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Nursing Home Transfers and Discharges FAQ

42 CFR 483.15 Notice Requirements

Do we need to send all transfers and discharges to the notification email?

The facility-initiated transfers and discharges cover only facility initiated-discharges or transfers of long-term care residents. 

·         Per federal regulation, when an involuntary discharge notice is presented to the resident, the notice must be emailed, on the same day it is given to the resident, to the State Long-Term Care Ombudsman at lauren.owens@tn.gov

CLICK HERE to get the Involuntary Discharge Template that meets the Tennessee and Federal nursing home regulations and the TennCare regulations for Medicaid certified facilities.

Notices that are sent via mail or certified mail, do not meet the requirement for “at the time of issuance to the resident” and facilities will be expected to add 5 additional days to the notice for the resident to make up for time lost during the postal delivery. 

Do NOT fax the notice as HIPAA compliance and receipt by the intended party cannot be ensured.

·         Transfers to another facility are to be reported via email notification when a resident transfers to another facility permanently. All transfers to acute care facilities or for short-term stays will be reported on the monthly Emergency Transfer Log report.

·         Transfers home or to a CLS group home should be reported via the notification email. This email should include the residents name and the date he/she left the facility. No other information is required at this time.


How do I find the information for my local long-term care ombudsman?

CLICK HERE to access the contact information of the District Long-Term Care Ombudsmen, listed with the counties served.


How am I required to send the notice to the State Ombudsman?

Per Federal regulations, you must send notification to the State Long-Term Care Ombudsman. Please send all notices and reports to lauren.owens@tn.gov  on the same day that the notice is given to the resident to meet the “at the time of issuance” requirement.

Notices that are sent via mail or certified mail, do not meet the requirement for “at the time of issuance to the resident” and facilities will be expected to add additional days to the notice for the resident to make up for time lost during the postal delivery. 

Do NOT fax the notice as HIPPA compliance and receipt by the intended party cannot be ensured.

When sending notices to your local ombudsman per State regulations, you may send the notices via email, fax or post. If you have further questions about how to send notifications to a district ombudsman, please contact that person directly for further assistance.  CLICK HERE for the list of contact information.

Regulations:

The new requirement of participation rules and CMS guidance (S&C 17-27 NH May 12, 2017) state that all involuntary discharge and transfer notices (including 5 day Emergency discharges) must be sent to the Office of the State Ombudsman at the time of issuance to the resident to meet compliance.

1200-08-06-.05 (14): No involuntary transfer or discharge shall be made until the nursing home has first informed the department and the area long-term care ombudsman. Unless a disaster occurs on the premises or the attending physician orders the transfer as a medical emergency (due to the resident’s immediate need for a higher level of care) no involuntary transfer or discharge shall be made until five (5) business days after these agencies have been notified, unless they each earlier declare that they have no intention of intervening.


Can you explain emergency transfers to acute care facilities?

This monthly report should include all residents who are transferred out of the facility for care. This includes all emergency room visits, geri-psych stays or hospital stays. This does not include routine care (ex: dialysis) that is part of a resident's care plan. If you have any questions about what transfers should be documented, please call or email the State Long-Term Care Ombudsman or your local District Long-Term Care Ombudsman. CLICK HERE for the contact list.

Note: Do not document trips outside the facility that are not of an emergency nature (ex: church, shopping).

This log is due by the 20th of the month for the previous month’s transfers.


Where can I find the template for the monthly report?

CLICK HERE for the updated PDF version of the Emergency Transfer Log, required to be send to the State Long Term Care Ombudsman.  

CLICK HERE for the updated Word version of the Emergency Transfer Log, required to be send to the State Long Term Care Ombudsman.  


What is meant by the "Date of Notice to Resident" box on the monthly report?

When residents are transferred to the hospital or geriatric psychiatrist for a short-term stay, the resident should be given a transfer notice outlining the facility's bed-hold policy. This box is to document the day the notice was given to the resident.


Are all nursing homes required to send a written notice to a resident/ responsible party each time they are sent to an acute care facility, especially if the facility is expecting the resident to return once the acute episode is over?

What if the facility receives notice the ER does not plan on admitting a resident, does that change anything?

The Tennessee Long-Term Care Ombudsman program interprets the “notice of transfer” in this instance to be the notice and bed-hold policy that is provided to residents when they transfer to an acute care facility. For consistency, please give all residents notice of transfer and bed-hold policy. 

This answer is based on the language in the “Emergency Transfers to Acute Care Facilities” section:

CMS Guidance for 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). 


Is a notice required if a resident is being sent to an inpatient mental health facility if the resident is planning to return to the LTC facility at some point? 

Yes, per the regulations all residents should receive this notice. Please give all transferring residents the notice of transfer and bed-hold policy. Also, please make sure that these residents are documented on the “Emergency Transfer Document” that is due to the State Ombudsman by the 20th of the month. 


Should you have any questions or concerns not addressed in this FAQ section, please contact the State Long-Term Care Ombudsman or your local District Long-Term Care Ombudsman for clarification.  CLICK HERE for contact information.

You may also benefit from the June 2018 presentation on discharges and transfers (PDF format).

CLICK HERE to watch webinar on this topic.