Admission / Transfer / Discharge

Question 1

As a condition of Admission into a FACILITY, as part of that process, the FACILITY may NOT require what TYPE of payment?

Answer 1

Both 483.12/19.501
1-Guarantee Third Party of PAYMENT AND
** The deal is GUARANTEE of PAYMENT and Third PARTY
2-IN addition Can Not receive gifts or money ect .. as a condition of Admission, for Medicaid.

Question 2

When can a FACILITY TRANSFER or DISCHARGE a patient?

Answer 2

Both 483.12/19.502-b
1-Facility can no longer meet the needs of the resident- Dr. Documentation
2-Health- of RESIDENT has Improved enough-Dr. Documentation
3-SAFTY- of others is ENDANGED-
4-HEALTH-of OTHERS is ENDANGED-DR. Documentation
5-PAYMENT -after reasonable and appropriate NOTICE to collect ** 30 day Notice
6-REQUEST - of FAMILY or RESIDENT- TEXAS ONLY-
7-FACILITY - Ceases to operate** 75 day Notice

Question 3

Who MUST be NOTIFIED and When must NOTICE be given upon a Transfer or Discharge?

Answer 3

Both- 483.12/19.502

1-RESIDENT
2-FAMILY - if known
*****************
3- AT least 30 Days
4-5 Days if room change
5-75 Days when facility Ceases to OPERATE as a Medicaid facility
6- As soon as practical when:
Safety/Health/Needs being meet/Requests OR
has not been in the facility for more than 30 days

Question 4

If a Transfer or Discharge is because of the HEALTH or SAFTY of others in the facility the facility must?

Answer 4

Texas Only-19.502-e-4

1-CALL DADS (consumer rights and Services) to report intentions
2-Submit DADS required DR. Documentation

*** UNLESS the Transfer or Discharge is to a hospital

Question 5

What must be included in the NOTICE of Transfer or discharge from the facility

Answer 5

Both 483.12/19.502-f

1-Reason
2-DATE of when D/C or transfer will take place
3-LOCATION of D/C or transfer
4-STATEMENT of appeal
5-OMBUDSMAN - contact information

5A-Developmental Disabilities- contact information * if applies** (Fed) – and only if the NF has this type of resident.
5B-IF has a mental illness: Address and phone of state mental health authority
5C-If has a intellectual or developmental disability-Address and phone of State Authority and State protection and advocacy group.

** Discharge summary can be the LAST progress note

Question 6

How much prep time must be given to Residents before TRANSFER or DISCHARGE?

Answer 6

Both 483.12/19.502-g-

1-There is no TIME limit, BUT prep for D/C or Transfer must happen, and in enough time to ensure a safe and orderly exit

Question 7

When a TRANSFER to a NEW ROOM in the SAME Facility takes place, HOW much Notice must be given?
WHO is to be Notified?
HOW is notice to be given?

Answer 7

Texas Only- 19.502-h-

5 Days Notice;
1-Resident AND
2-Family;
Must be written NOTICE that includes: REASON/EFFECTIVE DATE/and the NEW ROOM

Question 8

What is the time limit on FAIR HEARINGS when a resident receives a DISCHARGE NOTICE? (How many days to appeal)

Answer 8

-Texas Only- 19.502-i-

90 days to appeal

Question 9

What happens to the RESIDENT if he makes an APPEAL of DISCHARGE before the DISCHARGE effective DATE?

Answer 9

-Texas Only- 19.502
IS allowed to stay in the FACILITY unless;
Health/Safety/Payment

Question 10

When two persons are married, when must Discharge/Transfer take place?

Answer 10

-Texas Only-19.502-j-
SAME DAY if POSSIBLE; and then only if the other spouse wants to be TRANSFERD.

*** this request must be in writing

Question 11

What two policies govern bed hold?

Answer 11

-Both- 483.12/19.503-

1-Medicaid
2-Facility

Question 12

What type of Notice is given for BED HOLD? and when is Notice given?

Answer 12

-Both- 483.12/19.503-

1-Must be Written and given at time of TRANSFER or LEAVE.
2-Must be given to Resident AND Family Member

Question 13

How much can a facility CHARGE for a BEDHOLD

Answer 13

-Texas Only- 19.503-

1-Not to exceed DHS daily Vendor rate.

Question 14

The discharge summary may be:

Answer 14

** the last PROGRESS NOTE

Question 15

Before a resident is transferred, a written notice is required specifying all the following except?
1-The right to refuse the transfer
2-location to where is being transferred too.
3-a statement that the resident has the right to appeal the action to the state
4-the name, address, and telephone number of the state nursing home association

Answer 15

4-the name, address, and telephone number of the state nursing home association

19. 501-f-5
    * *(5) the name, address, and telephone number of the regional representative of the Office of the State Long Term Care Ombudsman

Also must include:
Reason
Effective Date

Question 16

Regardless of transfer type, what must nurse do?

Answer 16

F-202
Nurse must document the transfer in the clinical record.

Only time not required is when it is requested by family or resident. -Texas Only-

Question 17

If a resident is private pay, and later converts to Medicaid rate, can this be deemed worthy of non-payment , and subject to the 30 notice and transfer or discharge?

Answer 17

F-202

No, switch of payment dose not constituent “non-payment”

Question 18

How many bed hold policies need to be issued? And when must they be issued?

Answer 18

1- 2 notices must be given
2- The first need to be given “well in advance” of a bed-hold
3- The 2ed must be given at time of transfer.

Question 19

When must facility give notification to family(ect) of an “emergency” transfer?

Answer 19

24 hours

** this requirement can be met if the residents copy is sent with the resident to the hospital.

Question 20

What are the re-admit bed hold rules for Private pay/ Medicaid / Medicare?

Answer 20

If leave is over state bed-hold limit resident:
Private pay: is required to pay for all bed hold stays

Medicaid:
1-Can pay of out pocket days not covered.
2-However, must be re-admitted to semi private room, once facility has room, regardless if owes money.
3-if dose owe money facility can start the process of non-payment after has been re-admitted.

Question 21

When is the only time(s) that the clinical record does not need to be documented on a transfer or discharge in a medicaid facility?

Answer 21

19.502-c-
1-The resident , or the family or REP requests a transfer or discharge
2-The facility ceases to operate as a nursing facility.