Analysis

Topic: Nursing Home Involuntary Transfers
Sponsor: Representative Faunce
Date Introduced: February 27, 2001
Date Passed by the House: March 28, 2001
Date of Analysis: October 4, 2001

Position: The Michigan Department of Consumer and Industry Services supports the bill.

Background: Federal regulations (Title 42, Chapter IV, Subchapter E, 483.12) provide for discharge or transfer of nursing home residents under certain circumstances, including inability to pay, and provide for a 30 day notice. Some people feel that similar language should be placed in state law to ensure that a resident would not be discharged or forced to transfer to another facility against his or her will simply because the facility decided to no longer participate in the Medicaid program. Title XIX of the federal Social Security Act, Section 1396r, specifies that "the facility's voluntary withdrawal from participation [in the Medicaid program] is not an acceptable basis for the transfer or discharge of residents of the facility who were residing in the facility on the day before the effective date of the withdrawal."

Description of Bill: The bill would amend the Public Health Code, MCL 333.21773, with regard to transfer or discharge of residents for nonpayment. A nursing home that voluntarily withdraws from participation in the Medicaid program, but continues to provide service, could not involuntarily transfer or discharge a patient who resided in the nursing home on the day before the home's withdrawal form the Medicaid program except as allowed under federal law (whether or not the patient was eligible for Medicaid benefits). The prohibition against transfer would remain in effect unless the patient met one of the other listed criteria for an allowable involuntary discharge (medical reasons, the patient's welfare, etc.)

In addition, the bill would require a nursing home to provide oral and written notice to new patients (after withdrawing from the Medicaid program) that the nursing home does not participate in Medicaid, and that the home could involuntarily transfer or discharge a patient for nonpayment even if the patient were eligible for Medicaid.

The bill would also increase the notice to a resident of discharge or involuntary transfer from 21 days to 30 days and clarify the current counseling requirement. It would specify that the nursing home would have to provide counseling before the transfer, and that the department would be responsible for making sure that the counseling was available after the transfer.

Arguments For: Most of the State's nursing homes participate in the Medicaid certification program. There is some concern, due to many facilities claiming that Medicaid reimbursements are falling short of provided services, that some facilities may opt out of the Medicaid program and accept private pay residents only. It was felt that there should be assurances in state law that a resident would not be forced out of the facility just because the facility would not be eligible to receive Medicaid reimbursements.

Arguments Against: Some people feel that the bill is not necessary. There has not been a facility in the state that has participated in Medicaid certification and then has withdrawn. Further, since the majority of nursing home residents are Medicaid eligible, it is not foreseen that any facilities would voluntarily end their participation.

Supporters:
- Health Care Association of Michigan
- Michigan Association of Homes and Services for the Aging

Fiscal Impact: The bill would have no fiscal impact.

Economic Impact: There may be some economic impact on facilities and residents if a facility withdraws from Medicaid certification. Administrative Rule Impact: There would be no impact on Administrative Rules.