Pennsylvania

The grounds, as Pennsylvania describes them

The Long-Term Care Handbook, section 423.61, "LTC Facility Discharge and Transfer" (PA Department of Human Services, Updated June 11, 2025, Replacing August 22, 2019, retrieved 2026-09-06), states, citing 42 CFR § 483.12 and 028 Pa. Code § 201.29(f), that:

"An LTC facility may discharge an individual for nonpayment of his payment towards the cost of LTC Facility Services when:"

"The LTC facility has provided reasonable and appropriate notice."

"The LTC facility has demonstrated that it made reasonable efforts to collect the debt."

"The individual’s health improved to the point where LTC facility services are no longer needed."

"The individual’s health has deteriorated requiring care which the facility is unable to provide."

These four items are listed in this order, immediately under the "when:" clause quoted above, in the handbook itself; the handbook's own formatting does not make clear whether the third and fourth items are additional preconditions for a nonpayment discharge or separate, freestanding grounds unrelated to nonpayment. Reproduced in the handbook's own order and grouping; not reconciled — see finding (8) below.

The currently published text of 28 Pa. Code § 201.29(f), captured in full as source 4, reads only "[Reserved]" — the cited subsection carries no operative text matching the handbook's own attribution. See finding (7) below.

The published process

Requesting the hearing

The handbook: "The individual or the individual’s representative has the right to appeal a discharge or transfer. There is no specific form that an individual or the individual’s representative must complete to file an appeal. However, the appeal request must contain the following:" — citing 55 Pa. Code § 275.1 — "the name of the individual on whose behalf the appeal is being filed.", "the name and address of the LTC facility involved.", "the reason for the appeal.", and "the name of the individual or the individual’s legally authorized representative filing the appeal." "The appeal must be received by the CAO within 30 days of the date of the facility's notice to the individual of discharge. The appeal must be filed with the Bureau of Hearings and Appeals. The CAO will send a copy of the appeal request to the Office of Long-Term Living (OLTL) at the following address:" — "Office of Long-Term Living Bureau of Provider Support P. O. Box 8025 Harrisburg, PA 17105 (717) 772-2570" — and "A copy of the appeal request must also be sent to the LTC facility. If the appeal involves a dispute with the recommendations of the individual’s physician, a copy must also be sent to the physician." No street address or filing portal for the Bureau of Hearings and Appeals itself is stated in the sources reviewed.

The Department of Human Services' general fair-hearing procedure, 55 Pa. Code § 275.4(a)(3)(v)(C)(I): "When an applicant/recipient responds to a written notice by requesting a hearing within the specified time period as described in § 133.4 (relating to procedures), the agency receiving the hearing request will date stamp the form upon receipt, review the complaint as required in this paragraph, and forward the appeal to the Office of Hearings and Appeals within 3 working days from the time the appeal is received from scheduling a fair hearing. In cases in which a hearing is requested within the specified time period, assistance will be continued pending the hearing decision unless the client waives continuation of benefits." This is a pendency statement about continuation of Medical Assistance payment, stated generally for the Department's fair-hearing procedure rather than specifically for a nursing-facility discharge appeal. No statement barring a facility from physically transferring or discharging a resident while an appeal is pending was found in the sources reviewed for Pennsylvania — searched: the Long-Term Care Handbook 423.6, 28 Pa. Code § 201.29, 28 Pa. Code § 201.2, and 55 Pa. Code § 275.4. Not stated in the sources reviewed. See finding (10) below.

The notice's required contents

The handbook: "When an LTC facility discharges an individual or transfers the individual to another facility, the former facility must give the individual 30 days advance written notice, and, if known, a copy of the notice to the individual’s representative." Exception: "The notice is not required for an emergency or an urgent need for medical services which the facility cannot provide." "The facility must make arrangements for the safe and orderly transfer and must prepare the individual for the transfer."

No captured Pennsylvania source separately enumerates the substantive items a discharge notice must itself contain — a reason, an effective date, appeal-rights text, or ombudsman contact information printed in the notice. 28 Pa. Code § 201.2(a), "Requirements": "The Department incorporates by reference 42 CFR Part 483, Subpart B of the Federal requirements for long-term care facilities, (relating to requirements for long-term care facilities), as licensing regulations for long-term care nursing facilities, with the exception of 42 CFR 483.1 (relating to basis and scope) and the requirements under 42 CFR Part 483 Subpart B for the transmission of data and minimum data set (MDS) reporting to the Centers for Medicare & Medicaid Services (CMS) unless the facility is participating in the Medicare or Medical Assistance Program." This is the Commonwealth's own regulation adopting the federal Subpart B requirements — which include the federal notice-content enumeration at 42 CFR 483.15(c) — as Pennsylvania's own licensing law, rather than a state-specific enumeration; the federal text is quoted on the federal page and is not restated here. See finding (9) below.

Separately, the Department of Health's own protocol for facilities states a routing step distinct from the notice's contents: for a facility-initiated, non-emergency discharge, the facility is to "Issue a written 30-day notice of discharge to the resident and e-mail notice to LTC-ombudsman@pa.gov the same day it’s issued to the resident. The State Office will distribute the notice to the appropriate local ombudsman."

Bed-hold and return

The handbook: "When an MA LTC Services recipient is admitted to a hospital, but not officially discharged from the facility, the CAO will not take any immediate action because a recipient can be eligible for a maximum of 15 days consecutive bed hold days due to hospitalization." The handbook cites 55 Pa. Code § 1187.104(a) in the same passage; see finding (11) below on how that citation sits relative to the quoted sentence. No captured Pennsylvania source states a readmission or return guarantee following a hospital bed-hold beyond the 15-day count itself — searched: the Long-Term Care Handbook 423.6, 28 Pa. Code § 201.29, and 28 Pa. Code § 201.2. Not stated in the sources reviewed.

The three rows above hoist the questions a facility's counsel answers in the first fifteen minutes. They are quotations from Pennsylvania's published 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' advance notice — the handbook: "the former facility must give the individual 30 days advance written notice", with the emergency exception quoted above.

30 days to file an appeal — the handbook: "The appeal must be received by the CAO within 30 days of the date of the facility's notice to the individual of discharge."

15 consecutive bed-hold days — the handbook: "a recipient can be eligible for a maximum of 15 days consecutive bed hold days due to hospitalization."

3 working days — the handbook: an LTC facility "will send a Long-Term Care Admissions and Discharge Transmittal (MA 103) to CAO staff within three working days of a transfer or discharge from the facility."

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

Source map

Captured: all six, in tools/packets/pennsylvania-packet.txt. Pending: a Pennsylvania regulation directly enumerating transfer and discharge grounds (the handbook's own citation, 28 Pa. Code § 201.29(f), is captured and found to read "[Reserved]"), the balance of 55 Pa. Code Chapter 275 beyond the sliced pendency clause, and any published filing address for the Bureau of Hearings and Appeals itself.

Change log

2026-09-06 — Deepened to a full page. Two additional first-party sources captured by extending the existing recipe (tools/recipes/pennsylvania.json, digest 3bda7ecf691c → e41d22209ad8, 4 → 6 sources), transport unchanged (plain curl, browser user-agent, both on pacodeandbulletin.gov): 28 Pa. Code § 201.2 (Requirements) in full, and a bounded slice of 55 Pa. Code § 275.4 covering clause (a)(3)(v)(C), the Department's general Medical Assistance pendency provision. The recipe was re-run twice and produced byte-identical captures both times; the four previously-captured sources are unchanged since the 2026-09-05 recipe-backfill pass. Sections 01 and 02 and the notice-periods register are now written. Findings, continuing the numbering from 2026-08-30: (7) the handbook's citation for the nonpayment/health-change grounds passage, "028 Pa. Code § 201.29(f)", names a subsection whose currently published text (captured in full as source 4) reads only "[Reserved]" — reproduced as printed, not reconciled. (8) The handbook's four listed conditions under "may discharge an individual for nonpayment ... when:" mix two conditions about the debt-collection process with two conditions unrelated to nonpayment (health improved, health deteriorated); the handbook's own formatting does not resolve whether the latter two are additional nonpayment preconditions or separate, freestanding grounds. (9) 28 Pa. Code § 201.2(a) adopts the federal Subpart B requirements, including the federal notice-content enumeration, as the Commonwealth's own licensing regulation rather than stating a state-specific list; the federal text stays on the federal page. (10) 55 Pa. Code § 275.4(a)(3)(v)(C)(I) states a pendency rule for continuation of Medical Assistance payment generally, not a bar on physically transferring or discharging a resident while an appeal is pending; no such bar was found in the sources reviewed. (11) The handbook's "15 days consecutive bed hold days" sentence is followed, after two intervening paragraphs about county residency and provider billing, by the citation "55 Pa. Code § 1187.104(a)"; the handbook's layout places citations after the passages they support without always adjoining the specific sentence, so this page states the citation as printed without asserting it governs only the bed-hold sentence. (12) No captured Pennsylvania source states a readmission or return guarantee following a hospital bed-hold beyond the 15-day count itself. Capture pending: per the source map. Internet Archive: not yet submitted for the two new sources. Reviewer: Carrie Schluter, reviewed 2026-09-06. Corrections: hello@fieldassembly.net.

2026-08-30 — Baseline page built from the first Pennsylvania packet: docket, lede, source map, change log. Not yet captured or written: section 01 (the grounds, as Pennsylvania describes them) and section 02 (the published process, including the notice's required contents, bed-hold and return, and the notice-periods register). Findings: (1) Pennsylvania publishes the operative notice period, appeal deadline and bed-hold period in a Medical Assistance eligibility manual, not in a residents' rights document; the handbook is quoted as the publisher it is, and the docket says so. (2) No captured Pennsylvania regulation enumerates the permissible bases for facility-initiated transfer or discharge: 28 Pa. Code § 201.29 states resident rights by incorporating 42 CFR 483.10 and adding state-specific rights, and the handbook's own grounds passage cites 42 CFR § 483.12; the grounds row states what the Commonwealth states and borrows nothing from the federal page. (3) The handbook states the appeal "must be filed with the Bureau of Hearings and Appeals" but publishes a postal address only for the Office of Long-Term Living, Bureau of Provider Support; the absence of a filing address for the bureau itself is stated rather than filled. (4) The handbook states a bed-hold period in the eligibility register — a recipient "can be eligible for a maximum of 15 days consecutive bed hold days due to hospitalization" — and that is the only captured Pennsylvania statement of a bed-hold period; it is recorded here and will be quoted in section 02 when that section is written. (5) The Department of Health's notice protocol is a decision-flow diagram; pdftotext -layout does not reproduce its reading order, and the document carries the publisher's own typographic errors, "reprentative" and "resident-initated", reproduced as printed. (6) The protocol document states no date of its own, and the ombudsman service page states none either. Capture pending: per the source map. Internet Archive: not yet submitted. Reviewer: Carrie Schluter, reviewed 2026-08-30. Corrections: hello@fieldassembly.net.