Indiana Administrative Code › Title 410 - INDIANA DEPARTMENT OF HEALTH › Article 16.2 - HEALTH FACILITIES; LICENSING AND OPERATIONAL STANDARDS › Rule 3.1 - Comprehensive Care Facilities › Section 3.1-12 - Transfer and discharge rights

Current through July 10, 2024
Authority: IC
				  16-28-1-7
Affected: IC 4-21.5; IC
				  16-28-5-1
Sec. 12.
(a) The
				transfer and discharge rights of residents of a facility are as follows:
(1) As used in this section, "interfacility
				transfer and discharge" means the movement of a resident to a bed outside of
				the licensed facility. For Medicare and Medicaid certified facilities, an
				interfacility transfer and discharge means the movement of a resident to a bed
				outside of the certified facility whether that bed is in the same physical
				plant or not.
(2) As used in this
				section, "intrafacility transfer" means the movement of a resident to a bed
				within the same licensed facility. For Medicare and Medicaid certified
				facilities, an intrafacility transfer means the movement of a resident to a bed
				within the same certified facility.
(3) When a transfer or discharge of a
				resident is proposed, whether intrafacility or interfacility, provision for
				continuity of care shall be provided by the facility.
(4) Health facilities must permit each
				resident to remain in the facility and not transfer or discharge the resident
				from the facility unless:
(A) the transfer or
				discharge is necessary for the resident's welfare and the resident's needs
				cannot be met in the facility;
(B)
				the transfer or discharge is appropriate because the resident's health has
				improved sufficiently so that the resident no longer needs the services
				provided by the facility;
(C) the
				safety of individuals in the facility is endangered;
(D) the health of individuals in the facility
				would otherwise be endangered;
(E)
				the resident has failed, after reasonable and appropriate notice, to pay for
				(or to have paid under Medicare or Medicaid) a stay at the facility;
				or
(F) the facility ceases to
				operate.
(5) When the
				facility proposes to transfer or discharge a resident under any of the
				circumstances specified in subdivision (4)(A), (4)(B), (4)(C), (4)(D), or
				(4)(E), the resident's clinical records must be documented. The documentation
				must be made by the following:
(A) The
				resident's physician when transfer or discharge is necessary under subdivision
				(4)(A) or (4)(B).
(B) Any physician
				when transfer or discharge is necessary under subdivision (4)(D).
(6) Before an interfacility
				transfer or discharge occurs, the facility must, on a form prescribed by the
				department, do the following:
(A) Notify the
				resident of the transfer or discharge and the reasons for the move in writing
				and in a language and manner that the resident understands. The health facility
				must place a copy of the notice in the resident's clinical record and transmit
				a copy to the following:
(i) The
				resident.
(ii) A family member of
				the resident if known.
(iii) The
				resident's legal representative if known.
(iv) The local long term care ombudsman
				program (for involuntary relocations or discharges only).
(v) The person or agency responsible for the
				resident's placement, maintenance, and care in the facility.
(vi) In situations where the resident is
				developmentally disabled, the regional office of the division of disability,
				aging, and rehabilitative services, who may assist with placement
				decisions.
(vii) The resident's
				physician when the transfer or discharge is necessary under subdivision (4)(C),
				(4)(D), (4)(E), or (4)(F).
(B) Record the reasons in the resident's
				clinical record.
(C) Include in the
				notice the items described in subdivision (9).
(7) Except when specified in subdivision (8),
				the notice of transfer or discharge required under subdivision (6) must be made
				by the facility at least thirty (30) days before the resident is transferred or
				discharged.
(8) 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 endangered;
(C) the resident's health improves
				sufficiently to allow a more immediate transfer or discharge;
(D) an immediate transfer or discharge is
				required by the resident's urgent medical needs; or
(E) a resident has not resided in the
				facility for thirty (30) days.
(9) For health facilities, the written notice
				specified in subdivision (7) must include the following:
(A) The reason for transfer or
				discharge.
(B) The effective date
				of transfer or discharge.
(C) The
				location to which the resident is transferred or discharged.
(D) A statement in not smaller than 12-point
				bold type that reads, "You have the right to appeal the health facility's
				decision to transfer you. If you think you should not have to leave this
				facility, you may file a written request for a hearing with the Indiana
				department of health postmarked within ten (10) days after you receive this
				notice. If you request a hearing, it will be held within twenty-three (23) days
				after you receive this notice, and you will not be transferred from the
				facility earlier than thirty-four (34) days after you receive this notice of
				transfer or discharge unless the facility is authorized to transfer you under
				subdivision (8). If you wish to appeal this transfer or discharge, a form to
				appeal the health facility's decision and to request a hearing is attached. If
				you have any questions, call the Indiana department of health at the number
				listed below.".
(E) The name of the
				director, address, telephone number, and hours of operation of the
				division.
(F) A hearing request
				form prescribed by the department.
(G) The name, address, and telephone number
				of the division and local long term care ombudsman.
(H) For facility residents with developmental
				disabilities or who are mentally ill, the mailing address and telephone number
				of the protection and advocacy services commission.
(10) If the resident appeals the transfer or
				discharge, the facility may not transfer or discharge the resident within
				thirty-four (34) days after the resident receives the initial transfer or
				discharge notice, unless an emergency exists as provided under subdivision
				(8).
(11) If nonpayment is the
				basis of a transfer or discharge, the resident 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.
(12) The department shall provide a resident
				who wishes to appeal the transfer or discharge from a facility the opportunity
				to file a request for a hearing postmarked within ten (10) days following the
				resident's receipt of the written notice of the transfer or discharge from the
				facility.
(13) If a facility
				resident requests a hearing, the department shall hold an informal hearing at
				the facility within twenty-three (23) days from the date the resident receives
				the notice of transfer or discharge. The department shall attempt to give at
				least five (5) days written notice to all parties prior to the informal
				hearing. The department shall issue a decision within thirty (30) days from the
				date the resident receives the notice. The facility must convince the
				department by a preponderance of the evidence that the transfer or discharge is
				authorized under subdivision (4). If the department determines that the
				transfer is appropriate, the resident must not be required to leave the
				facility within the thirty-four (34) days after the resident's receipt of the
				initial transfer or discharge notice unless an emergency exists under
				subdivision (8). Both the resident and the facility have the right to
				administrative or judicial review under IC 4-21.5 of any decision or action by
				the department arising under this section. If a hearing is to be held de novo,
				that hearing shall be held in the facility where the resident
				resides.
(14) An intrafacility
				transfer can be made only if:
(A) the transfer
				is necessary for medical reasons as judged by the attending physician;
				or
(B) the transfer is necessary
				for the welfare of the resident or other persons.
(15) If an intrafacility transfer is
				required, the resident must be given notice at least two (2) days before
				relocation, except when:
(A) the safety of
				individuals in the facility would be endangered;
(B) the health of individuals in the facility
				would be endangered;
(C) the
				resident's health improves sufficiently to allow a more immediate transfer;
				or
(D) an immediate transfer is
				required by the resident's urgent medical needs.
(16) The written notice of an intrafacility
				transfer must include the following:
(A)
				Reasons for transfer.
(B) Effective
				date of transfer.
(C) Location to
				which the resident is transferred.
(D) Name, address, and telephone number of
				the local and state long term care ombudsman.
(E) For facility residents with developmental
				disabilities or who are mentally ill, the mailing address and telephone number
				of the protection and advocacy services commission.
(17) The resident has the right to relocate
				prior to the expiration of the two (2) day notice.
(18) Prior to any interfacility or
				involuntary intrafacility relocation, the facility shall prepare a relocation
				plan to prepare the resident for relocation and to provide continuity of care.
				In nonemergency relocations, the planning process shall include a relocation
				planning conference to which the resident, his or her legal representative,
				family members, and physician shall be invited. The planning conference may be
				waived by the resident or his or her legal representative.
(19) At the planning conference, the
				resident's medical, psychosocial, and social needs with respect to the
				relocation shall be considered and a plan devised to meet these
				needs.
(20) The facility shall
				provide reasonable assistance to the resident to carry out the relocation
				plan.
(21) The facility must
				provide sufficient preparation and orientation to residents to ensure safe and
				orderly transfer or discharge from the facility.
(22) If the relocation plan is disputed, a
				meeting shall be held prior to the relocation with the administrator or his or
				her designee, the resident, and the resident's legal representative. An
				interested family member, if known, shall be invited. The purpose of the
				meeting shall be to discuss possible alternatives to the proposed relocation
				plan.
(23) A written report of the
				content of the discussion at the meeting and the results of the meeting shall
				be reviewed by the administrator or his or her designee, the resident, the
				resident's legal representative, and an interested family member, if known,
				each of whom may make written comments on the report.
(24) The written report of the meeting shall
				be included in the resident's permanent record.
(25) Before a facility transfers a resident
				to a hospital or allows a resident to go on therapeutic leave of twenty-four
				(24) hours duration or longer, the facility must provide written information to
				the resident and a family member or legal representative that specifies the
				following:
(A) The duration of the bed-hold
				policy under the Medicaid state plan during which the resident is permitted to
				return and resume residence in the facility.
(B) The facility's policies regarding
				bed-hold periods, which must be consistent with subdivision (27), permitting a
				resident to return.
(26)
				Except in an emergency, at the time of transfer of a resident for
				hospitalization or therapeutic leave, a facility 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 subdivision (25).
(27) Medicaid certified facilities must
				establish and follow a written policy under which a resident, whose
				hospitalization or therapeutic leave exceeds the bed-hold period under the
				state plan, is readmitted to the facility immediately upon the first
				availability of a bed in a semiprivate room if the resident:
(A) requires the services provided by the
				facility; and
(B) is eligible for
				Medicaid nursing facility services.