AFL 23-37
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Clearpol's Opinion of this Guidance as of 12/22/2023
SNF Admission, Transfer and Discharge requirements.
· Provide continuous skilled nursing care and supportive care to residents whose primary need is for skilled nursing care on an extended basis. T22 CCR §72101
· Provide residents with equal access to quality care regardless of diagnosis, severity of condition, or payment source. T42 CFR §483.10(a)(2)
· Not request assurances that residents or potential residents are not eligible for or will not apply for Medicare or Medi-Cal benefits. T42 CFR §483.15(a)(2)(ii)
o SOM Appendix PP prohibits both direct and indirect requests that residents waive their rights to Medicare or Medi-Cal
· Discharges of residents admitted for short-term rehabilitation who communicate they are not ready to leave the facility may be investigated for discrimination. SOM Appendix PP
o May not seek to transfer or discharge residents solely due to a change in their source of payment, e.g., Medicare to Medi-Cal, or to open a bed for residents with insurance coverage that provides a higher rate of reimbursement.
o Transferred or discharged only for medical reasons, the resident's welfare, the welfare of other residents, or for nonpayment for their stay. Such actions shall be documented in the resident's health record. T22 CCR §72527(a)(6)
· SNFs required to permit each resident to remain in the facility and prohibits the transfer or discharge from the facility unless T42 CFR §483.15(c)(1)(i):
o The transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the facility;
o 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;
o The safety of individuals in the facility is endangered due to the clinical or behavioral status of the resident;
o The health of individuals in the facility would otherwise be endangered;
o The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medi-Cal) a stay at the facility. Non-payment applies if the resident does not submit the necessary paperwork for third-party payment or after the third party, including Medicare or Medi-Cal, denies the claim and the resident refuses to pay for their stay. For a resident who becomes eligible for Medi-Cal after admission to a facility, the facility may charge a resident only allowable charges under Medi-Cal; or
o The facility ceases to operate.
Clearpol Inc. does not make any guarantees regarding the accuracy of the opinions provided on our platform. Please use your own judgement.
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