Nursing Home Discharge

In General

Transfer/Discharge form must be signed by either attending/treating physician, facility medical director, or physician designee, Code of Federal Regulation 42 C.F.R § 483.12- 09N-00074

The facility has the burden of proof for resident transfer or discharge, which is proof with clear and convincing evidence, Fla. Stat. § 400.0255, 09N-00089

Discharge is appropriate when resident’s health has improved enough that further services are no longer needed, 42 C.F.R. 483.12(a)(2) (missing page 5 of 6 from the decision)- 09N-00099

Benefits could not be terminated for failure of Petitioner to return the Interim Contact Form after she transferred facilities when the Department could not produce the Form at the hearing to prove it was sent and their policy was to make a phone call to update contact information before sending the Form, ACCESS Customer Service Center Guide, pg. 29 and 30 – 09F-04323

Health and Safety of others endangered

The discharge was upheld when the petitioner kicked and hit facility residents, roamed the facility, removed his clothing and exhibited inappropriate sexual behavior with himself. Therefore, the petitioner posed a potential safety endangerment to other individuals and was discharged from the respondent’s facility 42 C.F.R. § 483.12(a)(2)(iii)- 11N-00160

The discharge was upheld where the petitioner hit facility residents and exhibited aggressive behavior. Therefore, the petitioner posed a potential safety endangerment to other individuals and was discharged from the respondent’s facility 42 C.F.R. § 483.12(a)(2)(iii)11N-00165

The discharge was upheld where the petitioner was verbally abusive and spit on the facility’s CNA. Therefore, the petitioner posed a potential safety endangerment to other individuals and was discharged from the respondent’s facility. 42 C.F.R. §483.12(a)(2)(iii)- 11N-00110

The discharge was upheld where the petitioner was verbally abusive and failed to comply with the facility’s smoking rules and did not respond to the facility’s counseling. Therefore, the petitioner posed a potential safety endangerment to other individuals and was discharged from the respondent’s facility. 42 C.F.R. §483.12(a)(2)(iii)- 11N-00092

Discharge upheld where there were many incidents where the petitioner was aggressive and hostile towards the facilities employees. The respondent argued that an evaluation of the petitioner showed that the petitioner was a danger to himself and others based on his past conduct and aggressive nature. 42 C.F.R. § 483.12(a)(2)(iii), Fla. Stat. §400.0255(1)(a)- 11N-00076

Discharge upheld where the petitioner refused to comply with the smoking and alcohol requirements, and therefore posed a potential safety endangerment to other individuals in the facility. Fla. Stat. 400.0255 (15)(b), 42 C.F.R. §483.12(a)(2)(i)- 10N-00203

Discharge upheld where the petitioner’s treating psychologist testified that the petitioner’s verbal abuse caused emotional harm to others in the facility and that the petitioner would benefit from additional psychiatric services that are not available at this facility. Therefore, the petitioner posed a potential safety endangerment to other individuals and was discharged from the respondent’s facility. Fla. Stat. 400.0255 (15)(b), 42 C.F.R. §483.12(a)(2)(iii)- 10N-00213

The discharge was not upheld where the respondent did not meet its burden in proving that the safety of other individuals in the respondent’s facility were endangered by petitioner and that the petitioner’s health had improved sufficiently so that that petitioner no longer needed the services provided by this facility. Also, the reasons for the discharge were not subscribed by a physician on the transfer and discharge notice. Therefore, the respondent did not meet its burden and the respondent’s action to discharge the petitioner was not affirmed. Fla. Stat. 400.0255 (15)(b), (3),(7),42 C.F.R. §483.12(a)(2)(iii)- 10N-00214

Respondent issued a notice of intent to discharge 30 days prior to discharge date. Petitioner requests more time to make more agreeable arrangements. Appeal denied due to Petitioner’s repeated episodes of combative behavior, 42 C.F.R. § 483.12- 09N-00088

Without evidence that petitioner’s physician or the facility’s medical director recommended the discharge because the health and safety of others was endangered, the discharge is not consistent with Federal Regulations. Nurse’s notes and social progress notes, read into the record by someone other than the nurse, are hearsay. Hearsay, alone, is insufficient to support a decision, Fla. Stat. § 400.0255(7)(b), 42 C.F.R. § 483.12- 09N-00100

Hearing officer does not possess the jurisdiction to decide the appropriateness of a discharge location. Where petitioner is being discharged for violent behavior, wife of petitioner must contact AHCA to request transfer to a closer facility, 42 C.F.R. § 483.12(a), Fla. Stat. § 400.0255(8)- 09N-00049, 09N-00073 [Missing file]

Petitioner received corrected notice of discharge for endangering the safety of others on the same date that Petitioner was involuntarily discharged, under the Baker Act. Invocation of the Baker Act invalidates the 30-day notice requirement. Hearing officer lacked the authority to compel readmission to discharging facility. Appeal denied, 42 C.F.R. § 483.12, 09N-00182

Discharge was not appropriate where Respondent failed to meet its burden. No evidence was presented on how Petitioner had endangered the safety of others or why facility could no longer meet his needs due, to the discovery of a small amount of marijuana in his room, 42 C.F.R. § 483.12, Fla. Stat. § 400.0255- 09N-00166

Absence of physician’s signature was corrected on second notice. Petitioner was correctly discharged for repeated violent behavior towards staff, 42 C.F.R. § 483.12§ – 09N-00200

Discharge was appropriate where Petitioner repeatedly violated the smoking policy, endangering fellow residents. Petitioner’s desire to remain at facility with her friend did not override the safety concerns, 42 C.F.R. § 431.200, 42 C.F.R. § 483.12- 10N-00004

Discharge was not appropriate where facility claimed a § three strikes and you’re out§ smoking policy, but could offer no documentation of the policy or of Petitioner’s violation of the policy. 42 C.F.R. § 431.200, 42 C.F.R. § 483.12, Fla. Stat. § 400.0255(7)(b)- 10N-00013

Discharge is appropriate where there was proper notice and facility corroborated claims that petitioner’s aggressive and manic behavior could not be treated adequately with medicine and endangered the health and safety of others. Therefore, discharge to a facility with more appropriate geriatric psychiatric facilities is upheld. 42 C.F.R. § 483.12(a)(2)(i) and (iii), Fla. Stat. § 400.0255(7)(a) and (b)- 09N-00212

The discharge was not upheld where the respondent was seeking to discharge the petitioner based on an event that was identical to a similar incident committed by another patient who was not discharged.Therefore, the respondent did not meet the burden of proving that the petitioner posed a potential safety endangerment to other individuals and was discharged from the respondent’s facility. 42 C.F.R. § 483.12(a)(2)(iii)- 15N-00033

The discharge was not upheld when it was found that the Respondent did not meet the standard of clear and convincing evidence in its position of discharging the Petitioner for violating the smoking policy. Therefore, the petitioner posed a potential safety endangerment to other individuals and was discharged from the respondent’s facility. 42 C.F.R. §483.12(a)(2)(iii)- 15N-0084

Needs cannot be met by the facility

The discharge was upheld where the petitioner was aware of the non-smoking policy and the evidence presented showed that the nursing facility correctly established that the needs of the petitioner could not be met. 42 C.F.R. § 483.12 (a)- 14N-00153

The discharge was not upheld where the evidence presented showed that the nursing facility has not complied with the controlling state regulations, which require the Nursing Transfer and Discharge notice to be signed by the resident’s physician or medical director or include a written order for discharge or transfer by the resident’s physician. 42 C.F.R. § 483.12 (a)- 14N-00166

The respondent was not permitted to discharge the petitioner where the respondent’s reason for discharge was that the petitioner’s needs could not be met at the nursing facility. The respondent argued that the petitioner repeatedly violated the facility’s non-smoking policy, which was not held to be a valid reason to prove that the petitioner’s needs could not be met by the nursing facility. 42 C.F.R. § 483.12 (a)(2)- 11N-00199

The discharge was upheld where the respondent presented evidence of the attending physician’s order, which established that the petitioner’s needs cannot be met by facility. The petitioner’s health has improved sufficiently so that she no longer need the services provided by this facility, and the safety of others in the facility are endangered. 42 C.F.R. § 483.12 (a)(2)- 11N-00212

Discharge was upheld where the petitioner’s physician determined that the petitioner’s health had improved sufficiently so that the petitioner no longer needed the skilled services provided by the facility. 42 C.F.R. §483.12- 11N-00077

The discharge was upheld where the petitioner’s two doctors, physical therapist, care plan coordinator, the nursing facility’s executive director and administrator testified that the petitioner’s needs could be met at an assisted living facility. Also, a medical records consultant opined that the petitioner is able to perform her daily living activities independently with some staff supervision, and with limited staff assistance. 42 C.F.R. §483.12 (a)- 11N-00069

Discharge upheld where the petitioner hit and spit on the facility’s employees and the respondent asserted that the facility was not an appropriate facility for the 32 year old petitioner and that the petitioner should be with adults, not living in a setting with children. 42 C.F.R. §483.12 (a)- 11N-00047

The discharge was upheld where the petitioner expressed enormous dissatisfaction with the performance of physician and staff and the nursing facility had to overcome many obstacles in order to provide adequate care for the petitioner. Therefore, the facility could no longer meet the petitioner’s needs. 42 C.F.R. §483.12(a)(2)- 11N-00046

Discharge upheld where the facility indicated that the petitioner’s health improved and the petitioner no longer needed skilled nursing care. The petitioner’s mother argued that the petitioner did not have the finances to maintain an apartment, but there is nothing in the above controlling authorities that permits an individual to remain in a skilled nursing facility due to not having financial means in ALF settings. Therefore, the discharge was deemed to have met the requirements of the federal regulations and was upheld. Fla. Stat. §400.0255, 42 C.F.R. § 483.12(a)(2)- 11N-00012

The respondent decision to discharge the petitioner was affirmed where the petitioner was in need of additional psychiatric care and the petitioner’s needs would be better met at another facility with either a dementia unit or on site psychiatric care. 42 C.F.R. § 483.12(a)(2)(i)- 11N-00006

Discharge upheld where the facility determined that the petitioner’s health had improved sufficiently so that the petitioner no longer needed the skilled services provided by the facility. 42 C.F.R. §483.12(3)(v)(i), Fla. Stat. 400.0255(8)- 10N-00191

Discharge upheld where the petitioner was diagnosed with dementia of the Alzheimer’s type with episodes of aggression and the respondent demonstrated that the petitioner required more care than normally provided by the facility. 42 C.F.R. §483.12(a)(2)(i), Fla. Stat. 400.0255(8)- 10N-00196

The petitioner’s discharge was upheld where the petitioner had incidents of falls, restlessness and bouts of agitation caused by the petitioner’s dementia. The facility agreed to transfer the petitioner to an appropriate facility that could provide for the petitioner’s needs. 42 C.F.R. §483.12(a)(2)(i), 42 C.F.R. §483.12(3)- 11N-00023

Discharge upheld where the petitioner indicated a need or desire to smoke when facility staff was not present to supervise the petitioner. It was concluded that the petitioner’s needs could not be met by the respondent’s facility. 42 C.F.R. §483.12(a)(2)(i), 400.0255 (7)(a)- 10N-00199

The petitioner’s discharge was not justified where the petitioner’s unusual behavior and personal preferences presented significant challenges for the facility, but did not demonstrate the facility’s inability to meet needs. 42 C.F.R. §431.200, 42. C.F.R. §483.12(a)(2)- 11N-00024

Discharge upheld where the facility determined that the petitioner’s health had improved sufficiently when the petitioner was able to perform her own activities of daily living and did not require any skilled nursing care. 42 C.F.R. §483.12(a)(2)(ii)- 11N-00035

The Department is not a party to these proceedings, as the matter is one between two parties and the individual’s substantial interest has not been affected by Departmental action, 42 C.F.R. § 431.200, 42 C.F.R. § 483.12(a)- 09N-00085

The Petitioner’s representative agreed with the facility that discharge was appropriate because Petitioner’s needs could no longer be met, therefore the appeal is dismissed, 42 C.F.R. § 431.200, 42 C.F.R. § 483.12(a)- 09N-00085

Discharge was within federal regulations where petitioner was verbally aggressive and refused to participate in care. Arrest of petitioner for threats to staff did not render discharge void for failure to ensure safe and orderly transfer or discharge, 42 C.F.R. § 483.12- 09N-00157

Petitioner needs greater security because of behavioral problems. Despite family’s concern over discharge facility, federal regulations require only that the discharge location has a secure section and is appropriately licensed. Appeal denied, 42 C.F.R. § 483.12- 09N-00183

Appeal denied. Petitioner engaged in repeated verbal altercations with facility staff and his roommates. Facility was unable to place a roommate with Petitioner and unable to carry out the plan of care due to his refusal to comply. Discharge was appropriate, 42 C.F.R. § 483.12- 09N-00190

The discharge notice was denied when the respondent failed to prove by clear and convincing evidence that the petitioner’s needs could not be met. The totality of the evidence demonstrated that the petitioner’s needs could not be met. Therefore, respondent has met the respondent’s clear and convincing burden by proving that the proposed discharge complies with Federal Regulations. 42 C.F.R. § 483.12(a)(2)- 14N-11

The discharge notice was denied when the respondent failed to prove by clear and convincing evidence that the petitioner’s needs could not be met. The totality of the evidence demonstrated that the petitioner’s needs could not be met. Therefore, respondent has met the respondent’s clear and convincing burden by proving that the proposed discharge complies with Federal Regulations. 42 C.F.R. § 483.12(a)(2)- 14N-0086

The discharge notice was denied when the respondent failed to prove by clear and convincing evidence that the petitioner’s needs could not be met. The totality of the evidence demonstrated that the petitioner’s needs could not be met. The Department found that the discharge was appropriate, as the safety of another resident was endangered and the petitioner no longer required skilled care. Also, the Department found that the petitioner’s placement in an assisted living facility was more appropriate for the petitioner’s needs. Therefore, respondent has met the respondent’s clear and convincing burden by proving that the proposed discharge complies with Federal Regulations. 42 C.F.R. § 483.12(a)(2)- 14N-0022

The discharge notice was denied when the respondent failed to prove by clear and convincing evidence that the petitioner’s needs could not be met. The totality of the evidence demonstrated that the petitioner’s needs could not be met. The evidence presented showed that the petitioner’s health had improved sufficiently so that the petitioner no longer needed the services provided by the facility. Therefore, respondent has met the respondent’s clear and convincing burden by proving that the proposed discharge complies with Federal Regulations. 42 C.F.R. § 483.12(a)(2)- 14N-0066

The discharge notice was denied when the respondent failed to prove by clear and convincing evidence that the petitioner’s needs could not be met. The totality of the evidence demonstrated that the petitioner’s needs could not be met. Therefore, respondent has met the respondent’s clear and convincing burden by proving that the proposed discharge complies with Federal Regulations. 42 C.F.R. § 483.12(a)(2)- 15N-00047

The discharge was not upheld when the hearing officer found that the respondent’s suspicion that the petitioner was supplying other residents with alcohol was not substantiated with sufficient evidence to conclude that such is the case. Therefore, the hearing officer concluded that the Respondent had not established by standard of clear and convincing evidence that the health and safety of other residents is endangered at this time. 42 C.F.R. § 483.12(a)(2)(iii)- 15N-00005

The discharge was reversed where the totality of the evidence demonstrates that either the petitioner nor her representative (her son) was given reasonable and appropriate notice to pay, as to the only bill for services that was submitted into evidence. Therefore, the hearing officer does not uphold the respondent’s intention to discharge the petitioner at this time. 42 C.F.R. § 483.12(a)(2)(iii)- 14N-0164

The discharge was upheld when the Petitioner was notified by telephone that his wife was going to the hospital. Therefore, the discharge was proper and as the petitioner is no longer a resident of the respondent’s facility; the issue now becomes admission to the facility. 42 C.F.R. § 483.12(a)(2)(iii)- 15N-00001

The discharge was reversed where the totality of the evidence demonstrates that either for both of the discharge reasons at issue in the appeal, requires a physician, nurse practitioner or physician’s assistance as a physician designee for approval of the discharge. In this case, there was no evidence of any of these designated individuals approving the discharge action. Therefore, the hearing officer does not uphold the respondent’s intention to discharge the petitioner at this time. 42 C.F.R. § 483.12(a)(2)(iii)- 14N-00175

The discharge was not upheld when the nursing facility failed to establish by clear and convincing evidence that the petitioner’s needs could not be met and that the discharge is necessary for the petitioner’s welfare. 42 C.F.R. §483.12 (a)- 15N-00088

The discharge was not upheld when the nursing facility failed to establish by clear and convincing evidence that the petitioner’s needs could be met and that the discharge is necessary for the petitioner’s welfare. 42 C.F.R. §483.12 (a)- 15N-00103

Non-Payment of Bills

The discharge was upheld when the facility gave the petitioner reasonable and appropriate notice of the need to pay for the petitioner’s stay at the facility and the petitioner failed to pay the outstanding balance of the nursing facility bill. 42 C.F.R. § 483.12(a)(2)- 11N-00140

The discharge was upheld when the facility gave the petitioner reasonable and appropriate notice of the need to pay for the petitioner’s stay at the facility and the petitioner failed to pay his patient responsibility. 42 C.F.R. § 483.12(a)(2)- 11N-00146

The discharge was upheld where the facility gave the petitioner and the petitioner’s son reasonable and appropriate notice of the need to pay for the petitioner’s stay at the facility and the petitioner failed to pay the outstanding balance of the nursing facility bill. 42 C.F.R. § 483.12 (a)(2)- 11N-00167

The discharge was upheld where the facility gave the petitioner and the petitioner’s son reasonable and appropriate notice of the need to pay for the petitioner’s stay at the facility and the petitioner‘s son claimed to be unaware that he was obligated to send her Social Security payments to the facility. 42 C.F.R. § 483.12 (a)(2)- 11N-00172

The discharge was upheld where the facility gave the petitioner and the petitioner’s son reasonable and appropriate notice of the need to pay for the petitioner’s stay at the facility by mailing the bill to the petitioner’s son’s home. The petitioner’s son failed to pay the outstanding balance of the nursing facility bill. 42 C.F.R. § 483.12 (a)(2)- 11N-00176

The discharge was upheld where the facility gave the petitioner’s representative reasonable and appropriate notice of the need to pay for the petitioner’s stay at the facility by notifying the petitioner’s representative numerous times in writing and verbally of the outstanding balances. 42 C.F.R. § 483.12 (a)(2)- 11N-00181

The discharge was upheld where the facility gave the petitioner reasonable and appropriate notice of the need to pay for the petitioner’s stay at the facility by mailing the bill to the petitioner. 42 C.F.R. § 483.12 (a)(2)- 11N-00202

The discharge was upheld where the facility gave the petitioner reasonable and appropriate notice of the need to pay for the petitioner’s stay at the facility by mailing two billing statements to the petitioner. 42 C.F.R. § 483.12 (a)(2)- 11N-00203

The discharge was upheld where the facility gave the petitioner reasonable and appropriate notice of the need to pay for the petitioner’s stay at the facility by mailing monthly billing statements to the petitioner, engaging in numerous conversations with the petitioner regarding his outstanding balance and meeting with the petitioner and a representative from Ombudsman Program to discuss the outstanding balance and discharge notice. 42 C.F.R. § 483.12 (a)(2)- 11N-00210

The discharge was upheld where the facility gave the petitioner’s husband reasonable and appropriate notice of the need to pay for the petitioner’s stay at the facility by notifying the petitioner’s representative numerous times in writing and verbally of the outstanding balances. 42 C.F.R. § 483.12 (a)(2)- 11N-00214

The discharge was upheld where the petitioner failed to pay the nursing facility bill after the facility gave the petitioner and the petitioner’s family reasonable and appropriate notice of the need to pay for the petitioner’s room, board and care. 42 C.F.R. §483.12(a)(2)(i)- 11N-00127

The discharge was upheld where the petitioner did not pay the nursing facility bill after the petitioner’s brother/trustee failed to use the funds in the petitioner’s trust to pay the nursing facility bill. 42 C.F.R. §483.12(a)(2)(i)- 11N-00120

The discharge was upheld where the petitioner failed to pay the nursing facility bill after the facility gave the petitioner and the petitioner’s granddaughters reasonable and appropriate notice of the need to pay for the petitioner’s room, board and care. 42 C.F.R. §431.200 (15)(b), 42. C.F.R. §483.12 (a)(2)- 11N-00094

The discharge was upheld where the petitioner’s billing statements were sent to the petitioner and the petitioner failed to pay the outstanding balance of the nursing facility bill. 42 C.F.R. §431.200 (15)(b), 42. C.F.R. §483.12 (a)(2)- 11N-00102

The discharge was upheld where the hearing officer concluded that the facility had given the petitioner reasonable and appropriate notice of the need to pay for the petitioner’s stay at the facility and a reasonable and adequate financial arrangement did not result after the petitioner was given notice. Fla. Admin. Code §65A-1.701(23)- 11N-00084

The discharge was upheld where the petitioner’s billing statements were sent to the petitioner and the petitioner’s husband and the petitioner’s husband failed to pay the outstanding balance of the nursing facility bill. 42 C.F.R. §483.12(a)- 11N-00075

The discharge was upheld where the petitioner’s billing statements were sent to the petitioner and the petitioner’s representative failed to pay the outstanding balance of the nursing facility bill. Fla. Stat. 400.0255, 42 C.F.R. §483.12(a)(2)(v)- 11N-00053

Discharge upheld where the petitioner’s billing statements were sent to the petitioner’s son and the petitioner’s son failed to pay the outstanding balance of the nursing facility bill. Fla. Stat. 400.0255(15)(b), 42. C.F.R. §483.12- 11N-00027

Discharge upheld where the petitioner’s billing statements were sent to the petitioner’s personal representative and the petitioner failed to pay the nursing facility bill after the private-pay room and board rate were increased. The discharge was upheld due to non-payment, but the hearing officer noted that the respondent was not compelled to discharge the petitioner and that the respondent may make a suitable payment arrangement with the petitioner. 42 C.F.R. 431.200, 483.12(a)(2)(v)- 11N-00038

Discharge upheld where the petitioner failed to pay the outstanding balance of the nursing facility bill after the facility’s administrator left multiple voice messages with petitioner’s representative over a three month period and submitted a letter to petitioner’s representative indicating petitioner’s overdue balance. 42 C.F.R. §483.12(a)- 11N-00109

The discharge was upheld where the nursing facility met all the notice requirements for informing the petitioner of the payments that were due. Also, the petitioner made no payments to the nursing facility and there was no indication that the petitioner was ICP Medicaid eligible. 42 C.F.R. §483.12(a)- 11N-00045

Discharge upheld where the evidence showed that the petitioner failed to pay the facility after the respondent sent the petitioner and her family reasonable and appropriate notice of the need to pay for the petitioner’s stay at the facility. 11N-00009

Discharge upheld where the petitioner’s billing statements were sent to the petitioner’s sister who had power-of-attorney and was the petitioner’s representative. The representative’s receipt of the billing statements provided reasonable notice to the petitioner. 42 C.F.R. §483.12(a)(2)(v), Fla. Stat. 400.0255(15)(b)- 10N-00149

The respondent’s decision to discharge the petitioner was upheld where the petitioner’s billing statements were sent to the petitioner’s family member and the petitioner failed to pay the nursing facility bill. 42 C.F.R. §483.12(a)(2)(v), Fla. Stat. 400.0255(15)(b)- 10N-00168

Discharge upheld where the petitioner’s billing statements were sent to the petitioner and her son and the petitioner failed to pay the outstanding balance of the nursing facility bill. 42 C.F.R. §483.12(a)(2)(v), Fla. Stat. 400.0255(15)(b)- 10N-00181

Discharge upheld where the petitioner’s billing statements were sent to the petitioner and her family and the petitioner failed to pay the outstanding balance of the nursing facility bill. 42 C.F.R. §483.12(a)(2)(v), Fla. Stat. 400.0255(15)(b)- 10N-0182

The petitioner’s appeal was denied where the respondent incorrectly enrolled the petitioner in Medicaid ICP without removing the petitioner from the Nursing Home Diversion Medicaid Long Term Care Waiver Program. Therefore, the hearing officer had no remedy for the Department’s error because American Eldercare was potentially eligible for the payment to the nursing facility. Fla. Admin. Code §58N-1.009- 11F-06032

The respondent’s decision to discharge the petitioner was upheld where the petitioner’s billing statements were sent to the petitioner’s family member and the petitioner made a payment of $5 a month to the nursing facility, which is not a reasonable or adequate payment. Fla. Admin. Code 65A-1.701, Fla. Admin. Code 65-2.046- 11N-00016

Discharge upheld where the petitioner’s billing statements were sent to the petitioner and the petitioner failed to pay the outstanding balance of the nursing facility bill. The location for the discharge was the petitioner’s friend house, which was an unsafe location. The discharge was still upheld due to nonpayment, despite the unsafe discharge location. 42. C.F.R. §483.12(a)(2)(v)- 11N-00019

Discharge upheld where the petitioner’s billing statements were sent to the petitioner’s daughter and the petitioner’s daughter failed to pay the outstanding balance of the nursing facility bill. 42 C.F.R. §483.12(a)(2)(v), Fla. Stat. 400.0255(15)(b)- 10N-00205

Discharge upheld where the petitioner’s billing statements were sent to the petitioner’s step-daughter and the petitioner’s step-daughter failed to pay the outstanding balance of the nursing facility bill 42 C.F.R. §483.12(a)(2)(v), Fla. Stat. 400.0255(15)(b)- 10N-00211

Partial payment insufficient to prevent discharge after 4 months of non-payment, 09N-00101

Discharge upheld where non-payment resulted from cancellation of ICP Medicaid after petitioner suspended naturalization process due to stroke. Failure to pay for 8 months of nursing home care after reasonable and appropriate notice is not resolved by reprisal of naturalization efforts, 42 C.F.R. § 483.12- 09N-00105

Proper discharged occurred when patient failed to pay bills after reasonable and appropriate notice despite difficulties applying for ICP eligibility, 42 C.F.R. § 483.12- 09N-00106

Discharge was appropriate when Petitioner failed to pay bills after reasonable and appropriate notice where petitioner’s daughter claims she was advised by her counsel not to pay until the ICP Medicaid application was approved, 42 C.F.R. § 483.12, Fla. Stat. § 400.0255(15)(b)- 09N-00089

Discharge was appropriate when Petitioner failed to pay bills after reasonable and appropriate notice even though family emergencies prevented opening of the account statement, 42 C.F.R. § 483.12, Fla. Stat. § 400.0255(15)(b)- 09N-00094

Since Petitioner removed ALF as payee of his social security benefits and became payee himself, Petitioner has failed to pay his patient responsibility. Therefore, discharge was proper because reasonable and appropriate notice was given, 42 C.F.R. § 483.12(a)(2)(v)- 09N-00064

Discharge for failure to pay was appropriate where respondent never received verification of termination of alimony payments, Petitioner’s sole income source. Hearing concerned whether the facility had met burden of proof under clear and convincing standard and did not concern who was at fault for failure to pay, 42 C.F.R. § 483.12, Fla. Stat. § 400.0255(15)(b), DCF Online Policy Manual, 165-22, s. 0640.0107 and 0640.0109 Designated Representatives (MSSI)- 09N-00081

Discharge was appropriate under federal regulations with regard to notice and justification. Hearing officer has no jurisdiction over appropriateness of discharge location, 42 C.F.R. § 483.12(a)(2)- 09N-00150

Petitioner’s son received reasonable and appropriate notice of the failure to pay. Discharge was upheld despite the respondent never having examined the discharge location, son’s home, for compliance with safety and other regulations. 42 C.F.R. § 483.12- 09N-00137

Discharge is upheld where facility met burden of proof that the discharge complied with federal regulations, 42 C.F.R. § 483.12(a)- 09N-00140

Petitioner failed to pay after reasonable and appropriate notice. Appeal denied despite, the pending Medicaid application and husband’s claim that nursing home stay was extended after Petitioner fell and broke her hip, 42 C.F.R. § 483.12, Fla. Stat. § 400.0255- 09N-00142

Discharge was within the federal regulations where facility gave multiple notices, even though, Petitioner made some payments and Petitioner’s wife wanted to work out a payment plan, 42 C.F.R. § 483.12- 09N-00154

Federal regulations do not make exceptions, whereby a resident could remain after failing to pay his bill after reasonable and appropriate notice. Discharge was appropriate, despite allegations of trustee misconduct, 42 C.F.R. § 483.12(a)- 09N-00153

Petitioner made only partial payments to respondent because other medical bills were paid out of the same fixed income. Discharge was appropriate where remainder of bill was not paid after reasonable and appropriate notice, 42 C.F.R. § 483.12(a)- 09N-00133

Original notice to discharge for failure to pay did not contain discharge date. Second, corrected notice met federal requirements for reasonable and appropriate notice. Appeal denied, 42 C.F.R. § 483.12- 09N-00148

Petitioner was discharged in accordance with federal regulations despite his pending DCF Institutional Care Program application. Federal regulations do not address excusable situations, 42 C.F.R. § 483.12(a)- 09N-00179

Petitioner made only partial payments of ICP patient liability, even after receiving regular billing statements. Therefore, reasonable and appropriate notice was given and discharge is appropriate, 42 C.F.R. § 483.12(a)(2)(v)- 09N-00176

Appeal denied. Discharge was appropriate after reasonable and appropriate notice of an outstanding balance. Medicaid denial based on non-citizen status does not alter Petitioner’s indebtedness. Appropriateness of discharge location is not a matter to be considered at discharge hearing, under federal regulations, 42 C.F.R. § 483.12(a)(2)- 09N-00164

After the discharge notice was issued, Petitioner was approved for Medicaid ICP and Petitioner’s son significantly reduced outstanding debt. The parties agreed on a payment plan, which rendered the discharge moot, 42 C.F.R. § 483.12- 09N-00186

Petitioner was capable of functioning without skilled nursing. Therefore, a Medicare non-coverage notice was issued. Petitioner chose to stay in facility and was eligible for Medicaid, but failed to divert his income to the facility to satisfy patient responsibility. Discharge for failure to pay was proper. Alternative rationale for discharge, no longer needs service, was not reached, 42 C.F.R. § 483.12(a)(2)- 09N-00210

Discharge was appropriate where Petitioner knew of obligation, but failed to pay patient responsibility during the Medicaid reapplication process, 42 C.F.R § 483.12(a)- 09N-00177

Discharge appropriate where facility has not been paid after reasonable and appropriate notice. Lack of funds or medicaid application do no defeat discharge, 42 C.F.R § 483.12(a)(2)- 09N-00211

Discharge was appropriate under the federal guidelines. Discharge hearing is not the correct forum in which to reach safety of discharge location, 42 C.F.R. § 483.12(a)- 09N-00203

Appeal denied. Respondent decreased Petitioner’s outstanding balance to reflect her Medicaid authorization. Petitioner failed to pay the new balance, despite reasonable and appropriate notice, 42 C.F.R. § 483.12(a)(2)(v)- 09N-00218

Appeal moot. During the hearing, the parties entered into a repayment agreement, which was later entered into the record.- 10N-00011

In order for a discharge to be lawful, the nursing home must prove that the discharge is lawful and the nursing home must provide a discharge plan. The facility’s decision to discharge the petitioner was upheld when the facility provided evidence that the discharge was proper. The facility gave the petitioner reasonable and appropriate notice of the need to pay for the petitioner’s stay at the facility and the petitioner failed to pay the outstanding balance of the nursing facility bill. 42 C.F.R. § 483.12(a)(2)- 14N-0004

In order for a discharge to be lawful, the nursing home must prove that the discharge is lawful and the nursing home must provide a discharge plan. The facility’s decision to discharge the petitioner was upheld when the facility provided evidence that the discharge was proper. The facility gave the petitioner reasonable and appropriate notice of the need to pay for (or have paid under Medicare or Medicaid) the petitioner’s stay at the facility and the petitioner failed to pay the outstanding balance of the nursing facility bill. 42 C.F.R. § 483.12(a)(2)- 14N-0058

In order for a discharge to be lawful, the nursing home must prove that the discharge is lawful and the nursing home must provide a discharge plan. The facility must also give the petitioner reasonable and appropriate notice of the need to pay. The facility’s decision to discharge the petitioner was upheld when the facility provided evidence that the discharge was proper. The facility gave the petitioner reasonable and appropriate notice of the need to pay for the petitioner’s stay at the facility and the petitioner failed to pay the outstanding balance of the nursing facility bill. 42 C.F.R. § 483.12(a)(2)- 14N-0014

In order for a discharge to be lawful, the nursing home must prove that the discharge is lawful and the nursing home must provide a discharge plan. The facility’s decision to discharge the petitioner was upheld when the facility provided evidence that the discharge was proper. The facility gave the petitioner reasonable and appropriate notice of the need to pay for (or have paid under Medicare or Medicaid) the petitioner’s stay at the facility and the petitioner failed to pay the outstanding balance of the nursing facility bill. 42 C.F.R. § 483.12(a)(2)- 14N-0026

In order for a discharge to be lawful, the nursing home must prove that the discharge is lawful and the nursing home must provide a discharge plan. The facility must also give the petitioner reasonable and appropriate notice of the need to pay(or have paid under Medicare or Medicaid) for the petitioner’s stay. The facility’s decision to discharge the petitioner was upheld when the facility provided evidence that the discharge was proper. The facility gave the petitioner reasonable and appropriate notice of the need to pay for the petitioner’s stay at the facility and the petitioner failed to pay the outstanding balance of the nursing facility bill. 42 C.F.R. § 483.12(a)(2)- 14N-0028

In order for a discharge to be lawful, the nursing home must prove that the discharge is lawful and the nursing home must provide a discharge plan. The facility’s decision to discharge the petitioner was upheld when the facility provided evidence that the discharge was proper. The facility gave the petitioner reasonable and appropriate notice of the need to pay for (or have paid under Medicare or Medicaid) the petitioner’s stay at the facility and the petitioner failed to pay the outstanding balance of the nursing facility bill. 42 C.F.R. § 483.12(a)(2)- 15F-000076

In order for a discharge to be lawful, the nursing home must prove that the discharge is lawful and the nursing home must provide a discharge plan. The facility’s decision to discharge the petitioner was not upheld when the facility failed to wait until the Medicaid application was disposed of. Also, the petitioner was not given adequate notice of any amounts due after any possible reductions as a result of payments from Medicaid. 42 C.F.R. § 483.12(a)(2)- 14N-0081

In order for a discharge to be lawful, the nursing home must prove that the discharge is lawful and the nursing home must provide a discharge plan. The facility’s decision to discharge the petitioner was upheld when the facility provided evidence that the discharge was proper. The facility gave the petitioner reasonable and appropriate notice of the need to pay for (or have paid under Medicare or Medicaid) the petitioner’s stay at the facility and the petitioner failed to pay the outstanding balance of the nursing facility bill. 42 C.F.R. § 483.12(a)(2)- 14N-0093

The discharge was upheld where the facility gave the petitioner reasonable and appropriate notice of the need to pay for the petitioner’s stay at the facility and a reasonable and adequate financial arrangement did not result after the petitioner was given notice of the overdue payment. 42 C.F.R. § 431.200 (15)(b), 42. C.F.R. § 483.12 (a)(2)- 15N-00017

The discharge was upheld where the facility gave the petitioner reasonable and appropriate notice of the need to pay for the petitioner’s stay at the facility and a reasonable and adequate financial arrangement did not result after the petitioner was given notice of the overdue payment. 42 C.F.R. § 431.200 (15)(b), 42. C.F.R. § 483.12 (a)(2)- 14N-00168

The Respondent’s intention to discharge the Petitioner was upheld where the respondent met the standard of clear and convincing evidence in its position. Therefore, at the hearing, the hearing officer upheld the Respondent’s intention to discharge the facility at this time. 42 C.F.R. §431.200 (15)(b), 42. C.F.R. §483.12 (a)(2)- 15N-0065

The Respondent’s intention to discharge the Petitioner was not upheld when the evidence showed that the petitioner may have been noncooperative with her attending physician, which resulted in the respondent’s decision that it could no longer meet the petitioner’s needs. Therefore, at the hearing, the hearing officer granted the Petitioner’s appeal. 42 C.F.R. §431.200 (15)(b), 42. C.F.R. §483.12 (a)(2)- 15N-0077

The discharge was not upheld when the evidence showed that the Petitioner had a pending ICP Medicaid application. Therefore, the discharge is premature and the Respondent must wait until the August 26, 2015 ICP Medicaid application is processed before proceeding with this discharge action. 42. C.F.R. §483.12 (a)(2)- 15N-0079

The Respondent’s intention to discharge the Petitioner for non-payment was upheld where the respondent met the standard of clear and convincing evidence in its position. Therefore, at the hearing, the hearing officer upheld the Respondent’s intention to discharge the facility at this time. 42 C.F.R. §431.200 (15)(b), 42. C.F.R. §483.12 (a)(2)- 16N-00044

The discharge was not upheld when the evidence showed that the Petitioner had not received a denial notice. Therefore, the discharge is premature and the Respondent must wait until the Department of Children and Families receives denial notice for Petitioner’s ICP benefits. 42. C.F.R. §483.12 (a)(2)- 15N-00094

Health Improved; No longer needs service

Discharge met federal guidelines, despite notice being given on same date as effective discharge, because Petitioner no longer meets level of services provided by facility, physician’s written order was attached and notice provided location, 42 C.F.R. § 483.12(a)(2)- 09N-00093

Facility Ceases to Operate
Faulty Notice

Petitioner displayed disruptive behavior and needed more stimulation than the current facility could provide. However, notice of discharge was not signed by physician nor was a physician’s order attached. The requirements for discharge have not been met; appeal granted, 42 C.F.R. § 483.12- 09N-00074

Acronym Key

ADC

Adult Day Care

ADL

Activities of Daily Living

ALF

Assisted Living Facility

BSCIP

Brain and Spinal Cord Injury Program

C.F.R.

Code of Federal Regulations

DME

Durable Medical Equipment

F.A.C

Florida Administrative Code

HHA

Home Health Aid

ICP

Independent Care Provider

PCA

Personal Care Assistance

PDN

Private Duty Nurse

POV

Power-operated vehicle

PPEC

Prescribed Pediatric Extended Care

QIT

Qualified Income Trust

SIPP

Statewide Impatient Psychiatric Program

SSA

Social Security Administration