Sec. 10.07.09.10. Resident Transfers and Discharges

A. A nursing facility may not involuntarily transfer or discharge a resident from the nursing facility unless the:

(1) Transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the nursing facility;

(2) Transfer or discharge is appropriate because the resident's health has improved sufficiently so that the resident no longer needs the health care or services provided by the nursing facility;

(3) Resident's presence endangers the health or safety of other individuals in the nursing facility;

(4) Resident has failed, after reasonable and appropriate notice, to pay, or to have paid under third-party payers, for a stay at the nursing facility; or

(5) Nursing facility ceases to operate or, in the case of a resident who receives Medicare or Medicaid services, when the nursing facility has been decertified or has withdrawn from the Medicare or Medicaid Program.

B. A resident has a right to request a hearing on the proposed transfer or discharge, except when the transfer or discharge is being taken pursuant to §A(5) of this regulation.

C. Notice.

(1) Transfer and Discharge. Except in emergency situations such as a hospitalization, or if the resident has not resided in the facility for 30 days, the nursing facility shall notify the resident, representative, or interested family member, the State Long-Term Care Ombudsman, and the Department at least:

(a) 30 days before any proposed transfer or discharge if the nursing facility is not part of a continuing care retirement community as defined in Article 70B, Annotated Code of Maryland; or

(b) 60 days before any proposed transfer or discharge if the nursing facility is part of a continuing care retirement community.

(2) Emergency Transfers, Discharges, and Relocations. In an emergency situation, a nursing facility shall notify the resident, representative, or interested family member of a transfer as soon as possible.

D. Contents of Notice. The required notice to a resident under this regulation shall be on a form developed by the Department and shall include:

(1) Each reason for the proposed transfer or discharge;

(2) A statement that the resident has the right to request a hearing on a proposed transfer or discharge, and how to request a hearing pursuant to Regulation .13 of this chapter, except in the case of a discharge made pursuant to §A(5) of this regulation;

(3) The name, address, and telephone number of the State's Office on Aging and local office on aging long-term care ombudsman;

(4) The right of a resident to consult with any lawyer the resident chooses;

(5) The name, address, and telephone number of the Legal Aid Bureau, The Older American Act Senior Legal Assistance Programs, and other agencies that may provide assistance to individuals who need legal counsel;

(6) For nursing facility residents with developmental disabilities, the mailing address and telephone number of the agency responsible for the protection and advocacy of developmentally disabled individuals;

(7) For nursing facility residents who are mentally ill, the mailing address and telephone number of the agency responsible for the protection and advocacy of mentally ill individuals;

(8) The effective date of the proposed transfer or discharge which, except as set forth in §C of this regulation, is at least 30 days after receiving the notice and at least 60 days after receipt of the notice if the nursing facility is part of a continuing care retirement center; and

(9) The resident's rights concerning discharge, as set forth in Regulation .11 of this chapter.

E. Documentation.

(1) In the event of a discharge or transfer of a resident, a nursing facility shall ensure that the following appears in the resident record:

(a) The circumstances surrounding the discharge or transfer, including interventions initiated by the facility before proposing the discharge;

(b) The notice described in §§C and D of this regulation; and

(c) If applicable, any express consent given by the resident or, when applicable, the resident's representative.

(2) When a resident is transferred or discharged pursuant to §A(1) and (2) of this regulation, the resident's physician shall document in the resident's clinical records the reason or reasons why the transfer or discharge is necessary.

(3) When a resident is transferred or discharged pursuant to §A(3) of this regulation, a physician shall document in the resident's clinical records the reason or reasons why the transfer or discharge is necessary.