Under federal nursing home discharge rules at 42 CFR Part 483, a facility that takes Medicare or Medicaid can only transfer or discharge you involuntarily for one of six specific reasons, and it has to follow strict steps on written notice, physician documentation, and appeal rights before it can move you. If any of those steps are missing, the discharge is improper, and a timely appeal freezes it in place while you challenge it.
The Only Six Reasons a Facility Can Discharge You
A nursing home cannot push you out because you are difficult, because your family complains, or because it wants your bed for a higher-paying resident. Federal law limits involuntary discharge to these situations:
- The facility cannot meet your needs, and it has documented specific attempts to do so.
- Your health has improved to the point that you no longer need the facility’s services, which is common after short-term rehabilitation.
- Your clinical or behavioral status endangers the safety of others in the facility.
- Your condition endangers the health of others, such as certain communicable diseases.
- You have failed to pay after reasonable notice. This includes situations where a third-party payer denies a claim and you refuse to pay, or you fail to submit paperwork needed for third-party coverage. If you become Medicaid-eligible after admission, the facility can only charge you what Medicaid allows.
- The facility is closing entirely.
If the reason on your discharge notice does not fit squarely inside one of those six, the discharge is improper on its face. That is the first thing to check.
The Written Notice You Are Entitled To
Before any involuntary discharge, the facility has to give you and your representative a formal written notice, in a language and manner you can understand. A copy goes to the State Long-Term Care Ombudsman at the same time.
In most cases the notice has to arrive at least 30 days before the planned discharge date. Shorter notice is only allowed when your health has improved enough for immediate discharge, when your medical needs require an urgent transfer the facility cannot provide, or when the safety or health of others is endangered. Even then, notice has to come as soon as practicable before the move, not after.
The notice itself must include:
- The specific reason for the transfer or discharge.
- The effective date.
- The location you are being moved to.
- A statement of your appeal rights, including the name, mailing address, email, and phone number of the entity that handles appeals, plus instructions on how to get and submit an appeal form.
- The name, mailing address, email, and phone number of the State Long-Term Care Ombudsman.
- For residents with intellectual or developmental disabilities, contact information for the state’s protection and advocacy agency under the Developmental Disabilities Assistance and Bill of Rights Act.
- For residents with mental disorders, contact information for the state’s protection and advocacy agency under the Protection and Advocacy for Mentally Ill Individuals Act.
A notice missing any of these items is deficient. Deficient notices are one of the most common issues surveyors cite, and they can be grounds for overturning the discharge on appeal. If yours is incomplete, tell the Ombudsman right away.
What the Facility Must Have in Your Medical Record
The reason on the notice is not enough by itself. The basis for discharge has to be documented in your medical record, and the requirements shift with the reason.
When the facility says it cannot meet your needs, the record has to spell out which needs specifically, what the facility tried, and what services the receiving facility offers that fill the gap. Your attending physician has to complete that documentation. The same physician-documentation requirement applies when discharge is based on health improvement. When the reason is a health or safety danger to others, a physician has to document the basis, though it does not have to be your own attending physician.
The facility also has to send the receiving provider your practitioner’s contact information, your representative’s contact information, any advance directive instructions, special care precautions, your comprehensive care plan goals, and a copy of your discharge summary.
Missing signatures, thin documentation of what the facility tried, and gaps in the record all weaken the facility’s case at a hearing. Ask for a copy of your record early.
Your Right to Return After a Hospital Stay
Facilities sometimes tell residents on hospital transfer or therapeutic leave that their bed is gone. That is not how the rule works.
Before any transfer, the facility must give you written information about your right to return, covering the duration of any state bed-hold policy (if your state’s Medicaid plan includes one), the state’s reserve bed payment policy, and the facility’s own bed-hold rules. A second written notice restating those terms goes out at the time of the transfer itself.
If your hospital stay or leave runs past the bed-hold period, the facility still has to take you back when you are ready, as long as you need its services and remain eligible for Medicare SNF or Medicaid nursing facility coverage. You get your previous room if it is available, or the first available semi-private bed. If the facility decides you cannot return, that decision is an involuntary discharge, and it has to run through the full formal process: written notice, appeal rights, everything above.
How to Appeal and Stop the Move
You have the right to appeal any involuntary transfer or discharge, and one rule is universal across every track: a timely appeal freezes the discharge. The facility cannot move you while it is pending.
State Administrative Hearings
For discharge disputes that do not involve a Medicare coverage denial, you file with your state’s administrative hearing body, usually tied to the State Survey Agency. Deadlines vary by state but generally fall somewhere between 10 and 90 days after you receive the notice. File before the planned discharge date. That is what triggers the stay.
While the appeal is pending, the facility is barred from discharging you unless it can document that letting you stay would endanger your health or safety, or the health or safety of others. The burden of proving that danger is on the facility.
At the hearing, the facility has to justify the discharge. This is where thin documentation and defective notices matter. If the facility never had a physician sign what it needed signed, never documented its attempts to meet your needs, or left required information off the notice, those failures are your argument.
Medicare Coverage Appeals
If you are a Medicare beneficiary and the facility tells you Medicare will no longer cover your stay, a separate expedited process applies. You can request an immediate review by the Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO), an independent reviewer that operates outside the facility and outside Medicare’s payment system.
The BFCC-QIO has to issue its decision by close of business the day after it gets the information it needs. File on time and you can stay in the facility during the review without owing more than your usual coinsurance or deductibles. Miss the deadline and you can still ask for a review, but you may be on the hook for costs after the facility’s original planned discharge date.
If the BFCC-QIO rules against you, the next step is expedited reconsideration by a Qualified Independent Contractor. You or your representative have to contact the QIC by noon of the calendar day after you receive the BFCC-QIO’s decision. The QIC then has 72 hours to decide unless you request an extension of up to 14 additional days to gather records. You are financially responsible for continued-stay costs during this stage.
Who to Call for Help
The State Long-Term Care Ombudsman is more than a name printed on the notice. Under the Older Americans Act, the Ombudsman program represents resident interests before government agencies and works to protect residents’ rights. An Ombudsman representative can walk you through the appeal process, review your notice for deficiencies, examine your medical records, and help build your case. If you do not have an attorney, the representative may be able to present your case at the administrative hearing directly, with your consent. If you do have a lawyer, the Ombudsman can coordinate with them.
The Ombudsman’s contact information has to appear on every discharge notice. If you got one and are unsure what to do, that number is the right first call.
For violations of the discharge rules themselves, you can also file a complaint with your State Survey Agency. CMS maintains a directory of contact information for every state’s agency. A complaint can trigger a survey investigation, and if surveyors find the facility violated discharge requirements, the facility can face deficiency citations and, in serious or repeated cases, enforcement actions affecting its Medicare and Medicaid participation.
Separate rules apply when a facility is actually closing: the administrator has to submit written notice at least 60 days before closure to the State Survey Agency, the Ombudsman, and all residents, stop admitting new residents, and follow a state-approved plan for relocating every current resident to an appropriate setting.