Section 300.3300 Transfer or Discharge

Section 300

TITLE 77: PUBLIC HEALTH

CHAPTER I: DEPARTMENT OF PUBLIC HEALTH

SUBCHAPTER d: LONG-TERM CARE FACILITIES

PART 300 SKILLED NURSING AND INTERMEDIATE CARE FACILITIES CODE

SECTION 300.3300 TRANSFER OR DISCHARGE

Section 300.3300  Transfer or

Discharge

a)

A resident shall not be transferred or discharged in

violation of

the

Act.  A resident may be discharged from a facility

after

the resident

gives the administrator, a physician, or a nurse of

the facility written notice of

their

desire to be discharged.  If a

guardian has been appointed for a resident or if the resident is a minor, the

resident shall be discharged upon written consent of

their

guardian or

if the resident is a minor,

their

parent unless there is a court order

to the contrary.  In such cases, upon the resident's discharge, the facility is

relieved from any responsibility for the resident's care, safety or well-being.

A resident has the right to not be unlawfully transferred or discharged.

(Section

2-111 of the Act)

b)         Each resident's rights regarding involuntary transfer or

discharge from a facility shall be as described in subsections (c) through (y)

of this Section.

c)         Reasons for Transfer or Discharge

1)

A facility may involuntarily transfer or discharge a

resident only for one or more of the following reasons

:

A)

The facility is unable to meet the medical needs of the

resident, as documented in the resident's clinical record by the resident's

physicians;

B)

For the resident's physical safety;

C)

For the physical safety of other residents, the facility

staff or facility visitors; or

D)

For either late payment or nonpayment for the resident's

stay, except as prohibited by Titles XVIII and XIX of the federal Social

Security Act.  For purposes of this Section, "late payment" means

non-receipt of payment after submission of a bill.  If payment is not received

within 45 days after submission of a bill, a facility may send a notice to the

resident and responsible party requesting payment within 30 days

or nonpayment for the resident's

stay, except as prohibited by Titles XVIII and XIX of the federal Social

Security Act.  For purposes of this Section, "late payment" means

non-receipt of payment after submission of a bill.  If payment is not received

within 45 days after submission of a bill, a facility may send a notice to the

resident and responsible party requesting payment within 30 days.  If payment

is not received within such 30 days, the facility may thereupon institute

transfer or discharge proceedings by sending a notice of transfer or discharge

to the resident and responsible party by registered or certified mail.  The

notice shall state, in addition to the requirements of Section 3-403 of

the

Act

and subsection (e) of this Section,

that the responsible party has

the right to pay the amount of the bill in full up to the date the transfer or

discharge is to be made and then the resident shall have the right to remain in

the facility.  Such payment shall terminate the transfer or discharge

proceedings.

This subsection (c)

does not apply to those residents whose

care is provided under the Illinois Public Aid Code

.

2)

In the absence of other bases for transfer or discharge in

subsection

(c)(1),

unless

the facility

has complied with the prior notice and

other procedural requirements of

the

Act, a facility may not refuse to

readmit a resident following a medical leave of absence if the resident's need

for care does not exceed the provisions of the facility's license or current

services offered.

(Section 3-401 of the Act)

3)         Prohibition of Discrimination

A)

A facility participating in the Medical Assistance Program

is prohibited from failing or refusing to retain as a resident any person

because

the resident

is a recipient of or an applicant for the Medical

Assistance Program

s need

for care does not exceed the provisions of the facility's license or current

services offered.

(Section 3-401 of the Act)

3)         Prohibition of Discrimination

A)

A facility participating in the Medical Assistance Program

is prohibited from failing or refusing to retain as a resident any person

because

the resident

is a recipient of or an applicant for the Medical

Assistance Program.

(Section 3-401.1(a) of the Act)

For the purposes of

Section 3-401.1 of the Act

, a recipient or applicant shall be considered

a resident in the facility during any hospital stay totaling 10 days or less

following a hospital admission.

(Section 3-401.1(a-10) of the Act) The day

on which a resident is discharged from the facility and admitted to the

hospital shall be considered the first day of the 10-day period.

B)

A facility of which only a distinct part is certified to

participate in the Medical Assistance Program may refuse to retain as a

resident any person who resides in a part of the facility that does not

participate in the Medical Assistance Program and who is unable to pay for

the

person's

own

care in the facility without Medical Assistance only if:

i)

The facility, no later than at the time of admission and

at the time of the resident's

contract renewal, explains to the resident

(unless

the

resident is

incompetent), and to the resident's

representative, and to the person making payment on behalf of the resident for

the resident's stay, in writing, that the facility may discharge the resident

if the resident is no longer able to pay for

the resident's

care in the

facility without Medical Assistance;

ii)

The resident (unless

the resident is

incompetent),

the resident's representative, and the person making payment on behalf of the

resident for the resident's stay acknowledge in writing that they have received

the written explanation;

iii)

In circumstances where the Medicare coverage is ending prior

to the full 100-day benefit period, the facility provides notice to the

resident and to the resi

he resident (unless

the resident is

incompetent),

the resident's representative, and the person making payment on behalf of the

resident for the resident's stay acknowledge in writing that they have received

the written explanation;

iii)

In circumstances where the Medicare coverage is ending prior

to the full 100-day benefit period, the facility provides notice to the

resident and to the resident's representative that the resident's Medicare

coverage will likely end in 5 days.  This notification shall specify that the

resident shall not be required to move under

this Section

until these 5

days are up.  In cases where the facility is notified in a shorter time frame

than 5 days by a managed care organization or the time frame is shorter than 5

days due to inaccurate reporting by an outside entity, the facility

shall

provide

a minimum of 2 days' notification.

(Section 3-401.1 (a-5) of the Act)

C)

A facility which violates

subsection (c)(2)(A) or (B) of

this Section

shall be guilty of a business offense and fined not less than

$500 nor more than $1,000 for the first offense and not less than $1,000 nor

more than $5,000 for each subsequent offense.

(Section 3-401.1(b) of the

Act)

d)

Involuntary transfer or discharge of a resident from a

facility shall be preceded by the discussion required under

subsection (j)

of this Section

and by a minimum written notice of 30 days, except in one of

the following instances:

1)

When an emergency transfer or discharge is ordered by the

resident's attending physician because of the resident's health care needs. The

State Long Term Care Ombudsman shall be notified at the time of the emergency

transfer or discharge;

(Section 3-402(a) of the Act)

2)

When the transfer or discharge is mandated by the physical

safety of other residents, the facility staff, or facility visitors, as

documented in the clinical record

s ordered by the

resident's attending physician because of the resident's health care needs. The

State Long Term Care Ombudsman shall be notified at the time of the emergency

transfer or discharge;

(Section 3-402(a) of the Act)

2)

When the transfer or discharge is mandated by the physical

safety of other residents, the facility staff, or facility visitors, as

documented in the clinical record.

The Department , the resident's

managed care organization, if applicable,

and the State Long Term Care

Ombudsman shall be notified prior to any such involuntary transfer or

discharge.  The Department

will

immediately offer transfer, or discharge

and relocation assistance to residents transferred or discharged under this

subsection

(d)(2)

, and the Department may place relocation teams as provided in Section

3-419 of

the

Act

; or (Section 3-402(b) of the Act)

3)

When an identified offender is within the provisional

admission period defined in Section 1-120.3

of the Act and Section 300.330

of this Part.

If the Identified Offender Report and Recommendation prepared

under Section 2-201.6

of the Act

shows that the identified offender

poses a serious threat or danger to the physical safety of other residents, the

facility staff, or facility visitors in the admitting facility, and the

facility determines that it is unable to provide a safe environment for the

other residents, the facility staff, or facility visitors, the facility shall

transfer or discharge the identified offender within 3 days after its receipt

of the Identified Offender Report and Recommendation.

(Section 3-402(c) of

the Act)

e)         For transfer or discharge made under subsection (d), the

notice of transfer or discharge shall be made as soon as practicable before the

transfer or discharge

s, the facility staff, or facility visitors, the facility shall

transfer or discharge the identified offender within 3 days after its receipt

of the Identified Offender Report and Recommendation.

(Section 3-402(c) of

the Act)

e)         For transfer or discharge made under subsection (d), the

notice of transfer or discharge shall be made as soon as practicable before the

transfer or discharge.

The notice required by

subsection (d)

shall be

on a form prescribed by the Department and shall contain all of the following:

1)

The stated reason for the proposed transfer or discharge;

(Section 3-403(a) of the Act)

2)

The effective date of the proposed transfer or discharge;

(Section 3-403(b) of the Act)

3)

A statement in not less than 12-point type, which reads:

"You have a right to appeal the facility's decision to transfer

or discharge you.  If you think you should not have to leave this facility, you

may file a request for a hearing with the Department of Public Health within 10

days after receiving this notice.  If you request a hearing, it will be held

not later than 10 days after your request, and you generally will not be

transferred or discharged during that time. If the decision following the

hearing is not in your favor, you generally will not be transferred or

discharged prior to the expiration of 30 days following receipt of the original

notice of the transfer or discharge.  A form to appeal the facility's decision

and to request a hearing is attached.  If you have any questions, call the

Department of Public Health or the State Long Term Care Ombudsman at the

telephone numbers listed below.";

(Section 3-403(c) of the Act)

4)

A hearing request form, together with a postage paid,

preaddressed envelope to the Department; and

(Section 3-403(d) of the Act)

5)

The name, address, and telephone number of the person

charged with the responsibility of supervising the transfer or discharge

epartment of Public Health or the State Long Term Care Ombudsman at the

telephone numbers listed below.";

(Section 3-403(c) of the Act)

4)

A hearing request form, together with a postage paid,

preaddressed envelope to the Department; and

(Section 3-403(d) of the Act)

5)

The name, address, and telephone number of the person

charged with the responsibility of supervising the transfer or discharge.

(Section 3-403(e) of the Act)

f)

A request for a hearing made under

subsection (e) of

this Section and Section 3-403 of the Act

shall stay a transfer or discharge

pending a hearing or appeal of the decision, unless a condition which would

have allowed transfer or discharge in less than 30 days as described under

subsections

(d)(1) and (2) of this Section

develops in the interim.

(Section 3-404

of the Act)

g)

A copy of the notice required by

subsection (d)(1) of

this Section and

Section 3-402

of the Act

shall be placed in the

resident's clinical record and a copy shall be transmitted to the Department,

the State Long-Term Care Ombudsman, the resident, the resident's

representative, if any, and the resident's managed care organization.

(Section 3-405 of the Act)

h)

When the basis for an involuntary transfer or discharge is

the result of an action by the Department of Healthcare and Family Services

with respect to a recipient of Title XIX and a hearing request is filed with

the Department of Healthcare and Family Services, the 21-day written notice

period shall not begin until a final decision in the matter is rendered by the

Department of Healthcare and Family Services or a court of competent

jurisdiction and notice of that final decision is received by the resident and

the facility.

(Section 3-406 of the Act)

i)

When nonpayment is the basis for involuntary transfer or

discharge, the resident shall have the right to redeem up to the date that the

discharge or transfer is to be made and then shall have the right to remain in

the facility

and Family Services or a court of competent

jurisdiction and notice of that final decision is received by the resident and

the facility.

(Section 3-406 of the Act)

i)

When nonpayment is the basis for involuntary transfer or

discharge, the resident shall have the right to redeem up to the date that the

discharge or transfer is to be made and then shall have the right to remain in

the facility.

(Section 3-407 of the Act)

j)

The planned involuntary transfer or discharge shall be

discussed with the resident, the resident's representative and person or agency

responsible for the resident's placement, maintenance, and care in the

facility.  The explanation and discussion of the reasons for involuntary

transfer or discharge shall include the facility administrator or other

appropriate facility representative as the administrator's designee.  The

content of the discussion and explanation shall be summarized in writing and

shall include the names of the individuals involved in the discussions and made

a part of the resident's clinical record.

(Section 3-408 of the Act)

k)

The facility shall offer the resident counseling services

before the transfer or discharge of the resident.

(Section 3-409 of the

Act)

l)

A resident subject to involuntary transfer or discharge

from a facility, the resident's guardian or if the resident is a minor,

the

resident's,

shall have the opportunity to file a request for a hearing with

the Department within 10 days following receipt of the written notice of the involuntary

transfer or discharge by the facility.

(Section 3-410 of the Act)

m)

The Department of Public Health, when the basis for

involuntary transfer or discharge is other than action by the Department of

Healthcare and Family Services with respect to the Title XIX Medicaid

recipient, shall hold a hearing at the resident's facility not later than 10

days after a hearing request is filed, and render a decision within 14 days

after the filing of the hearing request

)

m)

The Department of Public Health, when the basis for

involuntary transfer or discharge is other than action by the Department of

Healthcare and Family Services with respect to the Title XIX Medicaid

recipient, shall hold a hearing at the resident's facility not later than 10

days after a hearing request is filed, and render a decision within 14 days

after the filing of the hearing request.

1)

The Department has continuing jurisdiction over the

transfer or discharge irrespective of the timing of the hearing and decision.

Once a request for a hearing is filed, the Department shall hold a hearing

unless the request is withdrawn by the resident.

2)

If the request for hearing is withdrawn based upon a

representation made by the facility to the resident and the Department,

including the hearing officer, that a resident who has been denied readmission

will be readmitted, and the resident or resident representative notifies the Department

that the facility is still denying readmission,

that facility's

failure

to readmit

the resident

is considered

a

failure to comply with a

Department order to readmit pursuant to Section 3-305.6

of the Act, and as

a result, that facility shall be subject to applicable Department enforcement

action, permitted under the Act and Code

including the imposition of a

$2,500 fine under Section 3-305.6

of the Act.  (Section 3-411 of the Act)

n)

The hearing before the Department provided under

subsection

sidered

a

failure to comply with a

Department order to readmit pursuant to Section 3-305.6

of the Act, and as

a result, that facility shall be subject to applicable Department enforcement

action, permitted under the Act and Code

including the imposition of a

$2,500 fine under Section 3-305.6

of the Act.  (Section 3-411 of the Act)

n)

The hearing before the Department provided under

subsection

(m) of this Section

shall be conducted as prescribed under Section 3-703

of

the Act

. In determining whether a transfer or discharge is authorized, the

burden of proof in this hearing rests on the person requesting the transfer or

discharge.

(Section 3-412 of the Act)

o)

If the Department determines that a transfer or discharge

is authorized under

subsection (c) of this Section

, the resident shall

not be required to leave the facility before the 34

th

day following

receipt of the notice required under

subsection (d) of this Section

, or

the 10

th

day following receipt of the Department's decision,

whichever is later, unless a condition which would have allowed transfer or

discharge in less than 30 days as described under

subsections (d)(1) and

(2) of this

Section

develops in the interim.

The Department

maintains jurisdiction over the transfer or discharge irrespective of the

timing of the notice and discharge.

(Section 3-413 of the Act)

p)

If the Department determines that a transfer or discharge

is not authorized under Section 3-401

of the Act,

then the Department

will

issue a written decision stating that the transfer or discharge is denied. If

the action of the facility giving rise to the request for hearings is a

facility's failure to readmit the resident following hospitalization, other

medical leave of absence, or other absence, then the Department

will

order

the immediate readmission of the resident to the facility

of the Act,

then the Department

will

issue a written decision stating that the transfer or discharge is denied. If

the action of the facility giving rise to the request for hearings is a

facility's failure to readmit the resident following hospitalization, other

medical leave of absence, or other absence, then the Department

will

order

the immediate readmission of the resident to the facility.

1)

The facility shall comply with the order immediately;

2)

A copy of the Department's written decision shall be placed

in the resident's medical chart;

3)

A surveyor

will

make an on-site inspection of the

facility's compliance with the order unless the resident or resident

representative notifies the Department in writing that there is compliance with

the order.

(Section 3-413.1 of the Act)

q)

The Department of Healthcare and Family Services shall

continue Title XIX Medicaid funding during the appeal, transfer, or discharge

period for those residents who are Title XIX recipients affected by

subsection

(c) of this Section

.

(Section 3-414 of the Act)

r)

The Department

will

transfer or discharge any

resident from any facility required to be licensed under

the Act and this

Part

when any of the following conditions exist:

1)         The

facility is operating without a license;

(Section

3-415(a) of the Act)

2)

The Department has suspended, revoked or refused to renew

the license of the facility as provided under Section 3-119

of the Act

.

(Section 3-415(b) of the Act)

3)

The facility has requested the aid of the Department in the

transfer or discharge of the resident and the Department finds that the

resident consents to transfer or discharge;

(Section 3-415(c) of the Act)

4)

The facility is closing or intends to close and adequate

arrangement for relocation of the resident has not been made at least 30 days

prior to closure; or

(Section 3-415(d) of the Act)

5)

The Department determines that an emergency exists which

requires immediate transfer or discharge of the resident

t finds that the

resident consents to transfer or discharge;

(Section 3-415(c) of the Act)

4)

The facility is closing or intends to close and adequate

arrangement for relocation of the resident has not been made at least 30 days

prior to closure; or

(Section 3-415(d) of the Act)

5)

The Department determines that an emergency exists which

requires immediate transfer or discharge of the resident.

(Section

3-415(e) of the Act)

s)

In deciding to transfer or discharge a resident from a

facility under

subsection (q) of this Section

, the Department

will

consider the likelihood of serious harm which may result if the resident

remains in the facility.

(Section 3-416 of the Act)

t)

The Department

will

offer transfer or discharge and

relocation assistance to residents transferred or discharged under

subsections

(c) through (q) of this Section,

including information on available

alternative placements.  Residents shall be involved in planning the transfer

or discharge and shall choose among the available alternative placements,

except that where an emergency makes prior resident involvement impossible, the

Department

will

make a temporary placement until a final placement can

be arranged.  Residents may choose their final alternative placement and shall

be given assistance in transferring to such place.  No resident

shall

be

forced to remain in a temporary or permanent placement.

When

the

Department makes or participates in making the relocation decision,

consideration shall be given to proximity to the resident's relatives and

friends.  The resident shall be allowed 3 visits to potential alternative

placements prior to removal, except where medically contraindicated or where

the need for immediate transfer or discharge requires reduction in the number

of visits

ent.

When

the

Department makes or participates in making the relocation decision,

consideration shall be given to proximity to the resident's relatives and

friends.  The resident shall be allowed 3 visits to potential alternative

placements prior to removal, except where medically contraindicated or where

the need for immediate transfer or discharge requires reduction in the number

of visits.  When the Department provides information on available alternative

placements in community-based settings for individuals being discharged or

transferred from facilities licensed under

the

Act, the information must

include a comprehensive list of a range of appropriate, client-oriented

services and the name of and contact information for the ADA coordinator in the

relocation locale.  The comprehensive list must include the name and contact

information for each agency or organization providing those services and a

summary of the services provided by each agency or organization.  A hotline or

similar crisis telephone number must also be provided to individuals relocating

into the community.

(Section 3-417 of the Act)

u)

The Department

will

prepare resident transfer or

discharge plans to assure safe and orderly removals and protect residents'

health, safety, welfare and rights.  In nonemergencies and where possible in

emergencies, the Department

will

design and implement such plans in

advance of transfer or discharge.

(Section 3-418 of the Act)

v)

The Department

will

place relocation teams in any

facility from which residents are being discharged or transferred for any

reason, for the purpose of implementing transfer or discharge plans.

(Section 3-419 of the Act)

w)

In any transfer or discharge conducted under

subsections

e Department

will

design and implement such plans in

advance of transfer or discharge.

(Section 3-418 of the Act)

v)

The Department

will

place relocation teams in any

facility from which residents are being discharged or transferred for any

reason, for the purpose of implementing transfer or discharge plans.

(Section 3-419 of the Act)

w)

In any transfer or discharge conducted under

subsections

(q) through (t) of this Section

the Department

will

:

1)

Provide written notice to the facility prior to the

transfer or discharge.  The notice

will

state the basis for the order of

transfer or discharge and

will

inform the facility of its right to an

informal conference prior to transfer or discharge under this Section, and its

right to a subsequent hearing under

subsection (x) of this Section

.  If

a facility desires to contest a nonemergency transfer or discharge, prior to

transfer or discharge it shall, within four working days after receipt of the

notice, send a written request for an informal conference to the Department.

The Department

will

, within four working days from the receipt of the

request, hold an informal conference in the county in which the facility is

located.  Following this conference, the Department

will

affirm, modify

or overrule its previous decision. Except in an emergency, transfer or

discharge

shall

not begin until the period for requesting a conference

has passed or, if a conference is requested, until after a conference has been

held;

and (Section 3-420(a) of the Act)

2)

Provide written notice to any resident to be removed, to

the resident's representative, if any, and to a member of the resident's

family, where practicable, prior to the removal.  The notice

will

state

the reason for which transfer or discharge is ordered and

will

inform

the resident of the resident's right to challenge the transfer or discharge

under

subsection (x) of this Section

e Act)

2)

Provide written notice to any resident to be removed, to

the resident's representative, if any, and to a member of the resident's

family, where practicable, prior to the removal.  The notice

will

state

the reason for which transfer or discharge is ordered and

will

inform

the resident of the resident's right to challenge the transfer or discharge

under

subsection (x) of this Section

. The Department

will

hold an

informal conference with the resident or the resident's representative prior to

transfer or discharge at which the resident or the representative may present

any objections to the proposed transfer or discharge plan or alternative

placement.

(Section 3-420(b) of the Act)

x)

In any transfer or discharge conducted under

subsection

(q)(5) of this Section

, the Department

will

notify the facility and

any resident to be removed that an emergency has been found to exist and

removal has been ordered, and

will

involve the residents in removal

planning if possible.  With the consent of the resident or

the resident's

representative, the facility must inform the resident's designated

care

coordination unit, as defined in 89 Ill. Adm. Code 240.260, of the resident's

pending discharge and must provide the resident or

the resident's

representative with the

care

coordination unit's telephone number and

other contact information.  Following emergency removal, the Department

will

provide written notice to the facility, to the resident, to the resident's

representative, if any, and to a member of the resident's family, where

practicable, of the basis for the finding that an emergency existed and of the

right to challenge removal under

subsection (x) of this Section.  (Section

3-421 of the Act)

y)

Within ten days following transfer or discharge, the

facility or any resident transferred or discharged may send a written request

to the Department for a hearing under Section 3-703

of the Act

to

challenge the transfer or discharge

of the basis for the finding that an emergency existed and of the

right to challenge removal under

subsection (x) of this Section.  (Section

3-421 of the Act)

y)

Within ten days following transfer or discharge, the

facility or any resident transferred or discharged may send a written request

to the Department for a hearing under Section 3-703

of the Act

to

challenge the transfer or discharge.  The Department

will

hold the

hearing within 30 days

after

receipt of the request.

The hearing

will

be held at the facility from which the resident is being

transferred or discharged, unless the resident or resident's representative

requests an alternative hearing site.

If the facility prevails, it may

file a claim against the State under the Court of Claims Act for payments lost

less expenses saved as a result of the transfer or discharge.  No resident

transferred or discharged may be held liable for the charge for care which

would have been made had the resident remained in the facility.  If a resident

prevails, the resident may file a claim against the State under the Court of

Claims Act

for

any excess expenses directly caused by the order to

transfer or discharge.  The Department

will

assist the resident in

returning to the facility if assistance is requested.

(Section 3-422 of

the Act)

z)

The administrator of a facility licensed under

the

Act

shall give 60 days notice prior to voluntarily closing a facility or closing

any part of a facility, or prior to closing any part of a facility if closing

such part will require the transfer or discharge of more than 10% of the

residents.  Such notice shall be given to the Department, to the Office of

State Long Term Care Ombudsman, to any resident who must be transferred or

discharged, to the resident's representative, and to a member of the resident's

family, where practicable.  If the Department suspends, revokes, or denies

renewal of the facility's license, then notice shall be given no later than the

date specified by the Department

e shall be given to the Department, to the Office of

State Long Term Care Ombudsman, to any resident who must be transferred or

discharged, to the resident's representative, and to a member of the resident's

family, where practicable.  If the Department suspends, revokes, or denies

renewal of the facility's license, then notice shall be given no later than the

date specified by the Department.  Notice shall state the proposed date of

closing and the reason for closing.  The facility shall submit a closure plan

to the Department for approval which shall address the process for the safe and

orderly transfer of residents.  The approved plan shall be included in the

notice.  The facility shall offer to assist the resident in securing an

alternative placement and shall advise the resident on available alternatives.

When

the resident is unable to choose an alternate placement and is not

under guardianship, the Department shall be notified of the need for relocation

assistance.  A facility closing in its entirety shall not admit any new

residents on or after the date written notice is submitted to the Department

under

the Act and this Part.

The facility shall comply with all

applicable laws and regulations until the date of closing, including those

related to transfer or discharge of residents.  The Department

will

place a relocation team in the facility as provided under

subsection (u) of

this Section

.

(Section 3-423 of the Act)