The federal floor

The grounds, as the federal publisher describes them

42 CFR 483.15(c)(1)(i) states that "The facility must permit each resident to remain in the facility, and not transfer or discharge the resident from the facility unless—" one of six circumstances applies, quoted here in the regulation's own order (eCFR, 42 CFR 483.15, current as of 2026-08-27, retrieved 2026-08-30):

(A) "The transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the facility;"

(B) "The transfer or discharge is appropriate because the resident's health has improved sufficiently so the resident no longer needs the services provided by the facility;"

(C) "The safety of individuals in the facility is endangered due to the clinical or behavioral status of the resident;"

(D) "The health of individuals in the facility would otherwise be endangered;"

(E) "The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility. Non-payment applies if the resident does not submit the necessary paperwork for third party payment or after the third party, including Medicare or Medicaid, denies the claim and the resident refuses to pay for his or her stay. For a resident who becomes eligible for Medicaid after admission to a facility, the facility may charge a resident only allowable charges under Medicaid; or"

(F) "The facility ceases to operate."

Documentation accompanies the grounds: under 483.15(c)(2), when a facility transfers or discharges under any of the circumstances above, it "must ensure that the transfer or discharge is documented in the resident's medical record and appropriate information is communicated to the receiving health care institution or provider."

The published process

Requesting the hearing

The federal sources place the hearing in the state Medicaid agency's fair-hearing apparatus and name no federal filing office. 42 CFR 431.220(a)(2) requires the state agency to grant an opportunity for a hearing to "Any resident who requests it because he or she believes a skilled nursing facility or nursing facility has erroneously determined that he or she must be transferred or discharged." On time to request, 431.221(d): "The agency must allow the applicant or beneficiary a reasonable time, not to exceed 90 days from the date that notice of action is mailed, to request a hearings." On remaining in place while the appeal is heard, 483.15(c)(1)(ii) states the facility "may not transfer or discharge the resident while the appeal is pending, pursuant to § 431.230 of this chapter, when a resident exercises his or her right to appeal a transfer or discharge notice from the facility pursuant to § 431.220(a)(3) of this chapter, unless the failure to discharge or transfer would endanger the health or safety of the resident or other individuals in the facility. The facility must document the danger that failure to transfer or discharge would pose." The filing route — form, address, portal, deadline — is published by each state; see the state's page.

The notice's required contents

42 CFR 483.15(c)(5) states that the written notice must include: "The reason for transfer or discharge;" "The effective date of transfer or discharge;" "The location to which the resident is transferred or discharged;" "A statement of the resident's appeal rights, including the name, address (mailing and email), and telephone number of the entity which receives such requests; and information on how to obtain an appeal form and assistance in completing the form and submitting the appeal hearing request;" and "The name, address (mailing and email) and telephone number of the Office of the State Long-Term Care Ombudsman;" with two further items at (c)(5)(vi) and (vii) for residents with intellectual and developmental disabilities or related disabilities and for residents with a mental disorder or related disabilities, naming the protection and advocacy agencies. Under (c)(3)(i), the facility must notify the resident and the resident's representative(s) "in writing and in a language and manner they understand", and "The facility must send a copy of the notice to a representative of the Office of the State Long-Term Care Ombudsman."

Bed-hold and return

42 CFR 483.15(d)(1) requires that before a nursing facility transfers a resident to a hospital or the resident goes on therapeutic leave, the facility provide written information specifying "The duration of the state bed-hold policy, if any, during which the resident is permitted to return and resume residence in the nursing facility;" the reserve bed payment policy in the state plan, if any; and the facility's own bed-hold policies. Under (d)(2), "At the time of transfer of a resident for hospitalization or therapeutic leave, a nursing facility must provide to the resident and the resident representative written notice which specifies the duration of the bed-hold policy described in paragraph (d)(1) of this section." On return, (e)(1) requires "a written policy on permitting residents to return to the facility after they are hospitalized or placed on therapeutic leave", under which a resident whose absence exceeds the bed-hold period "returns to the facility to their previous room if available or immediately upon the first availability of a bed in a semi-private room" if the resident requires the facility's services and is eligible for Medicare skilled nursing facility services or Medicaid nursing facility services. Where a facility determines that a resident transferred with an expectation of returning cannot return, (e)(1)(ii) states "the facility must comply with the requirements of paragraph (c) as they apply to discharges." The duration of any bed-hold period is set in each state's Medicaid plan materials; see the state's page.

The three rows above hoist the questions a facility's counsel answers in the first fifteen minutes. They are quotations from the federal sources, not a determination that any of them applies to any situation.

Notice periods and deadlines, as stated in the sources

All quoted; none calculated.

30 days — 42 CFR 483.15(c)(4)(i): except as specified in paragraphs (c)(4)(ii) and (8), the notice of transfer or discharge "must be made by the facility at least 30 days before the resident is transferred or discharged."

As soon as practicable — 42 CFR 483.15(c)(4)(ii): "Notice must be made as soon as practicable before transfer or discharge when—" the stated circumstances at (A) through (E) apply, including where "A resident has not resided in the facility for 30 days."

Not to exceed 90 days — 42 CFR 431.221(d), quoted in full above, on the time the state agency must allow for requesting a hearing.

10 days — 42 CFR 431.231(a): "The agency may reinstate services if a beneficiary requests a hearing not more than 10 days after the date of action."

Ordinarily, within 90 days — 42 CFR 431.244(f)(1): the agency must take final administrative action "Ordinarily, within 90 days from" the dates the regulation states.

What any of these periods means for a particular case is for the hearing office to determine.

Source map

Captured: all three, in tools/packets/federal-packet.txt. Pending: none at assembly.

Change log

2026-08-30 — Page built from the first federal packet. All three sources captured first-party. Findings: (1) The eCFR text of 431.221(d) reads "to request a hearings" — the publisher's own wording, reproduced as published. (2) Appendix PP tags F622 through F626 each carry a note that their regulatory requirements "have been relocated" to F627 and F628 (Rev. 231); the substance of the transfer-and-discharge guidance now sits at F627 and F628. (3) The federal sources name no hearing office and publish no ombudsman contact; both are state publications, carried on state pages. Capture pending: none. Internet Archive: not yet submitted. Reviewer: Carrie Schluter, reviewed 2026-08-30. Corrections: hello@fieldassembly.net.