CMS noted in the Letter that “discharge/eviction” was the most frequent nursing facility complaint category logged by Long-Term Care Ombudsman programs nationally in FY2015. CMS stated that the reasons for non-compliant discharges can vary but often are driven by payment concerns and behavioral/mental/emotional expressions or indications of resident distress.

To understand the full extent of the problem, CMS stated that it will be evaluating, at the CMS Regional Office (RO) level, all deficiencies precipitated by facility-initiated discharges. Specifically, it directed State survey agencies (SSAs) to transfer all cases “involving facility initiated discharge violations to the CMS RO for review where there is placement in a questionable or unsafe setting, where residents remain hospitalized, where there is a facility pattern or other circumstances that the RO may identify of cases they would like transferred.”

Additionally, the agency stated that it is considering a variety of interventions to combat the problem, including surveyor and provider training, intake and triage training, CMP-funded projects that may help prevent facility-initiated discharges that violate federal regulations, and enforcement.

CMS has asked States for proposals of projects to address improper facility-initiated discharges, including but not limited to, the following:

  • Residents’ rights education;
  • Teams of health professionals to provide immediate support to facilities around the state to reduce risk of harm to self or other when a resident is exhibiting expressions or indications of distress;
  • Facility staff education on best practices for engaging residents in collaborative strategies to reduce resident distress; and
  • Formation and support of a collaborative group to focus on nursing home issues.

The changes announced in the Letter took effect immediately.