F846

§483.70(l) Facility closure.
The facility must have in place policies and procedures to ensure that the administrator’s duties and responsibilities involve providing the appropriate notices in the event of a facility closure, as required at paragraph (l) of this section.
 

GUIDANCE §483.70(l)
Policies and procedures must be in place at all times in order to be used in the case of a facility closure or in case of termination of a facility’s Medicare and/or Medicaid Provider Agreement, in order to meet the requirements of §483.70(k) The policies and procedures must address:
    • The administrator’s duties and responsibilities as required per §483.70(k) for submitting a closure plan and providing timely written notice to the State Survey Agency, the State LTC Ombudsman, residents of the facility, and the legal representatives of residents or other responsible parties, including the CMS Location, the State Medicaid Agency, and staff responsible for providing care and services to residents;
    • How facility staff will identify available settings in terms of quality, services, and location, by taking into consideration each resident’s individual needs, choices, and best interests. The facility may not close until all residents are transferred, relocated or discharged in a safe and orderly manner to the most appropriate setting; and
    • Assurance that no new residents will be admitted to the facility on or after the date that the written notice of impending closure was provided to the State Survey Agency;
 

To ensure resident safety during a facility closure or termination of a facility’s Medicare and/or Medicaid Provider Agreement, the policies and procedures should also address:
    • How facility staff will ensure that all pertinent information about each resident is communicated to the receiving provider in accordance with §483.15(c)(2)(iii), and each resident’s complete medical record information including archived files, Minimum Data Set (MDS) assessments, and all orders, recommendations or guidelines from the resident’s attending physician;
    • In addition to the administrator, the primary contact(s) responsible for the daily operation and management of the facility during the facility’s closure process;
    • The roles and responsibilities of the facility’s owners, administrator, or their replacement(s) or temporary managers/monitors during the closure process, and their contact information;
    • Provisions for ongoing operations and management of the facility and its residents and staff during the closure process that include:
        o Payment of salaries and expenses to staff, vendors, contractors, etc.;
        o Continuation of appropriate staffing and resources to meet the needs of each resident, including the provision of medications, services, supplies, and treatments as ordered by the resident’s physician/practitioner;
        o Ongoing accounting, maintenance, and reporting of resident personal funds; and
        o Labeling, safekeeping and appropriate transfer of resident’s personal belongings, such as clothing, medications, furnishings, etc. at the time of transfer or relocation, including contact information for missing items after the facility has closed.
 

The facility’s policies and procedures should also consider certain provisions to prepare residents to ensure a safe and orderly transfer from the facility. These provisions include, but are not limited to:
    • Interviewing residents and their legal or other responsible parties, to determine each resident’s goals, preferences, and needs in planning for the services, location, and setting to which they will be moved;
    • Offering each resident (in a manner and language understood by the resident) the opportunity to obtain information regarding their community options, including setting and location;
    • Providing residents with information or access to information pertaining to the quality of the providers and/or services they are considering; psychological preparation or counseling of each resident as necessary; and
    • Making every reasonable effort to accommodate each resident’s goals, preferences and needs regarding receipt of services, location, and setting.
 

PROCEDURES §483.70(l)
 

Once notified of a facility’s impending closure, if a copy of the facility’s plan for the transfer and relocation of the residents was not included with the notice, the State Survey Agency should immediately request a copy of the facility’s closure plan for their review and approval. In addition, the State Survey Agency should request the facility’s admissions records to verify that no new residents have been admitted on or after the date that the notice of closure was provided.
 

A resident who had been temporarily transferred to an acute care setting, is on bed hold, or is on a temporary leave would not be considered to be a new admission upon return to the facility. However, each of these situations may need to be evaluated on a case by case basis in order to determine if the clinical care or social needs of the resident may continue to be met by the facility if transferred back to the facility in closure. If it is determined that the clinical care or social needs of the resident cannot be met by the closing facility and the resident is not transferred back to the closing facility, the same notice requirements specified above apply to the resident and the resident’s legal representatives, other responsible parties, and other parties as if the resident was still living in the facility.
 

Interview the administrator and other individual(s) responsible for managing, overseeing, coordinating and implementing the plan to evaluate how each component of the plan is being operationalized.
 

NOTE: The review of certain components such as an evaluation of the facility’s closure plan, policies and procedures may be conducted off-site by the State Survey Agency and may include assistance from the State LTC Ombudsman as the State Survey Agency deems suitable and necessary.
 

When conducting an onsite survey prior to the impending closure, tour the facility and interview staff including the medical director, residents, and family. Determine their involvement in and/or knowledge of the facility closure plans and the resident transfer procedures. Determine through observation, interview, and record review, as applicable:
    • That the delivery of resident care and services are continuing to be provided, monitored and supervised based upon the assessed needs and choices of each resident. If problems are noted it may be necessary to further investigate and review other quality of care regulations as appropriate. Do not cite quality of care issues under the Facility Closure regulations;
    • Whether written notices were provided timely and that the notice included the expected date of the resident’s transfer to another facility or other setting; and
    • How the facility involved the resident, his/her legal representative or other responsible party, and the resident’s primary physician to determine the resident’s goals, preferences and needs in planning for the services, location and setting to which they will be moved.
 

NOTE: Refer to §483.15 for guidance for the post-discharge plan of care for an anticipated discharge which applies to a resident whom the facility discharges to a private residence or other home and community based setting, to another nursing home, or to another type of residential facility such as a board and care home or an intermediate care facility for individuals with intellectual disabilities or mental illness.
 

NOTE: §488.426(a)(1) and(2) - Transfer of residents, or closure of the facility and transfer of residents, gives authority to the State for temporary facility closure in emergency situations. If the State Survey Agency approves a facility’s temporary relocation of residents during an emergency with the expectation that the residents will return to the facility, this would not be regarded as a facility closure under these requirements and the notification requirements would not be applicable. However, if a facility ultimately closes permanently due to an emergency, the administrator is required to provide proper notifications and follow the procedures outlined in this guidance.