150.003 - Admissions, Transfers and Discharges

150.003. Admissions, Transfers and Discharges

(A) The admission, transfer and discharge of residents shall be in accordance with written policies and procedures developed by each facility and acceptable to the Department. Any restrictions, priorities or special admission criteria shall be applied equally to all potential admissions. All facilities shall comply with state and federal anti-discrimination laws and regulations.

(B) Facilities shall admit and care for only those individuals in need of long-term care services for whom they can provide care and services appropriate to the individual's physical, emotional, behavioral, and social needs. Prior to admission, an individual's needs shall be evaluated and alternative care plans considered. This evaluation shall be a joint responsibility of the referring agency or institution, the primary care provider and the receiving facility.

(1) Residents shall be admitted only on the written order of the primary care provider, who designates the placement as medically and socially appropriate.

(2) No facility shall admit a resident without written consent of the individual or his or her guardian except in emergencies.

(a) No SNCFC shall admit a resident without written consent of the individual (if he or she is competent to enter into such an agreement) or his or her parent or guardian (if he or she is not) except in emergencies.

(b) A SNCFC may provide respite services only after prior approval by the Department and contingent upon submission of policies and procedures related to respite care. The Department shall be duly notified in regard to any changes in an approved respite service policy or in regard to the termination of a SNCFC respite service.

(3) In order to promote appropriate placements, facilities shall exchange information on resources and services with other agencies and institutions providing health care in their area.

(C) Transfer of Information.

(1) Prior to or at the time of admission, a health care referral form approved by the Department shall be completed for each resident. Residents shall not be admitted without a completed referral form.

(2) A discharge summary or complete medical evaluation sufficient to provide the care and services required by the resident shall be made available to the receiving facility either prior to or immediately following admission as specified in 105 CMR 150.005(F)(2).

(D) Level IV facilities designated Community Support Facilities or admitting Community Support Residents shall meet the following requirements.

(1) When a resident who has been determined, following his or her consent and evaluation, to be a Community Support Resident, is admitted to a Community Support Facility, or to a Resident Care Facility (by waiver) a written agreement must be signed between certain referring public or private agencies or institutions and the accepting facility. All referring agencies which are also providers of mental health or psychiatric services must agree in writing to provide or arrange for the following services with another designated provider:

(a) Seven days per week, 24 hours per day psychiatric consultation services.

(b) Mental health personnel who will be available on a monthly basis to coordinate their efforts with Community Support Facility staff or other involved professionals in development of the resident's mental health treatment plan. These staff shall meet with other involved professionals if the Coordinator feels it is required to assure coordination.

(c) Psychiatric monitoring of the side effects of drug therapies. The psychiatrist from the referring agency or hospital must consult, and meet if necessary, with other professional staff involved in the development and implementation of the resident's mental health treatment plan to coordinate such monitoring with the treatment plan.

(d) Crisis Intervention. When the Administrator of the facility and the social worker agree a mental health crisis exists, the referring agency, hospital or designated provider must work with the facility staff in evaluation and development of a planned response to the crisis.

(e) On-site Crisis Intervention and Emergency Services. In those cases where the referring agency is either the Department of Mental Health or a provider of inpatient mental health services, the following procedure must be followed:

1. If phone consultation is not adequate, on-site evaluation should be provided to the rest home.

2. If the Administrator/Responsible Person, in consultation with other staff including physician, psychiatrist and social worker staff feels the crisis intervention services provided are not adequate and an emergency exists but the referring agency does not agree, the referring agency agrees to remove the client from the home, if the Administrator/Responsible Person requests this, while an evaluation is performed.

3. The Administrator/Responsible Person agrees to arrange for this evaluation within a period of three working days from the time the disagreement occurs.

4. Both parties agree to abide by the decision of the evaluating clinician.

5. If the evaluating clinician finds that the client may not return to the facility, the referring agency must arrange for alternate placement within a reasonable time.

6. If the evaluating clinician finds the client may return to the facility, the facility must readmit the client.

(2) All of the services in 105 CMR 150.003(D)(1) must be available during the 12-month period following the first day of admission. Crisis Intervention and Emergency services must be available for a three year period following the first day of admission.

(a) No individual may be placed in a Community Support Facility without the written consent of the individual (if he or she is competent to give such consent) or the written consent of his or her guardian (if he or she is not competent).

(b) No Community Support Facility shall admit residents from Department of Mental Health facilities until the Community Support Facility has received notice from the facility discharging the resident that it has made a good faith effort to find the least restrictive setting that can serve the client's needs.

(3) Long-term care facilities may not administer electroconvulsive therapy on-site. Mental health residents in need of such therapies shall be admitted or transferred to appropriate inpatient acute or mental health facilities.

(4) Long-term care facilities may not use aversive interventions.

(5) Individuals whose primary diagnosis is substance use disorder shall not be admitted to a facility for purposes of detoxification and shall be treated in an appropriate outpatient, acute care or rehabilitation facility for detoxification prior to admission to a long-term care facility.

(E) Admission of Residents Younger than 22 Years Old.

(1) Residents younger than 22 years old may be admitted to a long-term care facility only after prior approval by the Department's Medical Review Team (MRT).

(a) The MRT must approve all requests for respite care of individuals younger than 22 years old at long-term care facilities. Such approval is contingent upon reviewing assessments of the child's medical, nursing, social and developmental needs.

(b) The MRT must approve all admission requests for long-term residential care of individuals younger than 22 years old. Such approval is contingent upon reviewing assessments of the child's medical, nursing, social and developmental needs and consideration given to alternative placement.

(c) An approval may be granted by the MRT, on a case by case basis, to permit individuals who have resided in a pediatric nursing facility prior to their 22nd birthday to continue to reside at the facility until a more appropriate alternative is available.

(2) Facilities seeking MRT approval for admission of a child younger than 16 years old shall meet standards for SNCFC throughout 105 CMR 150.000 that the MRT deems relevant to caring for such child.

(F) Admission of Residents with Developmental Disability/Other Related Conditions (DD/ORC). No facility certified to participate in the Medicare or Medicaid programs shall admit a resident with DD/ORC with an anticipated length of stay of 30 days or longer unless the facility has verified a Pre-admission Screening and Annual Resident Review (PASARR) has been completed to determine whether admission is appropriate and whether there is a need for a referral for a specialized services assessment.

(G) Transfer and Discharge.

(1) Facilities providing Level I, II or in care shall enter into a written transfer agreement with one or more general hospitals providing for the reasonable assurance of transfer and inpatient hospital care for residents whenever such transfer is medically necessary. The agreement shall provide for the transfer of acutely ill residents to the hospital ensuring timely admission and provisions for continuity in the care and the transfer of pertinent medical and other information.

(2) Facilities providing Level I, II or in care shall designate a member of the permanent or consultant staff to be responsible for transfer and discharge planning.

(3) If major changes occur in the physical or mental condition of the resident requiring services not regularly provided to the resident by the facility, arrangements shall be made by the primary care provider and the facility to transfer the resident to a facility providing more appropriate care.

(4) If in the opinion of a facility a resident poses a danger to himself or herself or the health and welfare of other residents or staff, the facility shall arrange for transfer to a facility providing appropriate care.

(5) Except in an emergency, the facility shall give at least 24 hours' notice of anticipated or impending transfer to the receiving institution and shall assist in making arrangements for safe transportation.

(6) No resident shall be transferred or discharged without the primary care provider's order and notification to the resident or the resident's guardian and the resident's emergency contact, except in the case of an emergency. The reason for transfer or discharge shall be noted on the resident's clinical record.

(7) The following additional requirements apply to the transfer and discharge of residents in Level IV facilities. For the purposes of 105 CMR 150.003, any absence from the facility during which it is anticipated the resident will or may return, will not be considered a transfer or discharge.

(a) No resident shall be discharged or transferred from a Level IV facility or unit without his or her written consent or the written consent of the resident's guardian, solely for the reason the facility in which the resident resides, has been designated as a Community Support Facility or a non-Community Support Facility. The consent shall be filed in the resident's record.

(b) For those discharges occuring on a planned basis and exclude emergency discharges or unanticipated discharges (which may occur because of a change in the resident's level of care while in hospital), the following documentation is required:

1. the physician's and/or psychiatrist's order that sets out the justification for the resident's transfer or discharge;

2. the notice given to the resident or the resident's guardian by the facility of the anticipated transfer or discharge. Said notice shall be given at least 30 days prior to the anticipated date of discharge or transfer, and shall contain sufficient explanation for the discharge or transfer, including the facility's plans and procedures for the transfer or discharge. Such notice shall also state the resident has the right to object to the facility to his or her transfer or discharge. The reasons for such objections shall be noted in the resident's record.

3. the site to which the resident is to be discharged or transferred;

4. all reasonable efforts have been taken by the facility to provide counseling to the resident in order to prepare him or her in adjusting to any transfer or discharge;

5. all reasonable precautions have been taken to eliminate or reduce any harmful effects that may result from the transfer or discharge;

6. the resident's consent was voluntary.

(c) In the event of an emergency transfer or discharge, the facility shall, within 48 hours after such emergency discharge or transfer, document in the resident's record the following:

1. the nature of the emergency;

2. the physician's and/or psychiatrist's order that sets out the justification for the resident's emergency transfer or discharge;

3. the name of the resident's emergency contact, and that such notification has been made within 24 hours of such transfer or discharge;

(8) A health care referral form approved by the Department and other relevant information shall be sent to the receiving institution.

(9) Death of resident.

(a) Each long-term care facility shall develop specific procedures to be followed in the event of death.

(b) A physician shall be notified immediately at the time of death. Death shall be pronounced within a reasonable time. The deceased resident shall not be discharged from a facility until pronounced dead.

(c) Provisions shall be made so deceased residents are removed from rooms with other residents as soon as possible.

(d) The deceased resident shall be covered, transported and removed from the facility in a dignified manner.

(10) All facilities shall comply with 940 CMR 4.09: Discharge and Transfers. In addition, all Level I, II and in facilities, as applicable, shall comply with nursing home transfer and discharge regulations, 130 CMR 610.028 through 610.030, MassHealth Fair Hearing Rules, and federal regulations, 42 CFR 483.15.

(Amended by Mass Register Issue 1361, eff. 3/23/2018.)

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