Wyo. Code R. 048-0037-49
Medicaid
Chapter 49: Nursing Facility Involuntary Discharge or Transfer Hearings
Effective Date: 04/16/2020 to Current
Rule Type: Current Rules & Regulations
Reference Number: 048.0037.49.04162020
NURSING FACILITY INVOLUNTARY DISCHARGE OR TRANSFER HEARINGS
Section 1. Authority. This Chapter is promulgated pursuant to the Wyoming Medical Assistance and Services Act at Wyoming Statutes § 42-4-101 through – 122.
(a) This Chapter is intended to comply with federal law directives under applicable provisions of 42 U.S.C. § 1396r, which require notice and opportunity to be heard in cases of involuntary transfers or discharges of residents of nursing care facilities.
(b) The Department may issue manuals and bulletins to providers and other affected parties to interpret the sections of this Chapter. Such manuals and bulletins shall be consistent with and reflect the requirements outlined in this Chapter. The provisions contained in manuals and provider bulletins shall be subordinate to the sections of this Chapter.
(a) Pursuant to 42 CFR 483.15 (c), the facility shall permit each resident to remain in the facility, and not transfer or discharge the resident from the facility unless one of the following conditions is met:
(i) The transfer or discharge is necessary for the resident’s welfare and the resident’s needs cannot be met in the facility;
(ii) The transfer or discharge is appropriate because the resident’s health has improved sufficiently so the resident no longer needs the services provided by the facility;
(iii) The safety of individuals in the facility is endangered due to the clinical or behavioral status of the resident;
(iv) The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility. Non-payment applies if the resident does not submit the necessary paperwork for third party payment or after third party, including Medicare or Medicaid, denies the claim and the resident refuses to pay for his or her stay. For a resident who becomes eligible for Medicaid after admission to a facility, the facility may charge a resident only allowable charges as outlined in Chapter 7, Wyoming Nursing Home Reimbursement System;
(v) The facility ceases to operate; or (vi) The health of individuals in the facility would otherwise be endangered.
(b) Pursuant to 42 CFR 483.15 (c)(3) before a facility transfers or discharges a resident, the facility shall:
(i) Notify the resident and the resident's representative(s) of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand. The facility shall send a copy of the notice to a representative of the Office of the State Long-Term Care Ombudsman;
(ii) Record the reasons for the transfer or discharge in the resident's medical record in accordance with 42 CFR 483.15 (c)(2); and
(iii) Include in the notice the items described in 42 CFR 483.15 (c)(5).
(c) Pursuant to 42 CFR 483.15 (c)(4) the notice of transfer or discharge required under Section 3 (c) of this chapter shall be made by the facility at least 30 days before the resident is transferred or discharged. Under the following circumstances, notice may be made as soon as practicable before transfer or discharge:
(i) The safety of individuals in the facility would be endangered under 42 CFR 483.15 (c)(1)(i)(C);
(ii) The health of individuals in the facility would be endangered, under 42 CFR 483.15 (c)(1)(i)(D);
(iii) The resident's health improves sufficiently to allow a more immediate transfer or discharge, under 42 CFR 483.15 (c)(1)(i)(B);
(iv) An immediate transfer or discharge is required by the resident's urgent medical needs, under 42 CFR 483.15 (c)(1)(i)(A); or
(v) A resident has not resided in the facility for 30 days.
(a) A resident eligible for an administrative hearing under this Chapter shall submit the request in accordance with Chapter 4 of the Wyoming Department of Health, Medicaid Rules, within thirty (30) calendar days after a notice of transfer or discharge has been given by the facility. Failure to timely submit the request shall deprive the individual of a right to a hearing.
(b) The facility may not transfer or discharge the resident while the appeal is pending, unless failure to discharge or transfer would endanger the health or safety of the resident or other individuals in the facility. The facility shall document the danger that failure to transfer or discharge would pose.
(a) The hearing and all other affiliated processes will be conducted in accordance with Chapter 4 of the Wyoming Department of Health, Medicaid Rules.
(b) The hearing shall be held within forty (40) days of the receipt of the request.
(c) The burden of proof shall be placed upon the party contesting a determination to involuntarily transfer or discharge a resident.
(d) The party contesting a facility determination shall show by a preponderance of the evidence just cause why the proposed transfer or discharge does not comply with the grounds established by Section 3 of this chapter.
(e) The Wyoming Department of Health shall not be a party to the proceedings under this Chapter.
(f) The Department shall facilitate all correspondence between the resident, the facility, and the Office of Administrative Hearings for purposes of carrying out the proceedings.