Harmony Healthcare Blog

Intent to Transfer and Discharge Letter

Posted by The Harmony Team on Tue, Sep 18, 2018


Edited by Kris Mastrangelo

C.A.R.E.

Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency


Facility Initiated, Emergency and Resident Initiated
483.15(c) Transfer and Discharge (F622) 

Portrait of happy female patient showing thumbs up sign while standing with doctor in clinicThe regulatory and survey landscape continues to emphasize the importance of person-centered care and efficient resident transitions from one setting to another.  Communication and resident awareness are critical components vital to success. SNF Providers must implement systems that include proper notification to residents and representatives when a resident is transferred or discharged from the facility.  

Communication is designed to provide each resident with notice of a room changes, transfers and discharges. 

The Intent Transfer or Discharge Letter provides: 

  • Situations and reasons for a facility transfer or discharge of a resident.
  • Notification of the right to appeal.
  • Agencies to copy the letter, including the State LTC Ombudsman. 

The intent to discharge notice is provided to all residents, regardless if the transfer or discharge t is facility initiated, emergency transfer or resident initiated.  

Discharge Letter

The regulation at 42 CFR 483.15(c)(3)(i) requires, in part, that the notification occurs before a facility transfers or discharges a resident.   

The facility must: 

  1. Notify the Resident and the resident’s representative(s) of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand…. 
  2. Send a Copy of the notice to a representative of the Office of the State Long-Term Care Ombudsman.” Sending a copy of the notice to a representative of the Office of the State Long-Term Care (LTC) Ombudsman provides added protection to residents and ensures the Office of the State LTC Ombudsman is aware of facility practices and activities related to transfers and discharges. 

Specific requirements for transfers and discharges are outlined below: 

Facility-Initiated Transfers and Discharges 

A Facility Initiated transfer or discharge requires involvement of the Ombudsman and a 30-Day Transfer Notice Rule.  If the resident is sent to the acute care setting, the SNF Provider must complete the form to the resident/representative. 

In situations where the facility has decided to discharge the resident while the resident is still hospitalized, the facility must send a notice of discharge to the resident and resident representative and must also send a copy of the discharge notice to a representative of the Office of the State LTC Ombudsman. 

Notice to the Office of the State LTC Ombudsman must occur at the same time the notice of discharge is provided to the resident and resident representative, even though, at the time of initial emergency transfer, sending a copy of the transfer notice to the ombudsman only needed to occur as soon as practicable as described below. 

For any other types of facility-initiated discharges, the facility must provide notice of discharge to the resident and resident representative along with a copy of the notice to the Office of the State LTC Ombudsman at least 30 days prior to the discharge or as soon as possible. 

The copy of the notice to the ombudsman must be sent at the same time notice is provided to the resident and resident representative. 

Emergency Transfers 

When a resident is temporarily transferred on an emergency basis to an acute care facility, notice of the transfer may be provided to the resident and resident representative as soon as practicable, according to 42 CFR 483.15(c)(4)(ii)(D). 

Copies of notices for emergency transfers must also still be sent to the ombudsman, but they may be sent when practicable, such as in a list of residents on a monthly time frame. 

Resident-Initiated Transfers and Discharges 

A resident-initiated transfer or discharge means the resident or, if appropriate, the resident/representative has provided verbal or written notice of intent to leave the facility. 

The medical record must contain documentation or evidence of the resident’s or resident representative’s verbal or written notice of intent to leave the facility. 

A resident’s expression of a general desire or goal to return home or to the community or elopement of a resident who is cognitively impaired should not be taken as notice of intent to leave the facility. 

For resident-initiated transfers or discharges, sending a copy of the notice to the ombudsman is not required. 

Summary Grid Transfers and Discharges 

Transfers and Discharges

Notify
Resident/Representative

Send Copy to Ombudsman

Facility Initiated

At least 30 days prior to the discharge or as soon as possible.

Required at same time the notice of discharge is provided to the resident and resident representative

Emergency

As soon as practicable.

Required and sent as soon as practicable. Typically, send a monthly list.

Resident Initiated

The resident or representative provides written or verbal notice to the facility.

Not Required

 

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Tags: Transfers and Discharges

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