Assuring Compliance with new Transfer and Discharge Rules

Bruce G. Baron, Esquire (

The USDHHS Office of Inspector General (OIG) is expected to issue its Work Plan Report (OEI-01-18-00250) later this year (2020) on the extent to which LTC Ombudsmen address involuntary transfers and discharges and the extent to which State Survey Agencies (e.g., Pennsylvania Department of Health) investigated and took enforcement actions against nursing home for inappropriate involuntary transfers or discharges.  Under the 2016 updates to the Conditions of Participation regulations for transfers and discharges, 42 CFR § 483.15(c-e), the LTC Ombudsman must receive a copy of the required notice (42 CFR § 483.15(c)(3)(i)).   

In Pennsylvania, the LTC Ombudsman has filed appeals with State Medicaid Agency (the Bureau of Hearings and Appeals of the Pennsylvania Department of Human Services pursuant to 55 Pa. Code Chapter 1181 Appendix N) on behalf of nursing facility residents pursuant to the current Conditions of Participation, including obtaining an order to Stay the Transfer/Discharge or Readmit the Resident. 

Nursing homes that are subject to the Conditions of Participation and any related State licensure regulations (e.g., 28 Pa. Code §   201.2, incorporating the 1998 version of the transfer and discharge rules) should update and monitor the application of their transfer and discharge policies and procedures to assure compliance with the current requirements, including the timing, content, notice and safe/orderly requirements, as well as advance notice to residents of their rights under the regulations, given the increased oversight by the OIG, the LTC Ombudsman, and the State Survey Agency.