A. Conditions. Involuntary transfer or
discharge of a client may occur only under the following conditions:
1. the transfer or discharge is necessary for
the client's welfare and the client's needs cannot be met in the
facility;
2. the transfer or
discharge is appropriate because the client's health has improved sufficiently,
therefore, the client no longer needs the services provided by the
facility;
3. the safety of
individuals in the facility is endangered;
4. the health of individuals in the facility
would otherwise be endangered;
5.
the client has failed, after reasonable and appropriate notice, to pay for the
portion of the bill for services for which he/she is liable or when the client
loses financial eligibility for Medicaid. When a client becomes eligible for
Medicaid after admission to a facility, the facility may charge the client only
allowable charges under Medicaid; and
6. the facility ceases to operate.
B. When the facility proposes to
transfer or discharge a client under any of the circumstances specified in
Paragraphs A.1-5 above, the client's clinical records must be fully documented.
The documentation must be made by the following:
1. the client's physician when transfer or
discharge is necessary as specified in Paragraph A.1 or 2 as listed above;
or
2. any physician when transfer
or discharge is necessary as specified in Paragraph A.4 as listed above. Before
an interfacility transfer or discharge occurs the facility must:
a. notify the client of the transfer or
discharge and the reason for the move. The notification shall be in writing and
in a language and manner that the client understands. A copy of the notice must
be placed in the client's clinical record and a copy transmitted to:
i. the client;
ii. a family member of the client, if
known;
iii. the client's legal
representative and legal guardian, if known;
iv. the Community Living Ombudsman
Program;
v. DHH Health Standards
Section;
vi. the regional office of
OCDD for assistance with the placement decision;
vii. the client's physician;
viii. appropriate educational authorities;
and
ix. a representative of the
client's choice;
b.
record the reasons in the client's clinical record;
c. a interdisciplinary team conference shall
be conducted with the client, family member or legal representative and an
appropriate agency representative to update the plan and develop discharge
options that will provide reasonable assurances that the client will be
transferred or discharged to a setting that can be expected to meet his/her
needs.
3. the facility
must issue the notice of transfer or discharge in writing at least 30 days
before the resident is transferred or discharged, except under the
circumstances described in Subparagraph a below.
a. Notice may be made as soon as practicable
before transfer or discharge when:
i. the
safety of individuals in the facility would be endangered;
ii. the health of individuals in the facility
would be endangered;
iii. the
client's health improves sufficiently to allow a more immediate transfer or
discharge; or
iv. an immediate
transfer or discharge is required by the client's urgent medical needs as
determined by a physician.
b. Notice may be made at least 15 days before
transfer or discharge in cases of nonpayment of a bill for cost of
care.
c. The written notice must
include:
i. the reason for transfer or
discharge;
ii. the effective date
of transfer or discharge;
iii. the
location to which the client is transferred or discharged;
iv. an explanation of the client's right to
have personal and/or third party representation at all stages of the transfer
or discharge process;
v. the
address and telephone number of the Community Living Ombudsman
Program;
vi. the mailing address
and telephone number of the agency responsible for the protection of
individuals with developmental disabilities;
vii. names of facility personnel available to
assist the client and family in decision making and transfer
arrangements;
viii. the date, time
and place for the follow-up interdisciplinary team conference to make a final
decision on the client's/legal representative's choice of new facility of
alternative living arrangement;
ix.
an explanation of the client's right to register a complaint with DHH within
three days after the follow-up interdisciplinary team conference;
x. a statement regarding appeal rights that
reads:
"You or someone acting on your behalf has the right to
appeal the health facility's decision to discharge you. The written request for
a hearing must be postmarked within 30 days after you receive this notice or
prior to the effective date of the transfer or discharge. If you request a
hearing, it will be held within 30 days after the facility notifies the Bureau
of Appeals of the witnesses who shall testify at the discharge hearing as well
as the documents that will be submitted as evidence. You will not be
transferred/discharged from the facility until a decision on the appeal has
been rendered;" and
xi. the
name of the director, and the address, telephone number, and hours of operation
of the Bureau of Appeals of the Louisiana Department of Health and
Hospitals;
C. The facility shall provide all services
required prior to discharge that are contained in the final update of the
individual habilitation plan and in the transfer or discharge plan.
D. The facility shall be responsible for
keeping the client, whenever medical or other conditions warrant such action,
for as long as necessary even if beyond the proposed date of transfer or
discharge, except in emergency situations.
E. The facility shall provide transportation
to the new residence unless other arrangements are preferred by the
client/legal representative or the receiving facility.
F. Appeal of Transfer or Discharge. If the
client appeals the transfer or discharge, the ICF/MR facility must permit the
client to remain in the facility and must not transfer or discharge the client
from the facility until the final appeal decision has been reached or a
pre-hearing conference is held at the request of the facility. Failure to
comply with these requirements will result in termination of the facility's
provider agreement.
G. If
nonpayment is the basis of a transfer or discharge, the client shall have the
right to pay the balance owed to the facility up to the date of the transfer or
discharge and then is entitled to remain in the facility.
H. If an ICF/MR client requests a hearing,
the Louisiana Department of Health and Hospitals shall hold a hearing at the
ICF/MR facility, or by telephone if agreed upon by the appellant, within 30
days from the date the appeal is filed with the Bureau of Appeals and witness
and exhibit lists are submitted by the facility. The Louisiana Department of
Health and Hospitals shall issue a decision within 30 days from the date of the
client hearing. The ICF/MR facility must convince the department by a
preponderance of the evidence that the transfer or discharge is justified. If
the department determines that the transfer is appropriate and no appeal and/or
pre-hearing conference has been lodged with the Bureau of Appeals, the client
must not be required to leave the ICF/MR facility within 30 days after the
client's receipt of the initial transfer or discharge notice unless an
emergency exists.
Notes
La. Admin. Code tit.
50, §
VII-30905
Promulgated by the
Department of Health and Human Resources LR 13:578 (October 1987), amended by
the Department of Health and Hospitals, Office of the Secretary, Bureau of
Health Services Financing, LR 25:690 (April 1999), LR 30:1700 (August 2004),
repromulgated LR 31:2236 (September 2005).
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
36:254 and Title XIX of the Social Security
Act.