Alabama Administrative Code
Title 420 - ALABAMA STATE BOARD OF HEALTH
Chapter 420-5-10 - NURSING FACILITIES
Section 420-5-10-.06 - Admission, Transfer, Transport And Discharge Rights
Universal Citation: AL Admin Code R 420-5-10-.06
Current through Register Vol. 42, No. 11, August 30, 2024
(1) Admissions, transfers, transport and discharge.
(a) Transfer and discharge
includes movement of a resident to a bed outside of the certified 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 certified
facility.
(b) The facility must
permit each resident to remain in the facility, and not transfer or discharge
the resident from the facility unless--
1.
The transfer or discharge is necessary for the resident's welfare and the
resident's needs cannot be met in the facility;
2. 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 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 resident has failed, after reasonable
and appropriate notice, to pay for (or to have paid under Medicare or Medicaid)
a stay at the facility. For a resident who becomes eligible for Medicaid after
admission to a nursing facility, the nursing facility may charge a resident
only allowable charges under Medicaid; or
6. The facility ceases to operate.
(c) Documentation. When the
facility transfers or discharges a resident under any of the circumstances
specified in this section, the resident's clinical record must be documented.
The documentation must be made by--
1. The
resident's physician when transfer or discharge is necessary under paragraph
(1)(b)1 or paragraph (1)(b)2 of this section; and
2. A physician when transfer or discharge is
necessary under paragraph (1)(b)4 of this section.
(d) Notice before transfer. Before a facility
transfers or discharges a resident, the facility must--
1. Notify the resident and, if known, a
family members 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.
2. Record the
reasons in the resident's clinical record; and
3. Include in the notice the items described
in paragraph (f)l of this section.
(e) Timing of the notice. Except when
specified in paragraph (e)1 of this section, the notice of transfer or
discharge required under paragraph (d) 1 of this section must be made by the
facility at least 30 days before the resident is transferred or discharged.
1. Notice may be made as soon as practicable
before transfer or discharge when--
(i) The
safety of individuals in the facility would be endangered, under paragraph (1)
(b)3 of this section.
(ii) The
health of individuals in the facility would be endangered, under (1)(b)4 of
this section.
(iii) The resident's
health improves sufficiently to allow a more immediate transfer or discharge,
under paragraph (1)(b)2 of this section;
(iv) An immediate transfer or discharge is
required by the resident's urgent medical needs, under paragraph (1)(b)1 of
this section; or
(v) A resident has
not resided in the facility for 30 days.
(f) Contents of the notice. The written
notice specified in paragraph (d) of this section must include the following:
1. The reason for transfer or
discharge;
2. The effective date of
transfer or discharge;
3. The
location to which the resident is transferred or discharged;
4. A statement that the resident has the
right to appeal the action to the State;
5. The name, address and telephone number of
the State long term care ombudsman;
6. For nursing facility residents with
developmental disabilities, or are mentally ill, the mailing address and
telephone number of the Alabama Developmental Disabilities Advocacy Program
(ADDAP) at the University of Alabama School of Law; and
(g) Orientation for transfer or discharge. A
facility must provide sufficient preparation and orientation to residents to
ensure safe and orderly transfer or discharge from the facility.
(h) Resident Transport. If a resident is
unable to ride in an upright position or if such resident's condition is such
that he or she needs observation or treatment by Emergency Medical Services
personnel, or if the resident requires transportation on a stretcher, gurney or
cot, the facility shall arrange or request transportation services only from
providers who are ambulance service operators licensed by the Alabama State
Board of Health. If such resident is being transported to or from a health care
facility in another state, transportation services may be arranged with a
transport provider licensed as an ambulance service operator in that state. For
the purposes of this rule, and upright position means no more than 20 degrees
from vertical.
(2) Notice of bed-hold policy and readmission--
(a) Notice before transfer. Before a nursing
facility transfers a resident to a hospital or allows a resident to go on
therapeutic leave, the nursing facility must provide written information to the
resident and a family member or legal representative that specifies--
1. The duration of the bed-hold policy under
the State plan, if any, during which the resident is permitted to return and
resume residence in the nursing facility; and
2. The nursing facility's policies regarding
bed-hold periods, which must be consistent with paragraph (2)(c) of this
section, permitting a resident to return.
(b) Bed-hold notice upon transfer. At the
time of a transfer of a resident for hospitalization or therapeutic leave, a
nursing 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 paragraph (2)(a)1 and 2 of this section.
(c) 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 under the State plan, is readmitted to the facility immediately
upon the first availability of a bed in a semi-private room if the resident--
1. Requires the services provided by the
facility; and
2. Is eligible for
Medicaid nursing facility services.
(3) Equal access to quality care.
(a) A facility must establish and maintain
identical policies and practices regarding transfer, discharge, and the
provision of services under the State plan for all individuals regardless of
source of payment;
(b) The facility
may charge any amount for services furnished to non-Medicaid residents
consistent with the notice requirement in 420-5-10.05(3)(a)(e) and (f)
describing the charges; and
(c) The
State is not required to offer additional services on behalf of a resident
other than services provided in the State plan.
(4) Admissions policy.
(a) The facility must--
1. Not require residents or potential
residents to waive their rights to Medicare or Medicaid; and
2. Not require oral or written assurance that
residents or potential residents are not eligible for, or will not apply for,
Medicare or Medicaid benefits.
(b) Medicare/Medicaid facilities 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,
without incurring personal financial liability, to provide facility payment
from the resident's income or resources.
(c) In the case of a person eligible for
Medicaid, a nursing facility must not charge, solicit, accept, or receive, in
addition to any amount otherwise required to be paid under the State plan, any
gift, money, donation, or other consideration as a precondition of admission,
expedited admission or continued stay in the facility. However,--
1. A nursing facility may charge a resident
who is eligible for Medicaid for items and services the resident has requested
and received, and that are not specified in the State plan as included in the
term "nursing facility services" so long as the facility gives proper notice of
the availability and cost of these services to residents and does not condition
the resident's admission or continued stay on the request for and receipt of
such additional services; and
2. A
nursing facility may solicit, accept, or receive a charitable, religious, or
philanthropic contribution from an organization or from a person unrelated to a
Medicaid eligible resident or potential resident, but only to the extent that
the contribution is not a condition of admission, expedited admission, or
continued stay in the facility for a Medicaid eligible resident.
(d) States or political
subdivisions may apply stricter admissions standards under State or local laws
than are specified in this section, to prohibit discrimination against
individuals entitled to Medicaid.
Author: Rick Harris
Statutory Authority: Code of Ala. 1975, §§ 22-21-20, et seq.
Disclaimer: These regulations may not be the most recent version. Alabama may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
