Current through Register Vol. 47, No. 6, September 18, 2024
(1)
Involuntary discharge or transfer permitted. A facility may
involuntarily discharge or transfer a resident for only one of the following
reasons:
a. Medical reasons;
b. The resident's welfare or that of other
residents;
c. Nonpayment for the
resident's stay, as described in the contract for the resident's
stay;
d. Due to action pursuant to
Iowa Code chapter 229;
e. By reason
of negative action by the Iowa department of human services; or
f. By reason of negative action by the
quality improvement organization (QIO). (I, II, III)
(2)
Medical reasons. Medical
reasons for transfer or discharge shall be based on the resident's needs and
shall be determined and documented in the resident's record by the primary care
provider. Transfer or discharge may be required in order to provide a different
level of care to the resident. (II)
(3)
Welfare of a resident.
Welfare of a resident or that of other residents refers to a resident's social,
emotional, or physical well-being. A resident may be transferred or discharged
because the resident's behavior poses a continuing threat to the resident
(e.g., suicidal) or to the well-being of other residents or staff (e.g., the
resident's behavior is incompatible with other residents' needs and rights).
Written documentation that the resident's continued presence in the facility
would adversely affect the resident's own welfare or that of other residents
shall be made by the administrator or designee and shall include specific
information to support this determination. (II)
(4)
Involuntary discharge or transfer
prohibited-payment source. A resident shall not be transferred or
discharged solely because the cost of the resident's care is being paid under
Iowa Code chapter 249A or because the resident's source of payment is changing
from private support to payment under Iowa Code chapter 249A. (I, II)
(5)
Notice. Involuntary
transfer or discharge of a resident from a facility shall be preceded by a
written notice to the resident and the responsible party. (II, III)
a. The notice shall contain all of the
following information:
(1) The stated reason
for the proposed transfer or discharge. (II)
(2) The effective date of the proposed
transfer or discharge. (II)
(3) A
statement, in not less than 12-point type, that reads as follows: (II)
You have a right to appeal the facility's decision to
transfer or discharge you. If you think you should not have to leave this
facility, you may request a hearing, in writing or verbally, with the Iowa
department of inspections and appeals (hereinafter referred to as "department")
within 7 days after receiving this notice. You have a right to be represented
at the hearing by an attorney or any other individual of your choice. If you
request a hearing, it will be held no later than 14 days after the department's
receipt of your request and you will not be transferred before a final decision
is rendered. Extension of the 14-day requirement may be permitted in emergency
circumstances upon request to the department's designee. If you lose the
hearing, you will not be transferred before the expiration of either (1) 30
days following your receipt of the original notice of the discharge or
transfer, or (2) 5 days following final decision of such hearing, including the
exhaustion of all appeals, whichever occurs later. To request a hearing or
receive further information, call the department at (515)281-4115, or write to
the department to the attention of: Administrator, Division of Health
Facilities, Department of Inspections and Appeals, Lucas State Office Building,
Des Moines, Iowa 50319-0083.
b. The notice shall be personally delivered
to the resident and a copy placed in the resident's record. A copy shall also
be transmitted to the department; the resident's responsible party; the
resident's primary care provider; the person or agency responsible for the
resident's placement, maintenance, and care in the facility; and the department
on aging's office of the long-term care ombudsman. The notice shall indicate
that copies have been transmitted to the required parties by using the
abbreviation "cc:" and listing the names of all parties to whom copies were
sent.
c. The notice required by
paragraph 58.40(5)
"a" shall be provided at least 30 days in
advance of the proposed transfer or discharge unless one of the following
occurs:
(1) An emergency transfer or discharge
is mandated by the resident's health care needs and is in accordance with the
written orders and medical justification of the primary care provider.
Emergency transfers or discharges may also be mandated in order to protect the
health, safety, or well-being of other residents and staff from the resident
being transferred. (II)
(2) The
transfer or discharge is subsequently agreed to by the resident or the
resident's responsible party, and notification is given to the responsible
party, the resident's primary care provider, and the person or agency
responsible for the resident's placement, maintenance, and care in the
facility.
(3) The discharge or
transfer is the result of a final, nonappealable decision by the department of
human services or the QIO.
d. A hearing requested pursuant to this
subrule shall be held in accordance with subrule 58.40(7).
(6)
Emergency transfer or
discharge. In the case of an emergency transfer or discharge, the
resident must be given a written notice prior to or within 48 hours following
the transfer or discharge. (II, III)
a. A
copy of this notice shall be placed in the resident's file. The notice shall
contain all of the following information:
(1)
The stated reason for the transfer or discharge. (II)
(2) The effective date of the transfer or
discharge. (II)
(3) A statement, in
not less than 12-point type, that reads as follows: (II)
You have a right to appeal the facility's decision to
transfer or discharge you on an emergency basis. If you think you should not
have to leave this facility, you may request a hearing, in writing or verbally,
with the Iowa department of inspections and appeals (hereinafter referred to as
"department") within 7 days after receiving this notice. You have a right to be
represented at the hearing by an attorney or any other individual of your
choice. If you request a hearing, it will be held no later than 14 days after
the department's receipt of your request. You may be transferred or discharged
before the hearing is held or before a final decision is rendered. If you win
the hearing, you have the right to be transferred back into the facility. To
request a hearing or receive further information, call the department at
(515)281-4115, or write to the department to the attention of: Administrator,
Division of Health Facilities, Department of Inspections and Appeals, Lucas
State Office Building, Des Moines, Iowa 50319-0083.
b. The notice shall be personally delivered
to the resident and a copy placed in the resident's record. A copy shall also
be transmitted to the department; the resident's responsible party; the
resident's primary care provider; the person or agency responsible for the
resident's placement, maintenance, and care in the facility; and the department
on aging's office of the long-term care ombudsman. The notice shall indicate
that copies have been transmitted to the required parties by using the
abbreviation "cc:" and listing the names of all parties to whom copies were
sent.
c. A hearing requested
pursuant to this subrule shall be held in accordance with subrule
58.40(7).
(7)
Hearing.
a. Request for
hearing.
(1) The resident must request a
hearing within 7 days of receipt of the written notice.
(2) The request must be made to the
department, either in writing or verbally.
b. The hearing shall be held no later than 14
days after the department's receipt of the request unless either party requests
an extension due to emergency circumstances.
c. Except in the case of an emergency
discharge or transfer, a request for a hearing shall stay a transfer or
discharge pending a final decision, including the exhaustion of all appeals.
(II)
d. The hearing shall be heard
by a department of inspections and appeals administrative law judge pursuant to
Iowa Code chapter 17A and 481-Chapter 9. The hearing shall be public unless the
resident or resident's legal representative requests in writing that the
hearing be closed. In a determination as to whether a transfer or discharge is
authorized, the burden of proof by a preponderance of the evidence rests on the
party requesting the transfer or discharge.
e. Notice of the date, time, and place of the
hearing shall be sent by certified mail or delivered in person to the facility,
the resident, the responsible party, and the office of the long-term care
ombudsman not later than 5 full business days after the department's receipt of
the request. The notice shall also inform the facility and the resident or the
responsible party that they have a right to appear at the hearing in person or
be represented by an attorney or other individual. The appeal shall be
dismissed if neither party is present or represented at the hearing. If only
one party appears or is represented, the hearing shall proceed with one party
present. The office of the long-term care ombudsman shall have the right to
appear at the hearing.
f. The
administrative law judge's written decision shall be mailed by certified mail
to the facility, resident, responsible party, and the office of the long-term
care ombudsman within 10 working days after the hearing has been
concluded.
g. If the basis for an
involuntary transfer or discharge is the result of a negative action by the
Iowa department of human services or the QIO, an appeal shall be filed with
those agencies as appropriate. Continued payment shall be consistent with rules
of those agencies.
(8)
Nonpayment. If nonpayment is the basis for involuntary
transfer or discharge, the resident shall have the right to make full payment
up to the date that the discharge or transfer is to be made and then shall have
the right to remain in the facility. (II)
(9)
Discussion of involuntary
transfer or discharge. Within 48 hours after notice of involuntary
transfer or discharge has been received by the resident, the facility shall
discuss the involuntary transfer or discharge with the resident, the resident's
responsible party, and the person or agency responsible for the resident's
placement, maintenance, and care in the facility. (II)
a. The facility administrator or other
appropriate facility representative serving as the administrator's designee
shall provide an explanation and discussion of the reasons for the resident's
involuntary transfer or discharge. (II)
b. The content of the explanation and
discussion shall be summarized in writing, shall include the names of the
individuals involved in the discussion, and shall be made part of the
resident's record. (II)
c. The
provisions of this subrule do not apply if the involuntary transfer or
discharge has already occurred pursuant to subrule 58.40(6) and emergency
notice is provided within 48 hours.
(10)
Transfer or discharge
planning.
a. The facility shall
develop a plan to provide for the orderly and safe transfer or discharge of
each resident to be transferred or discharged. (II)
b. To minimize the possible adverse effects
of the involuntary transfer, the resident shall receive counseling services by
the sending facility before the involuntary transfer and by the receiving
facility after the involuntary transfer. Counseling shall be documented in the
resident's record. (II)
c. The
counseling requirement in paragraph 58.40(10)"b" does not
apply if the discharge has already occurred pursuant to subrule 58.40(6) and
emergency notice is provided within 48 hours.
d. Counseling, if required, shall be provided
by a licensed mental health professional as defined in Iowa Code section
228.1(6).
(II)
e. The health care facility
that receives a resident who has been involuntarily transferred shall
immediately formulate and implement a plan of care which takes into account
possible adverse effects the transfer may cause. (II)
(11)
Transfer upon revocation of
license or voluntary closure. Residents shall not have the right to a
hearing to contest an involuntary discharge or transfer resulting from the
revocation of the facility's license by the department of inspections and
appeals. In the case of the voluntary closure of a facility, a period of 60
days must be allowed for an orderly transfer of residents to other
facilities.
(12)
Intrafacility transfer.
a.
Residents shall not be arbitrarily relocated from room to room within a
licensed health care facility. (I, II) Involuntary relocation may occur only in
the following situations, which shall be documented in the resident's record:
(II)
(1) Resident's incompatibility with or
disturbance to other roommates.
(2)
For the welfare of the resident or other residents of the facility.
(3) For medical, nursing or psychosocial
reasons, as judged by the primary care provider, nurse or social worker in the
case of a facility which groups residents by medical, nursing or psychosocial
needs.
(4) To allow a new admission
to the facility that would otherwise not be possible due to separation of
roommates by sex.
(5) In the case
of a resident whose source of payment was previously private, but who now is
eligible for Title XIX (Medicaid) assistance, the resident may be transferred
from a private room to a semiprivate room or from one semiprivate room to
another.
(6) Reasonable and
necessary administrative decisions regarding the use and functioning of the
building.
b. Unreasonable
and unjustified reasons for changing a resident's room without the concurrence
of the resident or responsible party include:
(1) Change from private pay status to Title
XIX, except as outlined in subparagraph 58.40(12)"a"(5).
(II)
(2) As punishment or behavior
modification, except as specified in subparagraph
58.40(12)"a"(1). (II)
(3) Discrimination on the basis of race or
religion. (II)
c. If
intrafacility relocation is necessary for reasons outlined in paragraph
58.40(12)"a," the resident shall be notified at least 48 hours
prior to the transfer and the reason therefor shall be explained. The
responsible party shall be notified as soon as possible. The notification shall
be documented in the resident's record and signed by the resident or
responsible party. (II)
d. If
emergency relocation is required in order to protect the safety or health of
the resident or other residents, the notification requirements may be waived.
The conditions of the emergency shall be documented. The family or responsible
party shall be notified immediately or as soon as possible of the condition
that necessitates emergency relocation, and such notification shall be
documented. (II)
e. A transfer to a
part of a facility that has a different license must be handled the same way as
a transfer to another facility and not as an intrafacility transfer. (II,
III)
