On June 29, 2022, CMS issued QSO-22-19-NH,  announcing the release of new Interpretive Guidance for Phase 3 requirements, which went into effect November 28, 2019, as well as  revisions to Phase 2 guidance. Surveyors will begin using this guidance to identify noncompliance on October 24, 2022.

While all the new regulations and guidance related to Admission, Transfer, and Discharge Rights  occurred with Phase 2 and there were no Phase 3 requirements for this section, CMS included in this updated guidance revisions to specific F-tags relating to transfer and discharge in response to feedback and questions from nursing home providers.

Specifically significant clarification has been included to the guidance at F622 -Transfer and Discharge Requirements; F623 Notice Requirements before Transfer and Discharge; and F626 Permitting Residents to Return to the Facility.

Clarifications include the following:

      • When a resident is emergently transferred to acute care, this is considered facility‐initiated transfer, not discharge, because the resident’s return is generally expected.
      • In situations where a facility wishes to discharge a resident involuntarily while the resident remains in the hospital, the grounds for initiating the discharge must exist as of the time the discharge is initiated.
      • Residents who are sent to the acute care setting for routine treatment/planned procedures must be allowed to return to the facility.
      • When a resident leaves against medical advice (AMA) because he/she felt pressured, forced, or intimidated into doing so, the discharge shall be deemed facility-initiated and subject to investigation.
      • Residents admitted with the anticipation of a “short term” stays (for example, a “short-term rehabilitation stay”) have a right to remain in the facility even if they decide to stay beyond the time period of their initially projected discharge. In this case, a facility may only discharge the resident against his or her will if one of the grounds for an involuntary discharge at 42 C.F.R. § 483.70(c)(1)(i)(A)-(F) is satisfied.
      • If a resident’s Medicare coverage is ending (for example, based on a lack of skilled need or exhaustion of Part A of benefits), the resident must be offered an opportunity to remain in the facility by paying privately for his/her care or applying to a third-party payor for coverage (e.g., Medicaid). A resident who has applied for Medicaid and complied with applicable document submission requirements may not be discharged while his or her Medicaid application remains pending.
      • Where the circumstances of an involuntary discharge change, such as changes in proposed discharge location, or reason for the discharge, the facility must provide the resident with a new discharge notice which may give the resident with a new opportunity to appeal the discharge.

To learn more about the updated guidance related to the Admissions, Transfers and Discharge requirements and how to develop action plans with a focus on achieving compliance for these and other significant regulatory updates outlined in QSO-22-19-NH effective October 24th, 2022, please join Proactive Medical Review for a 5 part weekly webinar series Unpacking the RoP Interpretive Guidance: LTC Implementation Essentials beginning this Thursday, September 8, 2022.


Christine Twombly, RN-BC, RAC-MT, RAC-MTA, HCRM, CHC
Clinical Consultant

Learn more about the rest of the Proactive team.