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. Repeated refusal by
the resident to participate in the resident's service plan;
d. Due to action pursuant to Iowa Code
chapter 229; or
e. Nonpayment for
the resident's stay, as described in the residency agreement for the resident's
stay.
(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)
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 receipt of your
request by the department and you will not be transferred prior to a final
decision. In emergency circumstances, extension of the 14-day requirement may
be permitted upon request to the department's designee. If you lose the
hearing, you will not be transferred before the expiration of (1) 30 days
following receipt of the original notice of the discharge or transfer, or (2) 5
days following final decision of such hearing, including 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; and the
person or agency responsible for the resident's placement, maintenance, and
care in the facility. The notice shall indicate that a copy has been
transmitted to the required parties by using the abbreviation
"cc:" and listing the names of all parties to whom copies were
sent. (II)
c. The notice required
by paragraph 63.11 (4)
"a" shall be provided at least 3 0 days
in advance of the proposed transfer or discharge unless one of the following
occurs: (II)
(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.
d. A hearing
requested pursuant to this subrule shall be held in accordance with subrule
63.11(6).
(5)
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 transfer or discharge. (II, III)
a. A copy of this notice must be placed in
the resident's file. The notice must 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: (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 the 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
receipt of your request by the department. 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; and the person or agency responsible for
the resident's placement, maintenance, and care in the facility. The notice
shall indicate that a copy has been transmitted to the required parties by
using the abbreviation "cc:" and listing the names of all
parties to whom copies were sent. (II)
c. A hearing requested pursuant to this
subrule shall be held in accordance with subrule 63.11(6).
(6)
Hearing.
a. Request for hearing.
(1) The resident must request a hearing
within 7 days of receiving 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 receipt of the request by the department unless the resident
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 10. The hearing shall be public unless
the resident or the 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 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 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. A representative
of 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 licensee,
resident, responsible party, and the office of the long-term care ombudsman
within 10 working days after the hearing has been
concluded.
(7)
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)
(8)
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 63.11(5) and emergency
notice is provided within 48 hours.
(9)
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 be offered counseling services
by the sending facility before the involuntary transfer and by the receiving
facility after the involuntary transfer. Counseling, if accepted, shall be
provided by a licensed mental health professional as defined in Iowa Code
section
228.1(6).
Counseling shall be documented in the resident's record. (II)
c. The counseling requirement in paragraph
63.11(9) "b" does not apply if the discharge has already
occurred pursuant to subrule 63.11(5) and emergency notice is provided within
48 hours.
d. The receiving health
care facility of a resident involuntarily transferred shall immediately
formulate and implement a plan of care which takes into account possible
adverse effects the transfer may cause. (II)
(10)
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 30
days must be allowed for an orderly transfer of residents to other
facilities.
(11)
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) Incompatibility with or disturbing to
other roommates.
(2) For the
welfare of the resident or other residents of the facility.
(3) To allow a new admission to the facility
that would otherwise not be possible due to separation of roommates by
sex.
(4) 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.
(5) 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
63.11(11)"a" (4). (II)
(2) As punishment or behavior modification,
except as specified in subparagraph 63.11 (11)"a" (1). (II)
(3) Discrimination on the basis of
race or religion. (II)
c. If intrafacility relocation is necessary
for reasons outlined in paragraph 63.11(11)"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, III)
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, III)
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)
