La. Admin. Code tit. 50 § II-10163

Current through Register Vol. 50, No. 11, November 20, 2024

Section II-10163 - General Provisions

A. Health facilities must permit each resident to remain in the facility and not transfer or discharge the resident from the facility unless:

1. 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 that 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; and

6. the facility ceases to operate.

B. When the facility proposes to transfer or discharge a resident under any of the circumstances specified in number one through number five above, the resident's clinical records must be documented. The documentation must be made by the following:

1. the resident's physician when transfer or discharge is necessary as specified in number one or number two as listed above;

2. any physician when transfer or discharge is necessary as specified in number four as listed above.

C. Before an interfacility transfer or discharge occurs the facility must, on a form prescribed by the Louisiana Department of Health and Hospitals, do the following:

1. Notify the resident of the transfer or discharge and the reasons for the move in writing and in a language and manner that the resident understands. The health facility must place a copy of the notice in the resident's clinical record and transmit a copy to the following:

a. the resident;

b. a family member of the resident, if known;

c. the resident's legal representative and legal guardian, if known;

d. the local long term care ombudsman program (for involuntary relocations or discharges only);

e. the person or agency responsible for the resident's placement, maintenance, and care in the facility;

f. in situations where the resident is developmentally disabled, the Regional Office of the Division of Mental Health who may assist with placement decisions; and

g. the resident's physician when the transfer or discharge is necessary under situations as described in number three through six in §10163. A of this Subchapter;

2. record the reasons in the resident's clinical record;

3. Include in the notice the items as described in number one through eight in §10163. E of this Subchapter.

D. Except when specified in number one below, the notice of transfer or discharge required in §10163. D of this Subchapter must be made by the facility at least 30 days before the resident is transferred or discharged.

1. Notice may be made as soon as practicable before transfer or discharge when:

a. the safety of individuals in the facility would be endangered as described in number three §10163. A of this Subchapter;

b. The health of individuals in the facility would be endangered as described in number four in §10163. A of this Subchapter;

c. The resident's health improves sufficiently to allow a more immediate transfer or discharge as described in number two of §10163. A of this Subchapter;

d. an immediate transfer or discharge is required by the resident's urgent medical needs; and

e. a resident has not resided in the facility for 30 days.

E. For health facilities the written notice as described in §10163 of this Subchapter must include the following:

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 regarding appeal rights that reads: You have the right to appeal the health facility's decision to transfer you. If you think you should not have to leave this facility, you may file a written request for a hearing postmarked within ten days after you receive this notice. If you request a hearing, it will be held within 23 days after you receive this notice, and you will not be transferred from the facility earlier than 30 days after you receive this notice of transfer or discharge, unless the facility is authorized to transfer you as described in number one, §10163. D of this Subchapter. If you wish to appeal this transfer or discharge, a form to appeal the health facility's decision and to request a hearing is attached. If you have any questions, call the Louisiana Department of Health and Hospitals at the number listed below;

5. the name of the director, and the address, telephone number, and hours of operation of the Bureau of Appeals of the Louisiana Department of Health and Hospitals;

6. a hearing request form utilized by the Louisiana Department of Health and Hospitals;

7. the name, address, and telephone number of the state long term care ombudsman;

8. for health facility residents with developmental disabilities or who are mentally ill, the mailing address and telephone number of the protection advocacy services commission.

F. Appeal of Transfer or Discharge

1. If the resident appeals the transfer or discharge, the health facility may not transfer or discharge the resident within 30 days after the resident receives the initial transfer or discharge unless an emergency exists as described in number one §10163. D.1 of this subchapter. A physician determines that an emergency exists.

2. If non-payment is the basis of a transfer or discharge, the resident shall have the right to pay the balance owed to the facility up to the date of the transfer or discharge and then is entitled to remain in the facility.

3. The Louisiana Department of Health and Hospitals shall provide a resident who wishes to appeal the transfer or discharge from a facility the opportunity to file for a hearing postmarked within ten days following the resident's receipt of the written notice or the transfer or discharge from the facility.

4. If a health facility resident requests a hearing, the Louisiana Department of Health and Hospitals shall hold a hearing at the health facility, or by telephone if agreed upon by all parties, within 30 days from the date the resident receives the notice of transfer or discharge. The Louisiana Department of Health and Hospitals shall issue a decision within 30 days from the date the resident receives the notice. The health facility must convince the Department by a preponderance of the evidence that the transfer or discharge is authorized under Section A. If the Department determines that the transfer is appropriate, the resident must not be required to leave the health facility within 30 days after the resident's receipt of the initial transfer or discharge notice unless an emergency exists as described in number one § 10163. D.1 of this Subchapter.

G. Room to Room transfer (intra-facility). The resident or curator and responsible party shall receive at least a 24 hour notice before the room of the resident is changed. A reason for the move will be given to resident and curator/responsible party. Documentation of all of this information will be entered in the medical record. A resident has the right to receive notice when their roommate is changed.

NOTE: The resident has the right to relocate prior to the expiration of the 24 hours notice if this change is agreeable to him/her.

H. Facility Responsibilities In An Individual Involuntary Transfer or Discharge. Facility responsibilities in ensuring an orderly individual involuntary transfer shall include the following tasks:

1. The facility shall complete a final review and update the plan of care with the transfer in mind. The update shall include review of the following:

a. the discharge plan; and

b. the overall plan of care and current MDS.

2. A discharge plan shall be submitted to the individual or institution into whose care the resident is being discharged. It shall include the following information:

a. nursing services required including needed medications;

b. rehabilitative needs;

c. appropriate level of medical care;

d. any special medical arrangement necessary to alleviate any adverse effects of the discharge;

e. memory and orientation as to time, place, and person; and

f. length of residence in the facility;

g. a discharge plan containing all pertinent information regarding a resident's present condition and documentation showing lack of continued need for the level of care provided by the facility shall be submitted to the Bureau of Health Services Financing-Health Standard Section Regional Office, once the following conditions are met:

i. A medical assessment is made as near as practicable to the date of discharge; and

ii. The attending physician executes a written statement showing that on the basis of the resident's current physical and mental condition, there are no medical contraindications to the discharge.

h. Written Notice of Transfer or Discharge. The written notice of transfer or discharge shall contain the following information:

i. the proposed date of the transfer or discharge and reason(s) for same;

ii. a date, time, and place for a conference;

iii. the nursing home personnel available to assist in locating a new nursing facility or alternate living arrangement; and

iv. the resident's right for personal and/or third party representation at all stages of the transfer or discharge process.

i. Transfer or Discharge Conference. The facility Administrator and/or Nursing Director and/or Social Services Director shall meet with the resident and resident's legal representative or sponsor to discuss the transfer or discharge. The discussion shall be conducted within the following time frames to ensure an orderly process:

i. as soon as possible in advance of the transfer or discharge; but

ii. at least within the written 30 day advance notice time period.

(a). The resident's presence at the conference may be waived with a written statement from the attending physician explaining the medical contraindications for participation in such a meeting.

(b). Discussion should include information outlined above.

j. Pre-Transfer Services. The facility shall provide all pre-transfer services required in the final update of the individual plan of care and transfer or discharge plan.

k. Resident Overstay. The facility is responsible for keeping the resident whenever medical conditions warrant such action for as long as necessary, even if beyond the proposed date of transfer or discharge, except in emergency situations and when payment has been arranged.

l. Transportation. The facility shall arrange for transportation to the new residence.

I. Voluntary Individual Transfer or Discharge. Voluntary Individual Transfer.

1. To the extent possible, facilities shall adhere to the procedures outlined above prior to the actual transfer of residents who voluntarily transfer from one facility to another. The information in the plan of care, MDS, and discharge plan should be submitted to the receiving facility at the request of the resident and/or legal representative.

2. Voluntary Individual Discharge. To the extent possible, facilities shall adhere to the procedures outlined above prior to the actual discharge of residents who voluntarily leave the facility. The information in the care plan, MDS, and discharge plan shall be submitted to the individual or institution into whose care the resident is being discharged at the written request of the resident and/or legal representative.

3. Bed Hold. Before a nursing facility transfers a resident to a hospital or allows a resident to go on therapeutic home leave of 24 hours duration or longer, the nursing facility shall provide written information to the resident and a family member or legal representative that specifies the following:

a. the duration of the bed-hold policy under the State Plan during which the resident is permitted to return and resume residence in the facility; and

b. the health facility's policies regarding bed-hold periods, which must be consistent with §10163. I.3 ii. of this Subchapter.

i. Except in an emergency, at the time of transfer of a resident for hospitalization or therapeutic home leave, a health facility shall provide to the resident and a family member or legal representative written notice which specifies the duration of the bed-hold policy.

ii. Medicaid certified facilities must establish and follow a written policy under which a resident, whose hospitalization or therapeutic home leave exceeds the bed-hold period under the State Plan, is readmitted to the facility 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 Medicaid nursing facility services.

La. Admin. Code tit. 50, § II-10163

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 22:34 (January 1996).

AUTHORITY NOTE: Promulgated in accordance with R.S. 46:153.