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<section article="ghg" article_name="Health - General" number="19-345.1" title_number="19" title_name="Health Care Facilities" subtitle_number="3" subtitle_name="Hospitals and Related Institutions">
  <level label="a">
    <level label="1">
      <text>A facility shall provide the resident with written notice of:</text>
      <level label="i">
        <text>Any proposed discharge or transfer; and</text>
      </level>
      <level label="ii">
        <text>The opportunity for a hearing in accordance with the provisions of this section before the discharge or transfer.</text>
      </level>
    </level>
    <level label="2">
      <text>The notice required under paragraph (1) of this subsection shall include, at a minimum, the information listed under subsection (b) of this section.</text>
    </level>
  </level>
  <level label="b">
    <text>The Department shall prepare and provide each facility with a standardized form that provides, in clear and simple language, at least the following information:</text>
    <level label="1">
      <text>Notice of the intended discharge or transfer of the resident, including the proposed date of the intended discharge or transfer, which may change as a result of an appeal or the discharge planning process;</text>
    </level>
    <level label="2">
      <text>Each reason for the discharge or transfer;</text>
    </level>
    <level label="3">
      <text>The location to which the resident will be discharged or transferred, which may change as a result of an appeal or the discharge planning process;</text>
    </level>
    <level label="4">
      <text>The name of the social worker or other professionally qualified staff, which may change during the discharge planning process, who:</text>
      <level label="i">
        <text>Is designated to provide social services and discharge planning services to the resident in connection with the discharge or transfer; and</text>
      </level>
      <level label="ii">
        <text>Will be responsible for the development of the post discharge plan of care under subsection (g) of this section;</text>
      </level>
    </level>
    <level label="5">
      <text>A proposed date within 10 days after the date of the notice for a meeting between the resident, the resident’s representative, and facility staff to develop the post discharge plan of care under subsection (g) of this section;</text>
    </level>
    <level label="6">
      <level label="i">
        <text>The right of the resident to request a hearing;</text>
      </level>
      <level label="ii">
        <text>The name, mailing address, e–mail address, and telephone number of the entity to which the resident must submit a request for a hearing; and</text>
      </level>
      <level label="iii">
        <text>Instructions for obtaining, completing, and submitting a request for a hearing;</text>
      </level>
    </level>
    <level label="7">
      <text>The right of the resident to consult with any lawyer the resident chooses;</text>
    </level>
    <level label="8">
      <text>The availability of the services of Maryland Legal Aid, the Older American Act Senior Legal Assistance Programs, and other agencies that may provide assistance to individuals who need legal counsel;</text>
    </level>
    <level label="9">
      <level label="i">
        <text>The availability of the Long–Term Care Ombudsman Program to assist the resident; and</text>
      </level>
      <level label="ii">
        <text>The mailing address, e–mail address, and telephone number of the Long–Term Care Ombudsman Program;</text>
      </level>
    </level>
    <level label="10">
      <text>The mailing address, e–mail address, and telephone number of Disability Rights Maryland; and</text>
    </level>
    <level label="11">
      <text>The provisions of this section.</text>
    </level>
  </level>
  <level label="c">
    <text>Except as otherwise provided in this section, at least 30 days before the facility involuntarily transfers or discharges a resident, the facility shall:</text>
    <level label="1">
      <text>Provide to the resident the written notice required under subsection (a) of this section; and</text>
    </level>
    <level label="2">
      <text>Provide the written notice required under subsection (a) of this section to:</text>
      <level label="i">
        <text>The resident;</text>
      </level>
      <level label="ii">
        <text>The next of kin, guardian, or any other individual known to have acted as the resident’s representative, if any;</text>
      </level>
      <level label="iii">
        <text>The Long–Term Care Ombudsman; and</text>
      </level>
      <level label="iv">
        <text>The Department.</text>
      </level>
    </level>
  </level>
  <level label="d">
    <level label="1">
      <level label="i">
        <text>In accordance with regulations adopted by the Secretary, the facility shall provide the resident with an opportunity for a hearing on the proposed transfer or discharge.</text>
      </level>
      <level label="ii">
        <text>The regulations adopted by the Secretary may provide for the establishment of an escrow account when:</text>
        <level label="1">
          <text>The basis for the discharge is nonpayment; and</text>
        </level>
        <level label="2">
          <text>The resident continues to reside in the facility while the appeal is pending.</text>
        </level>
      </level>
    </level>
    <level label="2">
      <text>Except as otherwise provided in this subsection, hearings on proposed transfers or discharges shall be conducted in accordance with the provisions of Title 10, Subtitle 2 of the State Government Article and the Medicaid Fair Hearing Procedures.</text>
    </level>
    <level label="3">
      <text>Any hearing on a proposed discharge or transfer of a resident:</text>
      <level label="i">
        <text>Is not a contested case as defined in § 10–202 of the State Government Article; and</text>
      </level>
      <level label="ii">
        <text>May not include the Secretary as a party.</text>
      </level>
    </level>
    <level label="4">
      <text>A decision by an administrative law judge on a proposed discharge or transfer of a resident:</text>
      <level label="i">
        <text>Is not a decision of the Secretary;</text>
      </level>
      <level label="ii">
        <text>Unless appealed, is final and binding on the parties; and</text>
      </level>
      <level label="iii">
        <text>May be appealed in accordance with § 10–222 of the State Government Article as if it were a contested case but the appeal does not automatically stay the decision of the administrative law judge.</text>
      </level>
    </level>
  </level>
  <level label="e">
    <text>The facility shall provide the written notice required in subsection (a) of this section as soon as practicable before discharge or transfer if an emergency exists and health or safety of the resident or other residents would be placed in imminent and serious jeopardy if the resident were not transferred or discharged from the facility as soon as possible.</text>
  </level>
  <level label="f">
    <level label="1">
      <text>If the information in the notice provided under subsection (c) of this section changes before the discharge or transfer, the facility shall provide the changes to the recipients of the notice as soon as practicable after the new information becomes available.</text>
    </level>
    <level label="2">
      <text>If a new notice is provided under paragraph (1) of this subsection, the following time requirements apply to the discharge or transfer of the resident:</text>
      <level label="i">
        <text>The resident may not be discharged or transferred for at least 30 days after the new notice has been provided to the resident if the new notice is provided before:</text>
        <level label="1">
          <text>The expiration of the time period required under subsection (c) of this section; or</text>
        </level>
        <level label="2">
          <text>The date of an order of discharge issued by an administrative law judge under subsection (d) of this section; and</text>
        </level>
      </level>
      <level label="ii">
        <text>If the new notice is provided after a date described under item (i) of this paragraph:</text>
        <level label="1">
          <text>If the original notice indicated a discharge location that was a licensed skilled nursing facility and the new notice changes the date of discharge or transfer only, the resident may be discharged on the earliest date that a bed is available at the facility;</text>
        </level>
        <level label="2">
          <text>If the new notice changes the location of discharge or transfer from a licensed skilled nursing facility to a different licensed skilled nursing facility, the resident may not be discharged or transferred for at least 7 days after the new notice has been provided to the resident; and</text>
        </level>
        <level label="3">
          <text>If the new notice changes the location of discharge or transfer from a licensed skilled nursing facility to a location that is not a licensed skilled nursing facility but is otherwise determined to be a safe discharge location under an appropriate clinical evaluation and as set forth in the post discharge plan of care, the resident may not be discharged or transferred for at least 30 days after the new notice has been provided to the resident.</text>
        </level>
      </level>
    </level>
    <level label="3">
      <text>A new notice provided under this subsection shall:</text>
      <level label="i">
        <text>Indicate any differences between the prior notice and the new notice; and</text>
      </level>
      <level label="ii">
        <text>Include a notice of the right to appeal the new notice:</text>
        <level label="1">
          <text>For any discharge or transfer described under paragraph (2)(i) of this subsection; or</text>
        </level>
        <level label="2">
          <text>For a discharge or transfer described under paragraph (2)(ii)3 of this subsection, if the underlying basis of the original notice has changed.</text>
        </level>
      </level>
    </level>
    <level label="4">
      <text>For a discharge or transfer described under paragraph (2)(ii)1 or 2 of this subsection, a new notice is not required to include a notice of the right to appeal the new notice.</text>
    </level>
  </level>
  <level label="g">
    <level label="1">
      <text>Before any discharge or transfer and subject to paragraphs (4) and (5) of this subsection, a facility shall develop a post discharge plan of care for the resident to assist the resident with adjusting to the resident’s new living environment and that:</text>
      <level label="i">
        <text>Addresses the resident’s post discharge goals of care and treatment preferences;</text>
      </level>
      <level label="ii">
        <text>Identifies each of the resident’s reasonably anticipated medical and basic needs after discharge or transfer and establishes a plan for meeting those needs;</text>
      </level>
      <level label="iii">
        <text>Identifies the address at which the resident will reside post discharge; and</text>
      </level>
      <level label="iv">
        <text>In accordance with regulations adopted by the Secretary, provides a safe, secure, and sustainable environment for the resident.</text>
      </level>
    </level>
    <level label="2">
      <text>The facility shall designate a social worker or other professionally qualified staff member to coordinate the development of the resident’s post discharge plan of care.</text>
    </level>
    <level label="3">
      <text>The facility shall, if possible, meet with the resident and, with the resident’s consent, the resident’s representative within 10 days after providing the notice required under subsection (a) of this section to discuss the post discharge plan of care for the resident.</text>
    </level>
    <level label="4">
      <level label="i">
        <text>The resident’s post discharge plan of care shall be developed with the participation of the resident and, with the resident’s consent, the resident’s representative.</text>
      </level>
      <level label="ii">
        <text>If the post discharge plan of care was developed without the participation of the resident or the resident’s representative, the facility shall include in the resident’s medical record an explanation of why the resident or the resident’s representative did not participate.</text>
      </level>
    </level>
    <level label="5">
      <text>The resident’s post discharge plan of care shall be developed in consultation with:</text>
      <level label="i">
        <text>The resident’s attending physician;</text>
      </level>
      <level label="ii">
        <text>A registered nurse responsible for the care of the resident; and</text>
      </level>
      <level label="iii">
        <text>Any other appropriate staff or professional involved with meeting the resident’s medical needs.</text>
      </level>
    </level>
  </level>
</section>
