Connecticut Long Term Care Ombudsman Program

Admission and Discharge - SNF

Admissions, Discharges, Waiting Lists, and Third-Party Guarantees

This page explains your rights about nursing home admissions, deposits, waiting lists, discharges, Medicare coverage, and when a facility asks family to sign as a “third-party guarantee.” It also provides links to resources and advocacy organizations that can help.

Table of Contents

Deposits and Advance Payments

For Medicaid applicants and recipients: If you are already on Medicaid, nursing homes cannot request any deposit or advance payment. See Connecticut General Statutes § 19a-550(b)(24)-(26) in the Patients’ Bill of Rights.

If you have applied for Medicaid and are waiting for a decision, the nursing home may request a deposit of no more than $1,500. This deposit must be held for your benefit and returned when Medicaid eligibility is confirmed. This is described in Connecticut General Statutes § 19a-560(b)(3)(A-C) on advance payments and deposit requirements.

You also have federal rights about being informed in writing of services and charges and about fair admission and discharge rules. For more detail, see 42 CFR § 483.10 (resident rights) and 42 CFR § 483.15 (admission, transfer, and discharge rights).

For a plain-language explanation of admissions, deposits, and waiting lists, visit the CT Law Help guide “Admissions, Waiting Lists, Contracts, and Deposits”.

Relevant Laws and Resources

Admissions and Waiting Lists

Nursing homes that participate in Medicaid must follow fair admission and waiting list practices. They must keep dated application and waiting lists where required and may not discriminate against you because of your financial circumstances. These protections are spelled out in Connecticut General Statutes § 19a-533.

Facilities must manage their waiting lists in a consistent, transparent way and keep records of when applications are received and how admissions decisions are made. The detailed rules are located in Connecticut Regulations §§ 17-311-200 to 17-311-209.

For more detail in plain language about admissions and waiting lists, see the CT Law Help guide “Admissions, Waiting Lists, Contracts, and Deposits”.

Key Statutes and Regulations

Third-Party Payment Guarantees

Facilities cannot require a third-party guarantee of payment as a condition for admission, expedited admission, or continued stay. This protection comes from 42 CFR 483.15(a)(3).

A resident representative who has legal access to the resident’s income or resources can be asked to sign an agreement to use those resident funds to pay for care, but the representative cannot be made personally liable for the debt. The federal rule is quoted in 42 CFR 483.15(a)(3).

Fact sheets from national consumer organizations explain how to spot illegal “responsible party” clauses and what to do if a nursing home or debt collector tries to make you pay someone else’s nursing home bill.

Relevant Resources

Involuntary Discharges, Hearings, and Appeals

Being told you must leave a nursing home can feel scary and stressful for both residents and families. Sometimes, a nursing home may try to transfer or discharge a resident because the resident needs more care, is having difficulties, or because family members ask questions or complain. The Nursing Home Reform Law of 1987 and federal regulations say a nursing home cannot transfer or discharge a resident unless there is a valid reason.

Allowed Reasons for Transfer or Discharge

A Medicare- or Medicaid-certified nursing home may only transfer or discharge a resident for the specific reasons listed in federal law, including:

  • The facility cannot meet the resident’s needs, even after trying reasonable accommodations.
  • The resident’s health has improved so that nursing facility care is no longer needed.
  • The safety of individuals in the facility is endangered.
  • The health of individuals in the facility would otherwise be endangered.
  • The resident has not paid (or arranged for payment) for care after reasonable notice.
  • The facility is closing.

Many issues that lead to threatened discharge can be solved through good care planning and problem-solving with the care team, so transfer or discharge is not always necessary.

Notice Requirements

If a resident is going to be transferred or discharged, the nursing home must give a written notice, in a language and manner the resident can understand, at least 30 days in advance in most situations. The notice must be given to the resident and to their family member, guardian, or legal representative.

The written notice must include:

  • The reason for the transfer or discharge.
  • The effective date of the transfer or discharge.
  • The location to which the resident will be transferred or discharged.
  • Information about the resident’s right to appeal the decision and how to request a hearing.
  • Contact information for the State Long-Term Care Ombudsman Program.
  • Contact information for the protection and advocacy agency, if the resident has a developmental disability or mental illness.

These requirements are part of the federal transfer and discharge rules in 42 CFR § 483.15 (Admission, transfer, and discharge rights).

Hearings and Appeals

Residents have the right to appeal an involuntary transfer or discharge and to remain in the facility while the appeal is pending, except in limited emergency situations. The notice you receive should explain how to request a hearing and the deadline for doing so.

If you receive a discharge notice:

  • Read the notice carefully and note the stated reason and date.
  • Contact the Long-Term Care Ombudsman Program as soon as possible for help reviewing the notice and understanding your options.
  • Follow the instructions on the notice to request an appeal or hearing by the deadline.
  • Gather documents (care plans, medical records, correspondence) that support why you should not be discharged.

For more detail on your rights and the appeal process, see the Center for Medicare Advocacy article “Discharge from a Skilled Nursing Facility: What Does it Mean and What Rights Does a Resident Have?” and the transfer/discharge section of 42 CFR § 483.15.

How the Ombudsman Program Can Help

If you get a notice of discharge, contact the Connecticut Long-Term Care Ombudsman Program for help and support. Ombudsman staff can:

  • Review your discharge notice and help you understand the reason and your rights.
  • Help you request a hearing or appeal if you disagree with the discharge.
  • Work with you, your family, and facility staff to try to resolve issues and avoid unnecessary transfers.
  • Connect you with legal and advocacy resources when needed.

For nursing homes sending discharge notices to the Ombudsman, use the LTCOP Involuntary Discharge Portal.

Helpful Resident and Family Resources

Justice in Aging Tools: Challenging Nursing Home Evictions

Justice in Aging has created step-by-step advocacy tools that explain how to challenge different types of nursing home evictions:

Technical and Advocacy References

Medicare, Appeals, and Nursing Home Resident Rights

Medicare coverage rules can be confusing, especially when a nursing home says that Medicare will no longer pay. Residents and families have rights to clear information, proper notices, and appeal processes when Medicare coverage is denied, reduced, or terminated.

Medicare Coverage for Nursing Home Residents

The Connecticut Long-Term Care Ombudsman Program and the Center for Medicare Advocacy (CMA) offer education on Medicare coverage for residents in skilled nursing facilities, including what Medicare covers, when coverage may end, and where residents can get help.

Know Your Rights: Medicare Discharges and Nursing Home Admissions

In this educational presentation, the Center for Medicare Advocacy and CT LTCOP review your rights and protections regarding: Medicare vs. Medicaid coverage, notice and appeal rights when Medicare ends, third-party guarantees, admission agreements, and how to file complaints about abusive practices.

Medicare Denials, Appeals, and the “Jimmo” Standard

Residents have the right to appeal Medicare denials and to challenge decisions that are based on an incorrect “improvement only” standard. The Jimmo v. Sebelius settlement confirmed that Medicare coverage can continue when skilled care is needed to maintain or slow deterioration, not only when a resident is improving.

Self-Help Packets and Tools for Medicare Appeals

CMA has created self-help packets and toolkits that explain how residents and families can appeal Medicare denials, including in nursing homes and home health care. These tools include sample forms and step-by-step instructions.

Medicare and Home Health Care

Some residents may also receive Medicare-covered home health services before or after a nursing home stay. Understanding when Medicare should cover home health care can help you plan safely for discharge and avoid improper denials.

Medicare and Nursing Home Debt Collection

Improper Medicare denials and misunderstandings about coverage can sometimes lead to nursing home debt and collection efforts. National organizations have created tools to help residents and caregivers understand and defend against improper debt collection.

Additional Advocacy Resources

These organizations and tools can help residents and caregivers respond to improper bills, collection lawsuits, or unfair discharges, and to better understand their rights.