Ill. Admin. Code tit. 89, § 140.700 - Discharge of Long Term Care Residents
a) A nursing facility participating in the
Medical Assistance Program is prohibited from failing or refusing to retain as
a resident any person because he or she is a recipient or an applicant for the
Medical Assistance Program. A recipient or applicant shall be considered a
resident in the nursing facility during any hospital stay totaling ten days or
less following a hospital admission .
b) If a nursing facility should refuse to
accept a resident back in the facility after a stay in the hospital of less
than ten days, the result may be that the resident will thereafter incur
hospital bills of a greater amount than the nursing facility care would have
cost. If the Department were to become liable to pay such hospital bills as a
result of the nursing facility's refusal to take the recipient back into the
facility, the Department shall recoup its costs for that unnecessary
hospitalization from the nursing facility. The provider will be required to pay
the Department the portion of the hospital bill that is in excess of the amount
that would otherwise have been paid for care in the nursing facility from the
date on which the nursing facility refused to accept the resident's return. The
Department will notify the provider of its intent to recoup and opportunity for
a hearing shall be given pursuant to 89 Ill. Adm. Code 104, Subpart
C.
c) A nursing facility must
establish and follow a written policy under which a resident, whose
hospitalization exceeds ten days or therapeutic leave exceeds the bed reserve
period specified in Section
140.523, is
readmitted to the nursing facility immediately upon the first availability of a
bed in a semi-private, same sex room if the resident requires the services
provided by the nursing facility and is eligible for Medicaid certified
facility services.
d) The nursing
facility must permit each resident to remain in the nursing facility and not
transfer or discharge the resident except in specific instances as stated at 77
Ill. Adm. Code
300.3300(c)(1)(A) through
(C).
e) For all Medicaid certified nursing
facilities, notice of transfer or discharge must be made to any resident 30
days before the resident is transferred or discharged as mandated by
42 CFR
483.12(a)(4)(B). In addition
to requirements stated at 77 Ill. Adm. Code
300.3300(e),
the contents of the notice shall also include requirements under
42 CFR
483.12(a)(5).
f) Pursuant to Section 1919(c)(2)(F) of the
Social Security Act and Section
140.506,
a nursing facility that voluntarily withdraws from participation in the Medical
Assistance Program, but continues to provide nursing facility services, is
prohibited from using the facility's voluntary withdrawal from participation as
an acceptable basis for the transfer or discharge of residents of the facility
who were residing in the facility on the day before the effective date of the
withdrawal, including those residents who were not entitled to coverage under
the Medical Assistance Program as of that day.
Notes
Amended at 27 Ill. Reg. 18629, effective November 26, 2003
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