**§51.80 Admission, transfer and discharge rights.**

\(a\) *Transfer and discharge*.

\(1\) *Definition*: *Transfer and discharge* includes movement of a
resident to a bed outside of the facility whether that bed is in the
same physical plant or not. Transfer and discharge does not refer to
movement of a resident to a bed within the same facility.

\(2\) *Transfer and discharge requirements*. The facility management
must permit each resident to remain in the facility, and not transfer or
discharge the resident from the facility unless:

> \(i\) The transfer or discharge is necessary for the resident's
> welfare and the resident's needs cannot be met in the nursing home;
>
> \(ii\) The transfer or discharge is appropriate because the resident's
> health has improved sufficiently so the resident no longer needs the
> services provided by the nursing home;
>
> \(iii\) The safety of individuals in the facility is endangered;
>
> \(iv\) The health of individuals in the facility would otherwise be
> endangered;
>
> \(v\) The resident has failed, after reasonable and appropriate notice
> to pay for a stay at the facility; or
>
> \(vi\) The nursing home ceases to operate.

\(3\) *Documentation*. When the facility transfers or discharges a
resident under any of the circumstances specified in paragraphs
(a)(2)(i) through (a)(2)(vi) of this section, the primary physician must
document this in the resident's clinical record.

\(4\) *Notice before transfer*. Before a facility transfers or
discharges a resident, the facility must:

> \(i\) Notify the resident and, if known, a family member or legal
> representative of the resident of the transfer or discharge and the
> reasons for the move in writing and in a language and manner they
> understand.
>
> \(ii\) Record the reasons in the resident's clinical record; and
>
> \(iii\) Include in the notice the items described in paragraph (a)(6)
> of this section.

\(5\) *Timing of the notice*.

> \(i\) The notice of transfer or discharge required under paragraph
> (a)(4) of this section must be made by the facility at least 30 days
> before the resident is transferred or discharged, except when
> specified in paragraph (a)(5)(ii) of this section,
>
> \(ii\) Notice may be made as soon as practicable before transfer or
> discharge when:
>
> \(A\) The safety of individuals in the facility would be endangered;
>
> \(B\) The health of individuals in the facility would be otherwise
> endangered;
>
> \(C\) The resident's health improves sufficiently so the resident no
> longer needs the services provided by the nursing home;
>
> \(D\) The resident's needs cannot be met in the nursing home;

\(6\) *Contents of the notice*. The written notice specified in
paragraph (a)(4) of this section must include the following:

> \(i\) The reason for transfer or discharge;
>
> \(ii\) The effective date of transfer or discharge;
>
> \(iii\) The location to which the resident is transferred or
> discharged;
>
> \(iv\) A statement that the resident has the right to appeal the
> action to the State official designated by the State; and
>
> \(v\) The name, address and telephone number of the State long term
> care ombudsman.

\(7\) *Orientation for transfer or discharge*. A facility management
must provide sufficient preparation and orientation to residents to
ensure safe and orderly transfer or discharge from the facility.

\(b\) *Notice of bed-hold policy and readmission*.

\(1\) *Notice before transfer*. Before a facility transfers a resident
to a hospital or allows a resident to go on therapeutic leave, the
facility management must provide written information to the resident and
a family member or legal representative that specifies:

\(i\) The duration of the facility's bed-hold policy, if any, during
which the resident is permitted to return and resume residence in the
facility; and

\(ii\) The facility's policies regarding bed-hold periods, which must be
consistent with paragraph (b)(3) of this section, permitting a resident
to return.

\(2\) *Bed-hold notice upon transfer*. At the time of transfer of a
resident for hospitalization or therapeutic leave, facility management
must provide to the resident and a family member or legal representative
written notice which specifies the duration of the bed-hold policy
described in paragraph (b)(1) of this section.

\(3\) *Permitting resident to return to facility*. A nursing facility
must establish and follow a written policy under which a resident, whose
hospitalization or therapeutic leave exceeds the bed-hold period is
readmitted to the facility immediately upon the first availability of a
bed in a semi-private room, if the resident requires the services
provided by the facility.

\(c\) *Equal access to quality care*. The facility management must
establish and maintain identical policies and practices regarding
transfer, discharge, and the provision of services for all individuals
regardless of source of payment.

\(d\) *Admissions policy*. The facility management must not require a
third party guarantee of payment to the facility as a condition of
admission or expedited admission, or continued stay in the facility.
However, the facility may require an individual who has legal access to
a resident's income or resources available to pay for facility care to
sign a contract to pay the facility from the resident's income or
resources. (Authority: 38 U.S.C. 101, 501, 1710, 1741-1743)

*Next Section is §51.90*