This week on the CMSCG Blog “Ftag of the Week” series, we will be reviewing additional information about F623 Notice Requirements Before Transfer or Discharge. In Part 1, we looked at some key definitions and reviewed what constitutes a resident-initiated discharge. Now, we will look at what the Centers for Medicare & Medicaid Services (CMS) requires providers to do ahead of a transfer or discharge.
Facility-Initiated Discharges
Facilities are required to provide notification to the resident and resident representative in a language and manner that they can understand before a resident can be transferred or discharged. The notification must include the reasons for this occurring and a copy of the notice must be sent to the State LTC Ombudsman as well. This information must be documented in the resident record.
Facility-Initiated Discharges – Notice Contents
Facilities are required to provide certain specific information in a timely manner to the resident and the resident representative before they can transfer or discharge a resident. At the time the notice is provided, all of the following must be included in the notice:
- Specific reason for transfer/discharge
- Effective date of the transfer/discharge
- Specific location to which the resident is transferred or discharged, including location name or description or address
- Explanation of right to appeal to the State
- Information on how to obtain an appeal form
- Information on how to obtain assistance with completion and submission of an appeal hearing request
- Contact information for the State entity where requests for appeals can be sent, including mailing address, email address and phone number
- Contact information for the representative of the Office of the State Long-Term Care Ombudsman, including name, mailing address, email address and phone number
- If the resident has an intellectual or developmental disability or related disability, the contact information of the State agency responsible for protection and advocacy, including name, mailing address, email address and phone number
It is important to note that if the information initially issued in the notice changes, the facility is required to update anyone who received the notice, as soon as possible, with the updated information. This provides the resident/representative with the ability to respond appropriately. If the change is a significant change, then an entirely new notice must be issued which describes the updated information. In this case, the transfer or discharge date is “reset” to provide a 30-day advance notice. The Interpretive Guidance (IG) gives the example of a change to the initially expected location as a “significant” change to the notice.
Facility-Initiated Discharges – Timing
The general requirement for issuing the notice is that it must be provided at least 30 days prior to the transfer or discharge.
There are exceptions to the 30-day notice requirement, and these exceptions are applicable when a resident’s transfer or discharge is affected due to certain circumstances. These circumstances include:
- If the health and/or safety of others in the facility would be endangered due to the resident’s clinical or behavioral status
- If the resident’s health improves sufficiently to allow for a quicker than anticipated transfer or discharge
- If the resident’s urgent medical needs require an immediate transfer or discharge
- If the resident has not resided in the facility for 30 days yet
If a facility-initiated transfer or discharge meets one of the above circumstances, the provider is required to give the resident, resident representative (if appropriate) and State LTC Ombudsman the notice as soon as practicable before the transfer or discharge.
Discharge Critical Element Pathway
In lieu of some actual survey citations, CMSCG is advising its clients to review the updated CMS-20132 Discharge Critical Element Pathway dated 10/2022. Surveyors are instructed to ask facility staff whether a discharge was facility-initiated or resident-initiated. The updated CE Pathway then guides surveyors through two different scenarios for resident/representative interviews, staff interviews and record reviews.
If the facility initiated the discharge, surveyors are asked to determine whether the resident/rep and ombudsman were notified of the discharge in writing, in a manner that they could understand and at least 30 days in advance of the discharge (or as soon as practicable if the discharge met one of the exceptions above). If the notice requirements and contents were not provided per requirements, then the facility would likely be cited under F623.
