Iowa Admin. Code r. 481-62.14 - Discharge or transfer
Procedures for the discharge or transfer of the
(1)
Discharge plan. The decision to
discharge a person and the plan for doing so shall be established through the
participation of the resident , members of the interdisciplinary team and other
resource personnel as appropriate for the welfare of the individual. (II, III)
a. Discharge planning shall begin within 30
days of admission and be carried out in accordance with the IPP. (II,
III)
b. As changes occur in a
resident 's physical or mental condition, necessitating services or care which
cannot be adequately provided by the facility, the resident shall be
transferred promptly to another appropriate facility pursuant to 62.10(1) "a. "
(I, II)
c. Notification shall be
made to the resident 's family, the resident 's legal representative, primary
care provider, and sponsoring agency, if any, prior to transfer or discharge of
any resident . (Ill)
d. Proper
arrangements shall be made for the welfare of the resident prior to the
transfer or discharge in the event of an emergency or inability to reach the
resident 's family or the resident 's legal representative. (Ill)
e. The licensee shall not refuse to discharge
or transfer a resident when directed by the primary care provider, resident ,
legal representative, or court. (II, III)
f. Advance notification by telephone shall be made to
the receiving facility prior to the transfer of any resident . (Ill)
g. When a resident is transferred or
discharged, the current evaluation and treatment plan and progress notes for
the last 30 days, as set forth in these rules, shall accompany the resident .
(II, III)
h. Prior to the transfer
or discharge of a resident to another health care facility, arrangements to
provide for continuity of care shall be made with the facility to which the
resident is being sent. (II, III)
i. A discharge or transfer authorization and summary
shall be prepared for each resident who has been discharged or transferred from
the facility and shall be disseminated to appropriate persons to ensure
continuity of care and in accordance with the requirements to ensure
confidentiality. (II, III)
j. 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.
(2)
Intrafacility transfer. Residents shall not be moved from room
to room within a health care facility arbitrarily. (I, II)
a. Involuntary relocation may occur only to implement
goals and objectives in the IPP and in the following situations:
(1) Incompatibility with or behavior disturbing to
roommates, as documented in the residents' records; (I, II)
(2) To allow a new admission to the facility which
would otherwise not be possible due to separation of roommates by sex; (II,
III)
(3) Reasonable and necessary
administrative decisions regarding the use and functioning of the building.
(II, III)
b.
Unreasonable and unjustified reasons for changing a resident 's room without the
concurrence of the resident or legal guardian include:
(1) Punishment or behavior modification.
(II)
(2) Discrimination on the
basis of race or religion. (II)
c. If intrafacility relocation is necessary for
reasons outlined in paragraph"a, " the resident shall be
notified at least 48 hours prior to the transfer and the reason shall be
explained. The legal guardian shall be notified as soon as possible. The
notification shall be documented in the resident 's record and signed by the
resident or legal guardian. (II)
d.
If emergency relocation is required 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 and legal guardian
shall be notified immediately, or as soon as possible, of the condition
requiring emergency relocation and the notification shall be documented.
(II)
e. A transfer to a part of a
facility that has a different license must be handled in the same way as a
transfer to another facility and not as an intrafacility transfer. (II,
III)
(3)
Involuntary discharge or transfer permitted. A facility may
involuntarily discharge or transfer a resident for only one of the following
reasons:
a. Medical reasons, based on the
resident 's needs and determined and documented in the resident 's record by the
primary care provider;
b. The
resident 's social, emotional or physical well-being or that of other residents,
as documented by the administrator or designee with specific information to
support the determination that the resident 's continued presence in the
facility would adversely affect the resident 's own well-being or that of other
residents;
c. Due to action
pursuant to Iowa Code chapter 229; or
d. Nonpayment for the resident 's stay, as described in
the admission agreement for the resident 's stay. (I, II, III)
(4)
Involuntary transfer
or discharge -written notice. Involuntary transfer or
discharge of a resident from a facility shall be preceded by a written notice
to the resident or the resident 's family or resident 's legal representative.
(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:
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
legal representative, primary care provider, and the person or agency
responsible for the resident 's placement, maintenance, and care in the
facility. 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. (II)
c. The notice required by paragraph 62.14(4)
"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. (II)
(2) The transfer or discharge is subsequently agreed
to by the resident or the resident 's legal representative, and notification is
given to the legal representative, the resident 's primary care provider, and
the person or agency responsible for the resident 's placement, maintenance, and
care in the facility. (II)
d. A hearing requested pursuant to this subrule shall
be held in accordance with subrule 62.14(6).
(5)
Involuntary transfer or discharge
-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 must be placed in the
resident 's file. The notice must 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:
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 shall be placed in the resident 's record. A copy shall
also be transmitted to the department , the resident 's legal representative, the
resident 's primary care provider, and the person or agency responsible for the
resident 's placement, maintenance, and care in the facility. 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
62.14(6).
(6)
Involuntary transfer or discharge -hearing.
a. Request for hearing.
(1) The resident must request a hearing within 7 days
of receiving 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 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 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 and the resident 's legal representative 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 resident 's legal representative
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.
f. The administrative law judge's written
decision shall be sent by certified mail to the facility, resident , and
resident 's legal representative within 10 working days after the hearing has
been concluded.
(7)
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)
(8)
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 legal
representative, 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
62.14(5) and emergency notice is provided within 48 hours.
(9)
Involuntary discharge or
transfer -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
62.14(9) "b" does not apply if the discharge has already
occurred pursuant to subrule 62.14(5) 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)
(10)
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 30
days must be allowed for an orderly transfer of residents to other facilities.
This rule is intended to implement Iowa Code section 135C.14(8).
Notes
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