Current through Register Vol. 47, No. 6, September 18, 2024
Procedures for the discharge or transfer of the resident
shall be established and followed. (II, III)
(1)
Discharge plan. The
decision to discharge a person and the plan for doing so shall be established
through the participation of the resident, members of the interdisciplinary
team and other resource personnel as appropriate for the welfare of the
individual. (II, III)
a. Discharge planning
shall begin within 30 days of admission and be carried out in accordance with
the IPP. (II, III)
b. As changes
occur in a resident's physical or mental condition necessitating services or
care which cannot be adequately provided by the facility, the resident shall be
transferred promptly to another appropriate facility pursuant to subrule
65.10(1). (II, III)
c. Notification
shall be made to the next of kin, legal representative, attending physician,
and sponsoring agency, if any, prior to transfer or discharge of any resident.
(Ill)
d. Proper arrangements shall
be made for the welfare of the resident prior to the transfer or discharge in
the event of an emergency or inability to reach the next of kin or legal
representative. (Ill)
e. The
licensee shall not refuse to discharge or transfer a resident when directed by
the physician, resident, legal representative, or court. (II, III)
f. Advanced notification by telephone shall
be made to the receiving facility prior to the transfer of any resident.
(Ill)
g. When a resident is
transferred or discharged, the current evaluation and treatment plan and
progress notes for the last 30 days, as set forth in these rules, shall
accompany the resident. (II, III)
h. Prior to the transfer or discharge of a
resident to another health care facility, arrangements to provide for
continuity of care shall be made with the facility to which the resident is
being sent. (II, III)
i. A
discharge or transfer authorization and summary shall be prepared for each
resident who has been discharged or transferred from the facility. It shall be
disseminated to appropriate persons to ensure continuity of care and in
accordance with the requirements to ensure confidentiality. (II, III)
j. 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)
(2)
Intrafacility transfer.
Residents shall not be arbitrarily moved from room to room within a health care
facility. (II, III)
a. Involuntary relocation
may occur only to implement goals and objectives in the IPP and in the
following situations:
(1) Incompatibility
with or behavior disturbing to roommates, as documented in the residents'
records; (I, II)
(2) To allow a new
admission to the facility which would otherwise not be possible due to
separation of roommates by sex; (II, III)
(3) Reasonable and necessary administrative
decisions regarding the use and functioning of the building. (II,
III)
b. Unreasonable and
unjustified reasons for changing a resident's room without the concurrence of
the resident or legal guardian include:
(1)
Punishment or behavior modification; (II) and
(2) Discrimination on the basis of race or
religion. (II, III)
c.
If intrafacility relocation is necessary for reasons outlined in
paragraph"a, " the resident shall be notified at least 48
hours prior to the transfer and the reason shall be explained. The legal
guardian shall be notified as soon as possible. The notification shall be
documented in the resident's record and signed by the resident or legal
guardian within seven days unless documentation indicates that it was not
possible to contact the legal guardian or obtain their signature. (II,
III)
d. If emergency relocation is
required 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 and legal guardian shall be notified
immediately, or as soon as possible, of the condition requiring emergency
relocation, and the 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)
(3)
Involuntary discharge or transfer
permitted. A facility may involuntarily discharge or transfer a
resident for only one of the following reasons:
a. Medical reasons, based on the resident's
needs and determined and documented in the resident's record by the primary
care provider;
b. The resident's
social, emotional or physical well-being or that of other residents, as
documented by the administrator or designee with specific information to
support the determination that the resident's continued presence in the
facility would adversely affect the resident's own well-being or that of other
residents;
c. Due to action
pursuant to Iowa Code chapter 229; or
d. Nonpayment for the resident's stay, as
described in the admission agreement for the resident's stay. (I, II,
III)
(4)
Involuntary transfer or discharge -written
notice. Involuntary transfer or discharge of a resident from a
facility shall be preceded by a written notice to the resident or the
resident's legal representative. (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:
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. In emergency circumstances, provision may be made for extension of
the 14-day requirement upon request to the department designee. If you lose the
hearing, you will not be transferred before the expiration date of either (1)
30 days following your receipt of the original notice of the discharge or
transfer, or (2) no sooner than 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 you may write to the department to the attention of:
Administrator, Division of Health Facilities, Iowa Department of Inspections
and Appeals, Lucas State Office Building, Des Moines, Iowa 50319. (II)
b. The notice shall be
personally delivered to the resident, and a copy shall be placed in the
resident's record. A copy shall also be transmitted to the department, the
resident's legal representative, 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 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. (II)
c. The notice required by paragraph
65.16(4)
"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. (II)
(2) The transfer or discharge is subsequently
agreed to by the resident or the resident's legal representative, and
notification is given to the legal representative, the resident's primary care
provider, and the person or agency responsible for the resident's placement,
maintenance, and care in the facility. (II)
d. A hearing requested pursuant to this
subrule shall be held in accordance with subrule 65.16(6).
(5)
Involuntary transfer or
discharge -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 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:
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. (II)
b. The notice shall be personally
delivered to the resident, and a copy shall be placed in the resident's record.
A copy shall also be transmitted to the department, the resident's legal
representative, 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 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 65.16(6).
(6)
Involuntary transfer or
discharge -hearing.
a. Request for hearing.
(1) The resident must request a hearing
within 7 days of receiving 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 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 and the resident's legal
representative not later than five full business days after the department's
receipt of the request. The notice shall also inform the facility and the
resident or the resident's legal representative 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.
f. The administrative law judge's written
decision shall be sent by certified mail to the facility, resident, and
resident's legal representative 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
legal representative, 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 65.16(6) and emergency
notice is provided within 48 hours.
(9)
Involuntary discharge or
transfer -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 65.16(9) "b" does not apply if the discharge has
already occurred pursuant to subrule 65.16(5) 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)
(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.
This rule is intended to implement Iowa Code section
135C.14(8).
