New-Federal-Tag-F628

We're wrapping up our series on Admission, Transfer, and Discharge (ADT) requirements! We previously addressed the critical components of Admission Agreements under F620, ensuring they don't contain illegal third-party guarantees. With recent CMS updates designed to improve clarity and reduce citation overlap, we're focusing on the new F-Tags replacing F622-F626 and F660-F661. Today's post is the final installment, providing a compliance checklist for the new F628, covering the essential Transfer and Discharge Processes. Be sure to check out our previous post on F627, outlining what constitutes Inappropriate Transfers and Discharges. Let's dive in and make sure your facility is ready for April 28th when surveyors will begin using the revised regulations/guidance!

Compliance Check: CMS Federal Regulation F628 - Transfer and Discharge Requirements

This post is designed to help nursing home administrators understand and ensure compliance with CMS federal regulation F628, specifically §483.15(c)(2), (c)(3), (c)(4), (c)(5), (c)(6), (c)(8), §483.15(d), and §483.21(c)(2), which outline requirements related to resident transfer and discharge. This is crucial for maintaining resident rights, ensuring smooth transitions, and avoiding potential regulatory penalties.

Key Requirements of F628

📑 This regulation covers several aspects of resident transfer and discharge, encompassing both procedural and informational requirements. Key areas of focus are:

📝 1. Documentation (§483.15(c)(2)):

📤 Comprehensive Record Keeping: The facility MUST document every transfer or discharge in the resident's medical record.

🗂️ Information Transfer to Receiving Provider: Essential information MUST be communicated to the receiving healthcare institution or provider. This includes different requirements based on if the resident is being transferred (expected to return) or discharged (not expected to return). This information is crucial for continuity of care and resident safety.

#Transfer:

-Contact information of the practitioner responsible for the care of the resident

-Resident representative information, including contact information

-Advance directive information

-All special instructions and/or precautions for ongoing care, as appropriate such as:

1. Treatments and devices (oxygen, implants, IVs, tubes/catheters)

2. Transmission-based precautions such as contact, droplet, or airborne;

3. Special risks such as risk for falls, elopement, bleeding, or pressure injury and/or aspiration precautions;

-The resident’s comprehensive care plan goals

-All other information necessary to meet the resident’s needs, which includes, but may not be limited to:

1. Resident status, including baseline and current mental, behavioral, and functional status, reason for transfer, recent vital signs

2. Diagnoses and allergies

3. Medications (including when last received)

4. Most recent relevant labs, other diagnostic tests, and recent immunizations.

-Additional information, if any, outlined in the transfer agreement with the acute care provider.

#Discharge:

-Includes all information required for transfers, plus a copy of the resident’s discharge summary, consistent with §483.21(c)(2), as applicable, to ensure a safe and effective transition of care.

✉️ 2. Notice Requirements (§483.15(c)(3), (c)(4), (c)(5), (c)(6), (c)(8)):

🙋 Notification to Resident and Representative: Before a transfer or discharge, the resident and their representative(s) MUST be notified in writing, in a language and manner they understand.

🗣️ Ombudsman Notification: A copy of the transfer/discharge notice MUST be sent to the Office of the State Long-Term Care Ombudsman.

📑 Content of Notice: The written notice must include specific information:

*Reason for transfer/discharge (specifying the basis under §§483.15(c)(1)(i)(A)-(F)).

*Effective date of the transfer/discharge.

*Location to which the resident is transferred/discharged.

*A statement of the resident’s appeal rights:

-Name, address (mailing and email), and telephone number of the entity which receives such requests.

-Information on how to obtain an appeal form.

-Information on how to obtain assistance in completing the form and submitting the appeal hearing request.

-Name, address (mailing and email), and telephone number of the Office of the State Long-Term Care Ombudsman.

*For residents with intellectual and developmental disabilities or mental disorders, the mailing and email address and telephone number of the relevant protection and advocacy agency.

⏱️ Timing of Notice: Generally, a 30-day notice is required. Exceptions exist for situations where a shorter notice is permissible:

-Safety of individuals in the facility is endangered.

-Health of individuals in the facility is endangered.

-Resident's health improves sufficiently for more immediate transfer/discharge.

-Immediate transfer/discharge is required due to urgent medical needs.

-Resident has not resided in the facility for 30 days.

🔄 Updated Notices: If information changes prior to the transfer/discharge, the facility MUST update the recipients of the notice as soon as practicable. Significant changes, like a change in destination, warrant a new notice.

🏢 Facility Closure: In cases of facility closure, the administrator must provide written notification prior to the closure to the State Survey Agency, the Office of the State Long-Term Care Ombudsman, residents, and their representatives. This notification must also include the plan for the transfer and adequate relocation of the residents, as required at § 483.70(l).

🛏️ 3. Bed-Hold Policy Notices (§483.15(d)):

📝 Notice Before Transfer: Before transferring a resident to a hospital or therapeutic leave, the facility must provide written information regarding:

*The duration of the state bed-hold policy, if any.

*The reserve bed payment policy in the state plan, if any.

*The facility’s policies regarding bed-hold periods, which must be consistent with paragraph (e)(1) of this section. Specifically, this must include information about the resident’s right to return to their previous room if available during the bed-hold period, or to the first available semi-private room if the bed-hold period has expired, provided they still require the facility's services and are eligible for Medicare/Medicaid. Furthermore, this must also include information on the facility policies must provide that if the facility determines that a resident cannot return, the facility must comply with the requirements at 42 CFR 483.15(c).

🕒 Bed-Hold Notice Upon Transfer: At the time of transfer, the resident and representative must receive written notice specifying the duration of the bed-hold policy.

🏥 4. Discharge Summary (§483.21(c)(2)):

📑 When the facility anticipates discharge, a resident MUST have a discharge summary that includes the following:

*A recapitulation of the resident's stay that includes, but is not limited to, diagnoses, course of illness/treatment or therapy, and pertinent lab, radiology, and consultation results.

*A final summary of the resident's status to include items in paragraph (b)(1) of §483.20, at the time of the discharge that is available for release to authorized persons and agencies, with the consent of the resident or resident’s representative.

*Reconciliation of all pre-discharge medications with the resident’s post-discharge medications (both prescribed and over-the-counter).

✅ The discharge summary MUST be provided at the time of discharge to the receiving provider (or to the resident, with consent, in cases of discharge to home).

➡️ The medical record MUST document to whom the discharge summary was provided.

Compliance Probes for the Administrator

🔍 To ensure your facility is compliant with F628, use the following probes to evaluate your current practices. Answer yes or no to each question. A "no" answer indicates a potential area for improvement.

🗂️ Documentation and Information Transfer:

☐ Do we have a standardized transfer/discharge documentation form that includes ALL required information listed in §483.15(c)(2)?

☐ Do we have a policy in place for completing and transmitting transfer/discharge information to the receiving provider as close as possible to the time of transfer or discharge?

☐ Do we have a system to verify that the receiving provider has received the required information, and is it documented?

☐ Is the resident’s medical record clearly documented with the reason for the transfer/discharge and the specific basis under §§483.15(c)(1)(i)(A)-(F)?

☐ Is there a procedure to ensure all pending lab results are communicated with the transfer documentation?

☐ Do we have a written agreement that outlines transfer processes that meets the additional requirements of §483.70(j) in place with the acute care provider(s) used by the residents?

✉️ Notice Requirements:

☐ Do we have a standardized "Notice of Transfer/Discharge" form that includes ALL required elements under §483.15(c)(5), including appeal rights, Ombudsman contact information, and advocacy agency information (if applicable)?

☐ Do we have a process for providing notices in a language and manner the resident and representative understand?

☐ Do we maintain documentation verifying that the notice was provided to the resident and representative?

☐ Do we have a system in place to generate and send a copy of the transfer/discharge notice to the State Long-Term Care Ombudsman concurrently with providing the notice to the resident and representative? Is the confirmation of sending documented?

☐ Is there a tracking system to ensure the timely delivery of 30-day notices, or, in cases where exceptions apply, notice is provided "as soon as practicable?"

☐ Do we have a procedure for documenting the specific circumstances justifying a shortened notice period (if applicable)?

☐ Is there a process for updating the notice and recipients whenever information changes prior to the transfer/discharge, documenting the update?

☐ If the facility is closing, are we familiar with §483.70(l) and do we have a plan in place to notify all parties (State Survey Agency, Ombudsman, residents, and representatives) and ensure resident relocation?

🛏️ Bed-Hold Policy Notices:

☐ Do we have a written bed-hold policy, consistent with state law, that is readily available to residents and representatives?

☐ Is information about the bed-hold policy included in the admission packet?

☐ Do we have a standardized form for providing written notice of bed-hold policies prior to transfer for hospitalization or therapeutic leave, including all required information per §483.15(d)(1), specifically including:

-The duration of the state bed-hold policy (if any)?

-The reserve bed payment policy in the state plan (if any)?

-Information about the resident’s right to return to their previous room if available during the bed-hold period, or to the first available semi-private room if the bed-hold period has expired, provided they still require the facility's services and are eligible for Medicare/Medicaid?

-That if the facility determines that a resident cannot return, the facility must comply with the requirements at 42 CFR 483.15(c)?

☐ Do we provide a second written notice specifying the duration of the bed-hold policy at the time of transfer?

☐ Do we document the provision of both bed-hold notices in the resident's medical record?

🏥 Discharge Summary:

☐ Do we have a policy for completing a discharge summary for ALL residents anticipated to be discharged?

☐ Does the discharge summary template include ALL required elements as outlined in §483.21(c)(2)?

☐ Is the discharge summary provided to the receiving provider at the time of discharge, with documentation of to whom it was provided and the manner in which it was delivered (hard copy or electronic)?

☐ Is a medication reconciliation performed and documented in the discharge summary, resolving any discrepancies between pre-discharge and post-discharge medications?

☐ If a resident is being discharged to home and has no primary care physician, are we documenting our efforts to assist the resident in locating a continuing care provider?

📊 General Oversight:

☐ Are all relevant staff members (nursing, social services, admissions) adequately trained on F628 requirements and facility policies related to transfer/discharge?

☐ Is there a system for regularly auditing transfer/discharge documentation to ensure compliance?

☐ Do we have a system for tracking and responding to resident appeals of transfer/discharge decisions?

💡 By diligently reviewing these probes and addressing any identified gaps, administrators can significantly improve their facility's compliance with F628, ensuring resident rights are protected and transitions are as smooth and safe as possible. Remember to consult with legal counsel and state-specific guidance to ensure full compliance.

#TheAdministratorsDilemma #LNHA #NursingHomeAdmin #LTC #SNF #SkilledNursing #NursingHome #Regulations #Operations #RiskManagement #Compliance #F628 #SocialServices #SSD #ResidentRights #ADT #Discharges #Transfers