Discharge Appeal Process

The actual process and procedure for an appeal, as currently set forth in the proposed regulations, is vague, undefined, and incomplete.  As a result, a number of critical areas of concern involving the proposed appeal process and relevant procedures to be utilized for such an appeal have not been adequately addressed in the proposed regulations or the agency provided discharge notice form.

A few examples of these areas of concern include, but are not limited to, the following:

• The failure to include a specified and acceptable timeframe for the department to notify the facility and resident of the receipt of the appeal, for setting of the appeal for hearing, and the ruling on an appeal;
• A listing of the documents that the facility and/or resident will be required to present for the appeal;
• Clarification that the requirement for facilities to assist a resident in the appeal is limited to assistance with the actual filing of the request and does not include assistance in the resident’s preparation for a hearing. Further consideration of the obvious and inherent conflict of interest in requiring such facility assistance is required;
• The standard for granting an appeal and the applicable burden of proof;
• Information regarding the right to have an administrative or judicial review of the hearing officer’s decision, the timeframe for requesting same and whether the resident’s right to stay in the facility extends to this level of review.

All of the above noted deficiencies in the proposed regulations have significant cost implications to both residents and facilities. Virginia Code §63.2-1805 requires that the resident be allowed to stay in the facility pending finalization of the appeal. Facilities faced with non-paying residents will already have significant account balances that necessitated discharge. Charges incurred during the required 30-day cure period, the 30-day notice of discharge period, and an appeal that might extend for multiple months will quickly increase the balances owed by the residents and their family members. It will be unlikely that facilities will be able to recover these balances. The obvious burden on the facilities must be addressed through the appeal process and procedures must be implemented to minimize the burden on the facilities.

It is understood that the appeal process for involuntary discharge is mandated by statute and will have beneficial impacts for residents of assisted living facilities. However, more time is needed through the regular regulatory process for consideration of the all relevant issues and crafting regulations to address the needs of all parties involved.