Title: Section 1007.8 - Discharge

Section 1007.8 Discharge

(a) Discharge Planning.

(1) The medical respite program shall discharge recipients when they no longer qualify for medical respite services, as defined in section 1007.7(a) of this Part.

(2) If housing has not been identified when the recipient is ready for discharge, all housing packets and applications should be transferred to the recipient’s discharge location, which has agreed to continue to assist the recipient with securing permanent housing.

(3) The medical respite program shall begin discharge planning upon a recipient’s admission and shall engage in discharge planning throughout a recipient’s stay at the facility.

(4) In order to discharge a recipient, the medical respite program shall:

(i) Develop a discharge plan that identifies and provides referral to potential housing options, healthcare providers, and supportive services for the recipient;

(ii) Provide, at least 14 days advance written notice, of the discharge to the recipient, and as applicable and appropriate, the recipient’s managed care organization, referring entity or person, discharge location, health home, and family and caregivers, provided, any required authorization as set forth in section 1007.4(c) of this Part is obtained;

(iii) Coordinate the discharge with the recipient’s managed care organization, discharge location (e.g. shelter or housing provider, family member or friend’s home, etc.), the referring entity or person, as applicable, and if applicable, the health home, as described in section 1007.5(a)(3)(v) of this Part, provided, any required authorization as set forth in section 1007.4(c) of this Part is obtained;

(iv) Provide the recipient with the discharge summary, which shall comply with subdivision (b) of this section; and

(v) Comply with any other requirements established by the department.

(b) Discharge Summary.

(1) Upon discharge, a discharge summary shall be provided to the recipient, recipient’s primary provider, if applicable, the managed care organization and health home, and such other persons or entities requested by the recipient. The discharge summary must include the following:

(i) Written medication list and medication refill information (i.e., pharmacy), to the extent known;

(ii) Admitting diagnosis;

(iii) Length of stay in the medical respite program;

(iv) Ongoing medical problems or conditions, to the extent known;

(v) Instructions for accessing relevant resources in the community, including shelters or other housing options;

(vi) List of follow-up appointments and contact information for treating providers, to the extent known;

(vii) Special medical instructions (e.g., weight-bearing limitations, dietary precautions, allergies, wound orders), to the extent known;

(viii) Pain management plan, to the extent known; and

(ix) Primary point(s) of contact for the recipient.

(c) The medical respite program shall ensure that adequate protocols are in place for transferring a recipient’s information, or making available access to the recipients records, to appropriate providers, the recipient’s managed care organization, and health home, if applicable, in accordance with privacy and confidentiality laws and regulations and pursuant to any legally required authorization.

(d) Discharge.

(1) An operator of a medical respite program may discharge a recipient under the terms set forth in this Part, guidance, and the facility rules, when the recipient’s public or private payor no longer authorizes medical respite services, when funding is no longer available, when the recipient no longer qualifies for medical respite under section 1007.7 of this Part.

(2) A recipient may not be  discharged from a medical respite facility until the following procedures are observed:

(i) the recipient has been given written notice, by the operator of a medical respite program or the managed care organization, 14 days in advance of the discharge, which indicates the decision and of the reasons therefor; and for Medicaid enrollees, such notice shall include a statement that the recipient may request a fair hearing in which to challenge the discharge decision, and shall describe how a fair hearing may be requested and obtained;

(ii) the recipient’s need for protective services for adults, preventive services, or for other social services has been evaluated and an appropriate referral has been made, if necessary; and

(iii) if criminal activity may have occurred, the appropriate law enforcement agency has been contacted.

(3)(i) For Medicaid enrollees, a decision by an operator of a medical respite program to discharge a recipient may be challenged by the recipient or their representative in a fair hearing requested pursuant to Part 358 of Title 18 of the New York, Codes, Rules & Regulations (NYCRR), as applicable, and the recipient may have the right to receive aid continuing pursuant to 18 NYCRR section 358-3.6, if a fair hearing is timely requested pursuant to 18 NYCRR section 358-3.5.

(ii) A decision by a managed care organization to no longer authorize medical respite services may be challenged in accordance to applicable rules and guidance, including article 49 of the Public Health Law, 18 NYCRR Parts 358 and 360-10, and Sections 431 and 438 of Title 42 of Code of Federal Regulations.

(4) A recipient who is found upon internal appeal or fair hearing decision to have been wrongfully discharged from a medical respite program must be offered an opportunity to return to the facility as soon as an appropriate vacancy becomes available. No such opportunity may be offered if the recipient no longer meets the requirements for medical respite services.

(5) A recipient may be involuntarily discharged from a medical respite facility without advance written notice as described in paragraph (2)(i) of this subdivision if the basis for the discharge is that the recipient satisfies the requirement for immediate discharge pursuant to section 1007.7(b)(4)(v) of this Part or  has been absent from the facility for more than 48 hours without having complied with the facility’s rules concerning absences and has not been readmitted to the facility. The 48-hour period begins at the start of the period of the unauthorized absence. A written record of all unauthorized absences and involuntary discharges   must be maintained by the facility pursuant to sections 1007.14(c) and (d) of this Part.