| (a) Examples. Transfer and discharge includes movement
of a resident to a bed outside the certified facility, whether that
bed is in the same physical plant or not. Transfer and discharge does
not refer to movement within the same certified facility.
(b) Transfer and discharge requirements. The facility
must permit each resident to remain in the facility and must 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 the resident no
longer needs the services provided by the facility;
(3) the safety of individuals in the facility is endangered
due to the clinical or behavioral status of the resident;
(4) the health of other 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. Nonpayment 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 the resident's stay. For a resident
who becomes eligible for Medicaid after admission to a facility, the
facility may charge a resident only allowable charges under Medicaid;
(6) the resident or resident representative requests
a voluntary transfer or discharge; or
(7) the facility ceases to operate as a nursing facility
and no longer provides resident care.
(c) Documentation. When the facility transfers or discharges
a resident under any of the circumstances specified in subsection
(b)(1) - (7) of this section, the facility must ensure that the transfer
or discharge is documented in the resident's clinical record and appropriate
information is communicated to the receiving health care institution
or provider.
(1) Documentation must include:
(A) the basis for the transfer per subsection (b)(1)
- (7) of this section; and
(B) in the case of subsection (b)(1) of this section,
the specific resident's needs that cannot be met, facility attempts
to meet the resident needs, and the service available at the receiving
facility to meet the needs.
(2) The documentation required by paragraph (1) of
this subsection, must be made by:
(A) the resident's physician when transfer or discharge
is necessary under subsection (b)(1) or (b)(2) of this section; or
(B) a physician when transfer or discharge is necessary
under subsection (b)(3) or (b)(4) of this section.
(3) Information provided to the receiving health care
institution or provider must include the following:
(A) contact information of the practitioner responsible
for the care of the resident;
(B) resident representative information, including
contact information;
(C) advance directive information;
(D) all special instructions or precautions for ongoing
care, as appropriate;
(E) comprehensive care plan goals; and
(F) all other necessary information, including a copy
of the resident's discharge summary, consistent with §19.803
of this chapter (relating to Discharge Summary (Discharge Plan of
Care)), as applicable, to ensure a safe and effective transition of
care.
(d) Notice before transfer or discharge. Before a facility
transfers or discharges a resident, the facility must:
(1) notify the resident and the resident representative
about the transfer or discharge and the reasons for the move in writing
and in a language and manner the resident understands;
(2) if the discharge or transfer is initiated by the
facility, send a copy of the notice to a representative of the Ombudsman
Program at the time a discharge notice is presented to the resident
and resident representative, in accordance with the timeframes described
in subsection (e) of this section, except that the notice may be provided
as soon as practicable, such as in a list of residents sent on a monthly
basis, when a resident is temporarily transferred on an emergency
basis to an acute care facility;
(3) record the reasons for the transfer or discharge
in the resident's clinical record;
(4) include in the notice the items described in subsection
(f) of this section; and
(5) comply with §19.2310 of this chapter (relating
to Nursing Facility Ceases to Participate) when the facility voluntarily
withdraws from Medicaid or Medicare or is terminated from Medicaid
or Medicare participation by HHSC or the secretary.
(e) Timing of the notice.
(1) Except when specified in paragraph (3) of this
subsection or in §19.2310 of this chapter, the notice of transfer
or discharge required under subsection (d) of this section must be
made by the facility at least 30 days before the resident is transferred
or discharged.
(2) The requirements described in paragraph (1) of
this subsection and subsection (h) of this section do not have to
be met if the resident or resident representative requests the transfer
or discharge.
(3) Notice must be made as soon as practicable before
transfer or discharge when:
(A) the safety of individuals in the facility would
be endangered, as specified in subsection (b)(3) of this section;
(B) the health of individuals in the facility would
be endangered, as specified in subsection (b)(4) of this section;
(C) the resident's health improves sufficiently to
allow a more immediate transfer or discharge, as specified in subsection
(b)(2) of this section;
(D) the transfer and discharge is necessary for the
resident's welfare because the resident's needs cannot be met in the
facility, as specified in subsection (b)(1) of this section, and the
resident's urgent medical needs require an immediate transfer or discharge;
or
(E) a resident has not resided in the facility for
30 days.
(4) When an immediate involuntary transfer or discharge
as specified in subsection (b)(3) or (4) of this section, is contemplated,
unless the discharge is to a hospital, the facility must:
(A) immediately call the staff of the Office of the
State Long-term Care Ombudsman to report its intention to discharge;
and
(B) submit to HHSC the required physician documentation
regarding the discharge.
(f) Contents of the notice. For nursing facilities,
the written notice specified in subsection (d) of this section 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 of the resident's appeal rights, including:
(A) the resident has the right to appeal the action
as outlined in HHSC's Fair and Fraud Hearings Handbook by requesting
a hearing within 90 days after the date of the notice;
(B) if the resident requests the hearing before the
discharge date, the resident has the right to remain in the facility
until the hearing officer makes a final determination unless failure
to transfer or discharge would endanger the health or safety of the
resident or individuals in the facility. The facility must document
the danger failure to discharge would present; and
(C) information on how to obtain an appeal form and
assistance in completing the form and submitting the appeal hearing
request;
(5) the name, address, email address, and telephone
number of the managing local ombudsman and the toll-free number of
the Ombudsman Program;
(6) in the case of a resident with mental illness,
the address, email address, and phone number of the state mental health
authority; and
(7) in the case of a resident with an intellectual
or developmental disability, the authority for individuals with intellectual
and developmental disabilities, and the phone number, address, and
email address of the agency responsible for the protection and advocacy
of individuals with intellectual and developmental disabilities.
(g) Changes to the notice. If the information in the
notice changes before effecting the transfer or discharge, the facility
must update the recipients of the notice as soon as practicable once
the updated information becomes available.
(h) Orientation for transfer or discharge. 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.
(i) Notice of relocation to another room. Except in
an emergency, the facility must notify the resident and the resident
representative at least five days before relocation of the resident
to another room within the facility. The facility must prepare a written
notice which contains:
(1) the reasons for the relocation;
(2) the effective date of the relocation; and
(3) the room to which the facility is relocating the
resident.
(j) Fair hearings.
(1) Individuals who receive a discharge notice from
a facility have 90 days to appeal. If the recipient appeals before
the discharge date, the facility must allow the resident to remain
in the facility, except in the circumstances described in subsections
(b)(5) and (e)(3) of this section, until the hearing officer makes
a final determination. Vendor payments and eligibility will continue
until the hearing officer makes a final determination. If the recipient
has left the facility, Medicaid eligibility will remain in effect
until the hearing officer makes a final determination.
(2) When the hearing officer determines that the discharge
was inappropriate, the facility, upon written notification by the
hearing officer, must readmit the resident immediately, or to the
next available bed. If the discharge has not yet taken place, and
the hearing officer finds that the discharge will be inappropriate,
the facility, upon written notification by the hearing officer, must
allow the resident to remain in the facility. The hearing officer
will also report the findings to HHSC Regulatory Services Division
for investigation of possible noncompliance.
(3) When the hearing officer determines that the discharge
is appropriate, the resident is notified in writing of this decision.
Any payments made on behalf of the recipient past the date of discharge
or decision, whichever is later, must be recouped.
(k) Discharge of married residents. If two residents
in a facility are married and the facility proposes to discharge one
spouse to another facility, the facility must give the other spouse
notice of the spouse's right to be discharged to the same facility.
If the spouse notifies a facility, in writing, that the spouse wishes
to be discharged to another facility, the facility must discharge
both spouses on the same day, pending availability of accommodations.
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| Source Note: The provisions of this §554.502 adopted to be effective May 1, 1995, 20 TexReg 2393; amended to be effective March 1, 1998, 23 TexReg 1314; amended to be effective January 1, 2000, 24 TexReg 11781; amended to be effective August 1, 2000, 25 TexReg 6779; amended to be effective October 31, 2013, 38 TexReg 7465; amended to be effective April 5, 2018, 43 TexReg 2017; amended to be effective March 24, 2020, 45 TexReg 2025; transferred effective January 15, 2021, as published in the Texas Register December 11,2020, 45 TexReg 8871 |
