Current through Register Vol. 51, No. 19, September 20, 2024
A. In addition to the provisions of
Regulation .10 of this chapter, a facility may not involuntarily discharge or
transfer a resident unless, within 48 hours before the discharge or transfer,
the facility has:
(1) Provided or obtained:
(a) A comprehensive medical assessment and
evaluation of the resident, including a physical examination, that is
documented in the resident's medical record,
(b) A post-discharge plan of care for the
resident that is developed, if possible, with the participation of the
resident's representative, and
(c)
Written documentation from the resident's attending physician indicating that
the transfer or discharge is in accordance with the post-discharge plan of care
and is not contraindicated by the resident's medical condition; and
(2) Provided information to the
resident concerning the resident's rights to make decisions concerning health
care, including the right to:
(a) Accept or
refuse medical treatment,
(b) Make
an advance directive, including the right to make a living will and the right
to appoint an agent to make health care decisions, and
(c) Revoke an advance directive.
B. With the exception
of residents of a certified continuing care facility as set forth in §D of
this regulation, at the time of transfer or discharge, the facility shall
provide the resident and, when appropriate, the representative or interested
family member with:
(1) A written statement of
the medical assessment and evaluation and post-discharge plan of care required
under §A of this regulation;
(2) A written statement itemizing the
medications currently being taken by the resident;
(3) To the extent permitted under federal and
State law, at least a 3-day supply of the medications currently being taken by
the resident;
(4) Information
necessary to assist the resident or the resident's representative in obtaining
additional prescriptions for necessary medication through consultation with the
resident's attending physician; and
(5) A written statement containing the date,
time, method, mode, and destination of the resident's discharge.
C. A facility may not discharge or
transfer a resident:
(1) Unless the resident
or appropriate representative consented in writing to the discharge or
transfer; or
(2) Except when the
discharge or transfer:
(a) Is in accordance
with a post-discharge plan of care developed under §A of this
regulation;
(b) Is to a safe and
secure environment where the resident will be under the care of a:
(i) Licensed, certified, or registered care
provider, or
(ii) Person who has
agreed in writing to provide a safe and secure environment.
D. A
continuing care facility certified under Article 70B, Annotated Code of
Maryland, is not subject to §B of this regulation if the:
(1) Facility transfers a resident to a lesser
level of care within the same facility in accordance with a contract between
the facility and the resident; and
(2) Transfer is approved by the resident's
attending physician.
E.
If the requirements of A-----D of this regulation have been met, the resident's
representative, in conjunction with the facility, shall cooperate and assist in
the resident's discharge planning, including:
(1) Contacting, cooperating with, and
assisting other health care facilities considering admitting the resident;
and
(2) Cooperating with government
agencies, including applying for Medical Assistance for the resident.
F. If requested by a person during
the process of transferring or discharging a resident, or on its own
initiative, the Office of the Attorney General may investigate whether an abuse
of a resident's funds contributed to the decision to transfer or discharge the
resident, and may make appropriate referrals of the matter to other government
agencies.
G. The Secretary may
impose a civil money penalty not to exceed $10,000 for each:
(1) Violation by a facility of its
obligations under this regulation and Regulation .10 of this chapter;
or
(2) Willfully or grossly
negligent violation by a resident's representative of the representative's
obligations under this regulation and Regulation .10 of this chapter.
H. If a civil money penalty is
imposed under §G of this regulation, the facility or representative has
the right to request a hearing on the proposed civil money penalty in
accordance with State Government Article, Title 10, Subtitle 2, Annotated Code
of Maryland, and COMAR 10.01.04.
I.
A resident, resident's representative, resident's attorney, or the Attorney
General, on behalf of a resident who believes that an involuntary discharge or
transfer that violates this regulation is imminent or has taken place, may
request appropriate injunctive relief from the appropriate circuit
court.
