Kitch - Attorneys & Counselors
Post-Acute Care October Kitch Report

October, 2018

Post-Acute Care Kitch Report

Skilled Nursing Facility Update:
Federal Involuntary Transfer/Discharge Process and Michigan’s New Form

John Paul Hessburg
Kally Goodwin-Ratzloff


You may be aware that pursuant to 42 CFR §483.15(c)(6), skilled nursing facilities are required to update residents on any changes that may impact an issued Notice of Involuntary Transfer or Discharge. Specifically, “[i]f the information in the notice [of involuntary transfer/discharge] changes prior to effecting the transfer or discharge, the facility must update the recipients of the notice as soon as practicable once the updated information becomes available.”

However, many providers may not know that according to surveyor guidance, skilled nursing facilities are also required to provide an updated notice of involuntary transfer/discharge, when there are “significant changes, such as a change in the destination” (emphasis added). The State Operations Manual’s surveyor guidance considers a change in the destination to where the resident will be discharged as a basis to restart the 30-day advance notification period. By way of example, if the destination facility no longer has an open bed to accept the resident, the discharging facility must change the location on its notice and reissue it to the resident. A destination change and updated notice would then trigger the 30-day advance notice period to restart, according to the State Operations Manual, Appendix PP.


To incorporate the surveyor guidance, on August 23, 2018, Michigan’s Department of Licensing and Regulatory Affairs (LARA) updated its Notice of Involuntary Transfer or Discharge and Appeal Request Form. Specifically, the form has been revised to include the direction that “if the destination changes and this change was initiated by the facility, an updated notice with the new destination must be issued. This type of change restarts the 30-day timeline for transfer or discharge.” It is our opinion and has been our experience with LARA thus far that an updated notice does not prompt additional appeal rights.

The new “Notice of Involuntary Transfer or Discharge and Appeal Request Form” is available at

Please note that LARA is open to feedback from providers on its new form. Should you have comments or concerns, or need assistance with an involuntary transfer or discharge process, please do not hesitate to contact a member of our Post-Acute Care practice group.