Chapter 10 of Title 44 of the District of Columbia Official Code (D.C. Official Code §§ 44-1003.02 - 1003.13), and shall conduct the involuntary relocation, transfer, or discharge in accordance with this chapter and § 608(d)-(f) of the Act (D.C. Official Code § 44-106.08(d) -(f)).
10115.3 Prior to transferring a resident to another facility for reasons other than an emergency described in § 608(b) of the Act (D.C. Official Code § 44-106.08(b) ), or prior to a discharge, the ALR shall complete and transmit to the receiving facility or, if no receiving facility has been identified, to the resident (or surrogate) any information related to the resident that is necessary to ensure continuity of care and services, including at a minimum, the:
(a) Contact information of the healthcare practitioner or practitioners responsible for the primary care of the resident;(b) Current medication and treatment orders from the resident's healthcare practitioner or practitioners;(c) Dosage and date of each medication last administered to the resident;(d) Resident's most recent ISP, which shall include the resident's assessments;(e) Resident's name, date of birth, and a personal identifier number, such as a social security number or health insurance information, for purposes of continuing medical care services;(f) Primary medical diagnoses and allergies;(g) Name and contact information for the resident's surrogate, if applicable; and(h) Resident's Advanced Directive information.10115.4 An ALR shall not transmit the information prescribed in §10115.3 to the receiving facility without the prior, written, uncoerced consent of the resident (or surrogate). In the event that consent is withheld, an ALR shall transmit the information prescribed in §10115.3 directly to the resident (or surrogate) prior to transfer or discharge.
10115.5 Although an ALR shall make every effort to avoid discharge, grounds for involuntary discharge may include the following:
(a) Failure to pay all fees and costs as specified in the contract;(b) Inability of the ALR to meet the care needs of the resident as provided in the ISP, as amended by an SRA when applicable;(c) Engaging in sexual harassment, exploitation, or other degrading conduct to the detriment of another residents' dignity, in violation of the victim's rights provided under the Act and this chapter;(d) Resident presents a risk of physical self-harm, or harm to one or more other residents or staff, for which no other reasonable means of mitigation are available;(e) Discharge is essential to meet the ALR's reasonable administrative needs and no practicable alternative is available;(f) The ALR is ceasing to operate;(g) The licensed capacity of the ALR is being reduced by the District; or(h) The license to operate the ALR is suspended or revoked.10115.6 A resident's return to an ALR after transfer to, and subsequent discharge from, an acute care facility pursuant to § 608 (c) of the Act (D.C. Official Code § 44-106.08(c) ) shall be guided by the following provisions:
(a) Pursuant to § 608(c) of the Act (D.C. Official Code § 44-106.08(c) ), a resident's return to his or her ALR from an acute care facility pursuant to an attending healthcare practitioner's written approval shall be a provisional return pending renegotiation of the resident's ISP and the ALA's determination concerning whether the resident can continue to reside safely at the ALR in accordance with § 10115.1;(b) It shall be considered an involuntary discharge for the purposes of the Act and this chapter for an ALR to refuse or obstruct a resident's return to the ALR from an acute care facility pursuant to his or her attending healthcare practitioner's written approval. An involuntary discharge described in this paragraph shall be afforded the same notices, procedures, and provisions applicable to involuntary discharges described in the Act, this chapter, and D.C. Official Code §§ 44-1003.02 - 44-1003.13;(c) Ifthe attending healthcare practitioner's written approval to return to an ALR indicates that the resident requires additional supports in order to do so safely, those additional supports shall be arranged consistent with the resident agreement's financial provisions for coordinating and contracting services not covered by the resident agreement; (d) Except for under the circumstances set forth in D.C. Official Code § 44-1003.02(b)(1) and (2) or the occurrence of a separate event for which a resident may be lawfully discharged under the Act or this chapter, a resident who has returned to the ALR pursuant to an attending healthcare practitioner's written approval shall be permitted to remain in the ALR: (1) Throughout the ISP renegotiation performed under § 608(c) of the Act (D.C. Official Code § 44-106.08(c) );(2) Throughout the ALA's determination of whether the resident can continue to safely reside in the ALR in accordance with § 10115.1; and(3) If the ALA determines that the resident must be transferred or discharged because of the ALR's inability to continue supporting the resident safely, throughout the transfer or discharge notice period, andhearing period if applicable, provided by the Act, this chapter, and D.C. Official Code §§ 44-1003.02 and 44-1003.03.10115.7 As provided for by D.C. Official Code § 44-1003.02(d), the written notice due to a resident prior to an involuntary discharge, transfer, or relocation shall be on a form prescribed by the Director and shall, at a minimum, contain:
(a) The specific reason(s), stated in detail and not in conclusory language, for the proposed discharge, transfer, or relocation;(b) The proposed effective date of the discharge, transfer, or relocation;(c) A statement in not less than twelve (12)-point 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 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 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 discharged 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.";
(d) A hearing request form, together with a postage paid envelope preaddressed to the appropriate District official or agency;(e) The name, address, and telephone number of the person charged with the responsibility of supervising the discharge, transfer, or relocation;(f) The names, addresses, and telephone numbers of the Long-Term Care Ombudsman program and local legal services organizations; and(g) The location to which the resident will be transferred.10115.8 If the tribunal adjudicating a contested transfer, discharge, or relocation finds that the existence of a ground for transfer, discharge, or relocation, respectively, has been proven at a hearing requested by the resident pursuant to D.C. Official Code § 44-1003.03, the resident shall not be:
(a) Discharged or transferred from the facility before the 31st calendar day following his or her receipt of the transfer or discharge notice required under the Act and§ 10115.7, or the 5th calendar day following his or her notification of the hearing decision, whichever is later, unless a condition set forth in D.C. Official Code §§ 44-1003.02(b)(1) and (2) develops in the interim; or(b) Relocated within the facility before the 8th calendar day following his or her receipt of the relocation notice required under the Act and § 10115.7,or the 3rd calendar day following his or her notification of the hearing decision, whichever is later, unless a condition set forth in D.C. Official Code §§ 44-1003.02(b)(1) and (2) develops in the interim.10115.9 The involuntary transfer or dischargeof a resident shall be canceled, and the resident shall be entitled to remain in the ALR, upon remediation of the ground or grounds for transfer or discharge. Remediation may be, when applicable, the payment of all monies owed at any time prior to discharge, or the negotiation of a new ISP,and SRA if applicable, that meets the care needs of the resident prior to transfer or discharge.
10115.10 The ALR shall return all funds and personal property that have been deposited with or managed by the ALR for the benefit of the resident no later than the time of discharge.
10115.11 Within thirty (30) days after the date of the discharge or death of a resident, the ALR shall:
(a) Provide a final accounting of funds and personal property that have been deposited with or managed by the ALR for the benefit of the resident, which shall be delivered to the resident (or surrogate) in the event of discharge, or to the resident's legal representative in the event of the resident's death; and(b) Return any refunds due to the resident (or surrogate) in the event of discharge, or to the resident's legal representative in the event of the resident's death.10115.12 An ALR may temporarily relocate a resident to another living unit within the ALR on an involuntary basis if:
(a) Temporary relocation is necessary to protect the resident from an imminent and physical harm present in, or threatening to enter, the living unit;(b) The imminent and physical harm is due to a curable condition of the living unit; and(c) The temporary relocation lasts no longer than necessary to cure the threat to physical harm posed by the condition and return the living unit to its habitable condition.10115.13 An involuntary, temporary relocation that is necessitated by the conditions set forth in § 10115.12shall conform to the notices and procedures for involuntary relocation provided by subchapter 3 of Chapter 10 of Title 44 of the District of Columbia Official Code (D.C. Official Code §§ 44-1003.02 - 1003.13), except when an exigent threat to the resident's physical safety demands an abbreviated notice period.
10115.14 An ALR shall document in the resident's records any relocation, transfer, or discharge of a resident, and the basis for the action taken.
D.C. Mun. Regs. tit. 22, r. 22-B10115
Final Rulemaking published at 54 DCR 005591 (June 8, 2007); amended by Final Rulemaking published at 67 DCR 3717 (4/3/2020)