1. (a)

   1. (1) The facility must not admit or continue to care for residents whose needs are greater than the facility is licensed to provide.
   2. (2) If necessary services cannot be obtained in or by the facility, the resident and/or responsible party will be notified to seek alternate placement immediately.
   3. (3) The facility administrator should assist in helping to locate a facility that can provide the appropriate level of care.

2. (b)

   1. (1) The facility must develop and implement written admission policies and criteria that include, as a minimum, requirements that the applicant/resident:

      1. (A) Be eighteen (18) years of age or older;
      2. (B) Be independently mobile as defined in 20 CAR § 401-101;
      3. (C) Be able to self-administer medications as outlined in 20 CAR § 401-601;
      4. (D) Be capable of understanding and responding to reminders and guidance from staff;
      5. (E) Is not totally incontinent of bowel and bladder;
      6. (F) Does not have a feeding or intravenous tube;
      7. (G) Does not have a communicable disease that poses a direct threat to the health or safety of other residents or staff;
      8. (H) Does not need nursing services which exceed those that can be provided by a certified home health agency on a temporary or infrequent basis;
      9. (I) Does not have a level of mental illness, mental disorder, mental retardation, dementia, Alzheimer's disease, or addiction to alcohol/drugs that requires a higher level of medical, nursing, or psychiatric care or active treatment than can be safely and effectively provided in the residential care facility setting;
      10. (J) Does not require religious, cultural, or dietary regimens that cannot be met by the facility without undue burden; and
      11. (K) Does not require physical restraints, lock up, confinement, or have current violent behavior, nor is the resident being admitted against his or her will by court order or being released from a correctional facility.

   2. (2) The facility will interview and document all prospective residents and/or sponsors prior to admission in order to determine:

      1. (A) The needs of the prospective resident; and
      2. (B) Whether the facility can meet these needs.

3. (c)

   1. (1) Each facility must provide to the resident and/or his or her responsible party at or prior to admission and periodically thereafter as required, a written admission agreement or contract duly executed, dated, and signed by the facility administrator and the resident and/or responsible party.
   2. (2) A copy of the signed agreement must be maintained in the resident's permanent record.

   3. (3) The agreement shall be printed and must contain, at a minimum, the following:

      1. (A)

4. (i) A statement describing all services, materials, equipment, and food to be included within the basic charge.

   1. (ii) The agreement/contract must also state additional services delivered to the resident and the additional charges to be paid by the resident;

      1. (B) A written acknowledgement that the resident and/or responsible party has been notified of the charges for services;
      2. (C) The conditions and rules governing residency;
      3. (D) The conditions and rules governing termination of a resident's placement in the facility;

      4. (E)

         1. (i) If the resident receives state or federal funding, other than Medicaid, the amount must be included in the agreement.
         2. (ii) If the resident is private pay there may be a disclaimer signed by the responsible party that they have received a copy of the charges;
      5. (F) A provision that no additional charges shall be levied against the resident by the facility for basic residential care facility services identified in the admissions agreement or contract;
      6. (G) The conditions under which the facility may adjust the basic monthly or daily rate and charges for supplemental services and supplies, including the provision of a written notification to the resident or responsible party, by providing prompt notice of all changes in price prior to implementation;

      7. (H)

         1. (i) A written refund policy that addresses refund of advance payment of payments in the event of transfer, death, or voluntary or involuntary discharge.
         2. (ii) The policy shall include, as a minimum, the following:

5. (a)

   1. (1) (a)(1) For a fourteen-day period beginning on the date of entry into a facility, the resident shall have the right to rescind any contractual obligation into which he or she has entered and receive a full refund of any moneys transferred to the facility.
   2. (2) (2) If the resident entered the facility and received some benefit therefrom, the charges of the services provided shall be prorated and payment made only for the benefits conferred prior to the refund;

6. (b) (b) Residents with income of SSA/SSI benefits shall receive refunds on a pro rata basis from that income source, without regard for the reason of transfer;

   1. (c) (c) In the event of transfer for medical reasons, the refund policy must address the resident's need to maintain on-going medical care and services, and for that reason refunds shall be on a pro rata basis, regardless of income source; and

      1. (d)
   2. (1) (d)(1) If, after the expiration of the fourteen-day period referenced in subdivision (c)(3)(H)(1)(a) of this section, the resident provides a ten-day notice, any applicable refund shall be available the day the resident leaves the facility.

   3. (2) (2) If the resident does not provide a ten-day notice, any applicable refund will be available within ten (10) days of the resident's departure; and

      1. (I) A statement that the resident or his or her legal representative shall have the right to discharge the resident from the facility.

         1. (d) The facility must develop and implement written discharge and transfer policies and procedures that include, at a minimum, the following:

   4. (1) A resident may be transferred or discharged only when:

      1. (A) The resident's medical needs cannot be met by the facility, or a certified home health agency, on a temporary or infrequent basis;
      2. (B) The resident presents a danger to the health, safety, or welfare of himself or herself or others;
      3. (C) Nonpayment for his or her stay; or
      4. (D) The facility ceases operation.

   5. (2)

      1. (A) The reasons for transfer or discharge of a resident must be documented in the resident's permanent record and the transfer or discharge must be discussed with the resident, his or her guardian, or his or her personal representative, who must be given a copy of the documentation setting forth the alternatives available.
      2. (B) This notice must be given thirty (30) days prior to the date of transfer or discharge.
      3. (C) Transfer for the welfare of the resident or other residents may be effected immediately if the need for such action is documented in the record;

   6. (3) The term "transfer":

      1. (A) Applies to the movement of a resident from one (1) facility to another facility; and
      2. (B) Does not apply to a change in room assignment or services within the same facility;

   7. (4)

      1. (A) "Medical reasons" for transfer or discharge:

         1. (i) Must be based on the resident's needs; and
         2. (ii) Are to be determined and documented by a physician.
      2. (B) The resident's permanent record shall contain documentation of medical reasons for transfer or discharge;

   8. (5)

      1. (A) A written appeals process for residents objecting to transfer or discharge must be developed by the facility in conformity with Arkansas Code § 20-10-1005, as amended, as well as all applicable rules.

      2. (B) That process shall include:

         1. (i)
7. (a) (a) The written notice of transfer or discharge must state the reason for the proposed transfer or discharge as documented in 20 CAR § 401-309(d)(2).

8. (b) (b) The notice must inform the resident that he or she has the right to appeal the decision to the Director of the Office of Long-Term Care within seven (7) calendar days.

   1. (c) (c) The resident must be assisted by the facility in filing the written objection to transfer or discharge;

      1. (ii) Within fourteen (14) days of filing of the written objections, a hearing will be scheduled; and

         1. (iii) A final determination in the matter will be rendered within seven (7) days of the hearing;
   2. (6) The facility must provide assistance to residents to ensure a safe and orderly transfer or discharge;
   3. (7) The facility, in conjunction with the responsible party, must make arrangements to transfer residents who require a higher level of medical, nursing, or psychiatric care than can be safely and effectively provided in a residential long-term care facility setting (refer to 20 CAR § 401-309(a));

   4. (8)

      1. (A) If the Office of Long-Term Care determines that a resident is inappropriate for continued placement in the facility, the provider must arrange for transfer of the resident within ten (10) days of such notification.
      2. (B) Less time may be given by the office when a resident's life or health requires immediate medical attention.
      3. (C) The responsibility for the resident's care or lack of care shall rest with the provider.
      4. (D) If the office determines that the transfer of a resident is necessary for reasons other than appropriateness of placement, the office may afford the facility up to thirty (30) days to effectuate the transfer;

   5. (9)

      1. (A) Upon transfer of a resident to a health, mental health, or other residential long-term care facility, a copy of all pertinent resident records, as required by this section, must accompany the resident except when emergency situations prohibit such transmittal.
      2. (B) In such cases, pertinent information shall be telephoned to the receiving facility immediately and written transfer documents sent within seventy-two (72) hours; and
   6. (10) The facility must assist all residents proposed to be discharged or transferred to ensure the resident's placement in a care setting which is adequate and appropriate to the resident's condition and, where possible, consistent with the wishes of the resident.

Codification Notes: "SSA/SSI" means Social Security Administration/Social Security Income.