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CMS ROs reviewing facility-initiated discharges

Late in December, the Centers for Medicare & Medicaid Services (CMS) issued a S&C memo announcing an initiative to address facility-initiated discharges that violate federal regulations. The Agency is review State Agency’s (SA) practices for discharge complaints, which are one of the most frequent complaints made to State LTC Ombudsman Programs across the country.

Due to the volume of complaints of this nature, CMS conducted a review of federal deficiencies for discharges, and found that there are varying reasons for non-compliant discharges. Some discharges are driven by changes to payment source, but the most frequently reported discharge reason relates to residents that are discharged due to “behavioral, mental, and/or emotional expressions or indications of resident distress.” This includes facilities discharging residents while they are hospitalized related to these behaviors as the basis for discharge. To address this, SAs now must transfer any cases that involve facility-initiated discharges to the CMS Regional Office (RO) for review. These discharge violations include:

  • Placement in a questionable/unsafe setting
  • Where a resident remains hospitalized
  • Where there is a pattern of discharge violations in the facility
  • Any other circumstance where the RO identifies cases that it would like transferred

Once the RO has conducted a review, it may take enforcement actions if appropriate. Reviewing the SA practices will result in CMS developing examples of appropriate/inappropriate discharges for surveyors to reference, identify best practices for nursing homes, develop training, and provide a means to evaluate enforcement options for violations of this type.

Read the December 22, 2017 CMS S&C memo, “An Initiative to Address Facility Initiated Discharges that Violate Federal Regulations” (Ref: S&C 18-08-NH). The memo provides information on the circumstances under which a resident may be discharged by the facility as well as a list of discharge-related Ftags.

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