Iowa Admin. Code r. 481-58.40 - Involuntary discharge or transfer
(1)
Involuntary discharge or transfer permitted. A facility may
involuntarily discharge or transfer a resident for only one of the following
reasons:
a. Medical reasons;
b. The resident's welfare or that of other
residents;
c. Nonpayment for the
resident's stay, as described in the contract for the resident's
stay;
d. Due to action pursuant to
Iowa Code chapter 229;
e. By reason
of negative action by the Iowa department of human services; or
f. By reason of negative action by the
quality improvement organization (QIO). (I, II, III)
(2)
Medical reasons. Medical
reasons for transfer or discharge shall be based on the resident's needs and
shall be determined and documented in the resident's record by the primary care
provider . Transfer or discharge may be required in order to provide a different
level of care to the resident. (II)
(3)
Welfare of a resident. Welfare of
a resident or that of other residents refers to a resident's social, emotional,
or physical well-being. A resident may be transferred or discharged because the
resident's behavior poses a continuing threat to the resident (e.g., suicidal)
or to the well-being of other residents or staff (e.g., the resident's behavior
is incompatible with other residents' needs and rights). Written documentation
that the resident's continued presence in the facility would adversely affect
the resident's own welfare or that of other residents shall be made by the
administrator or designee and shall include specific information to support
this determination. (II)
(4)
Involuntary discharge or transfer prohibited-payment source. A
resident shall not be transferred or discharged solely because the cost of the
resident's care is being paid under Iowa Code chapter 249A or because the
resident's source of payment is changing from private support to payment under
Iowa Code chapter 249A. (I, II)
(5)
Notice. Involuntary transfer or discharge of a resident from a
facility shall be preceded by a written notice to the resident and the
responsible party . (II, III)
a. The notice
shall contain all of the following information:
(1) The stated reason for the proposed transfer or
discharge. (II)
(2) The effective
date of the proposed transfer or discharge. (II)
(3) A statement, in not less than 12-point type, that
reads as follows: (II)
You have a right to appeal the facility's decision to
transfer or discharge you. If you think you should not have to leave this
facility, you may request a hearing, in writing or verbally, with the Iowa
b. The notice shall be personally delivered to the
resident and a copy placed in the resident's record. A copy shall also be
transmitted to the department ; the resident's responsible party ; the resident's
primary care provider ; the person or agency responsible for the resident's
placement, maintenance, and care in the facility; and the department on aging's
office of the long-term care ombudsman. The notice shall indicate that copies
have been transmitted to the required parties by using the abbreviation "cc:"
and listing the names of all parties to whom copies were sent.
c. The notice required by paragraph 58.40(5)
"a" shall be provided at least 30 days in advance of the
proposed transfer or discharge unless one of the following occurs:
(1) An emergency transfer or discharge is mandated by
the resident's health care needs and is in accordance with the written orders
and medical justification of the primary care provider . Emergency transfers or
discharges may also be mandated in order to protect the health, safety, or
well-being of other residents and staff from the resident being transferred.
(II)
(2) The transfer or discharge
is subsequently agreed to by the resident or the resident's responsible party ,
and notification is given to the responsible party , the resident's primary care
provider , and the person or agency responsible for the resident's placement,
maintenance, and care in the facility.
(3) The discharge or transfer is the result of a
final, nonappealable decision by the department of human services or the
QIO.
d. A hearing
requested pursuant to this subrule shall be held in accordance with subrule
58.40(7).
(6)
Emergency transfer or discharge. In the case of an emergency
transfer or discharge, the resident must be given a written notice prior to or
within 48 hours following the transfer or discharge. (II, III)
a. A copy of this notice shall be placed in the
resident's file. The notice shall contain all of the following information:
(1) The stated reason for the transfer or
discharge. (II)
(2) The effective
date of the transfer or discharge. (II)
(3) A statement, in not less than 12-point type, that
reads as follows: (II)
You have a right to appeal the facility's decision to
transfer or discharge you on an emergency basis. If you think you should not
have to leave this facility, you may request a hearing, in writing or verbally,
with the Iowa
b. The notice shall be personally delivered
to the resident and a copy placed in the resident's record. A copy shall also
be transmitted to the department ; the resident's responsible party ; the
resident's primary care provider ; the person or agency responsible for the
resident's placement, maintenance, and care in the facility; and the department
on aging's office of the long-term care ombudsman. The notice shall indicate
that copies have been transmitted to the required parties by using the
abbreviation "cc:" and listing the names of all parties to whom copies were
sent.
c. A hearing requested
pursuant to this subrule shall be held in accordance with subrule
58.40(7).
(7)
Hearing.
a. Request for
hearing.
(1) The resident must request a
hearing within 7 days of receipt of the written notice.
(2) The request must be made to the department , either
in writing or verbally.
b. The hearing shall be held no later than 14 days
after the department 's receipt of the request unless either party requests an
extension due to emergency circumstances.
c. Except in the case of an emergency discharge or
transfer, a request for a hearing shall stay a transfer or discharge pending a
final decision, including the exhaustion of all appeals. (II)
d. The hearing shall be heard by a department
of inspections and appeals administrative law judge pursuant to Iowa Code
chapter 17A and 481-Chapter 9. The hearing shall be public unless the resident
or resident's legal representative requests in writing that the hearing be
closed. In a determination as to whether a transfer or discharge is authorized,
the burden of proof by a preponderance of the evidence rests on the party
requesting the transfer or discharge.
e. Notice of the date, time, and place of the hearing
shall be sent by certified mail or delivered in person to the facility, the
resident, the responsible party , and the office of the long-term care ombudsman
not later than 5 full business days after the department 's receipt of the
request. The notice shall also inform the facility and the resident or the
responsible party that they have a right to appear at the hearing in person or
be represented by an attorney or other individual. The appeal shall be
dismissed if neither party is present or represented at the hearing. If only
one party appears or is represented, the hearing shall proceed with one party
present. The office of the long-term care ombudsman shall have the right to
appear at the hearing.
f. The
administrative law judge's written decision shall be mailed by certified mail
to the facility, resident, responsible party , and the office of the long-term
care ombudsman within 10 working days after the hearing has been
concluded.
g. If the basis for an
involuntary transfer or discharge is the result of a negative action by the
Iowa department of human services or the QIO, an appeal shall be filed with
those agencies as appropriate. Continued payment shall be consistent with rules
of those agencies.
(8)
Nonpayment. If nonpayment is the basis for involuntary
transfer or discharge, the resident shall have the right to make full payment
up to the date that the discharge or transfer is to be made and then shall have
the right to remain in the facility. (II)
(9)
Discussion of involuntary transfer or
discharge. Within 48 hours after notice of involuntary transfer or
discharge has been received by the resident, the facility shall discuss the
involuntary transfer or discharge with the resident, the resident's responsible
party , and the person or agency responsible for the resident's placement,
maintenance, and care in the facility. (II)
a. The facility administrator or other appropriate
facility representative serving as the administrator 's designee shall provide
an explanation and discussion of the reasons for the resident's involuntary
transfer or discharge. (II)
b. The
content of the explanation and discussion shall be summarized in writing, shall
include the names of the individuals involved in the discussion, and shall be
made part of the resident's record. (II)
c. The provisions of this subrule do not apply if the
involuntary transfer or discharge has already occurred pursuant to subrule
58.40(6) and emergency notice is provided within 48 hours.
(10)
Transfer or discharge
planning.
a. The facility shall
develop a plan to provide for the orderly and safe transfer or discharge of
each resident to be transferred or discharged. (II)
b. To minimize the possible adverse effects of the
involuntary transfer, the resident shall receive counseling services by the
sending facility before the involuntary transfer and by the receiving facility
after the involuntary transfer. Counseling shall be documented in the
resident's record. (II)
c. The
counseling requirement in paragraph 58.40(10)"b" does not
apply if the discharge has already occurred pursuant to subrule 58.40(6) and
emergency notice is provided within 48 hours.
d. Counseling, if required, shall be provided by a
licensed mental health professional as defined in Iowa Code section
228.1(6).
(II)
e. The health care facility
that receives a resident who has been involuntarily transferred shall
immediately formulate and implement a plan of care which takes into account
possible adverse effects the transfer may cause. (II)
(11)
Transfer upon revocation of
license or voluntary closure. Residents shall not have the right to a
hearing to contest an involuntary discharge or transfer resulting from the
revocation of the facility's license by the department of inspections and
appeals. In the case of the voluntary closure of a facility, a period of 60
days must be allowed for an orderly transfer of residents to other
facilities.
(12)
Intrafacility transfer.
a.
Residents shall not be arbitrarily relocated from room to room within a
licensed health care facility. (I, II) Involuntary relocation may occur only in
the following situations, which shall be documented in the resident's record:
(II)
(1) Resident's incompatibility with or
disturbance to other roommates.
(2)
For the welfare of the resident or other residents of the facility.
(3) For medical, nursing or psychosocial
reasons, as judged by the primary care provider , nurse or social worker in the
case of a facility which groups residents by medical, nursing or psychosocial
needs.
(4) To allow a new admission
to the facility that would otherwise not be possible due to separation of
roommates by sex.
(5) In the case
of a resident whose source of payment was previously private, but who now is
eligible for Title XIX (Medicaid) assistance, the resident may be transferred
from a private room to a semiprivate room or from one semiprivate room to
another.
(6) Reasonable and
necessary administrative decisions regarding the use and functioning of the
building.
b. Unreasonable
and unjustified reasons for changing a resident's room without the concurrence
of the resident or responsible party include:
(1) Change from private pay status to Title XIX,
except as outlined in subparagraph 58.40(12)"a"(5).
(II)
(2) As punishment or behavior
modification, except as specified in subparagraph 58.40(12)
"a"(1). (II)
(3)
Discrimination on the basis of race or religion. (II)
c. If intrafacility relocation is necessary
for reasons outlined in paragraph 58.40(12)"a," the resident
shall be notified at least 48 hours prior to the transfer and the reason
therefor shall be explained. The responsible party shall be notified as soon as
possible. The notification shall be documented in the resident's record and
signed by the resident or responsible party . (II)
d. If emergency relocation is required in order to
protect the safety or health of the resident or other residents, the
notification requirements may be waived. The conditions of the emergency shall
be documented. The family or responsible party shall be notified immediately or
as soon as possible of the condition that necessitates emergency relocation,
and such notification shall be documented. (II)
e. A transfer to a part of a facility that has a
different license must be handled the same way as a transfer to another
facility and not as an intrafacility transfer. (II, III)
Notes
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