Involuntary discharge or transfer should be rare and preceded by demonstrated effort on the part of the interdisciplinary team to address the problem in a mutually beneficial way. The facility must have and follow written policies and procedures for involuntary discharge and transfer.

The Conditions for Coverage for End Stage Renal Disease Facilities state that it is the medical director’s responsibility to make sure no patient in their unit is discharged or transferred from the facility unless:

  1. The patient or payer no longer reimburses the facility for the ordered services.
    If a facility involuntarily discharges or transfers a patient for nonpayment of fees, there must be evidence in the patient’s medical in the patient’s medical record that the facility staff (e.g., billing personnel, financial counselor, social worker) made in good faith to help the patient resolve the nonpayment issue.
  2. The facility ceases to exist.
  3. The transfer is necessary for the patient’s welfare because the facility can no longer meet the patient’s documented medical needs.
    If a patient for example is no longer able to receive treatment in a chair, but now needs to treat in a stretcher/bed or has a tracheostomy / vent and a facility is unable to support this change in condition.
  4. The facility has reassessed the patient and determined that the patient’s behavior is disruptive and abusive to the extent that the delivery of care to the patient or the ability of the facility to operate effectively is seriously impaired in which the medical director ensures that the interdisciplinary team.
         a. Documents the reassessments, ongoing problems and efforts made to resolve the problem.
         b.  Provides the ESRD Network 30 days’ notice of the planed discharge.
    c.  Obtains a written physician’s order that must be signed by both the medical director and the patient’s attending physician concurring with the patient’s discharge or transfer from the facility.
    d. Contacts another facility and attempts to place the patient there and documents that effort.
    e. Notifies the State Survey agency of the Involuntary Transfer/ Discharge.
  5. In the event of an “immediate severe threat” where there is a threat of physical harm. Only in the instances of an immediate severe threat can the facility abbreviate their involuntary discharge procedure.  The dialysis facility will contact the Network for guidance on how to proceed with these types of cases.

Patient Services Department Contact Information:

Access to Care concerns:                 (516) 209-5622

Case consultations:                          (516) 209-5624

Failure to Place

A Failure to Place is defined as a situation in which no outpatient dialysis facility can be located that will accept an ESRD patient for routine dialysis treatment. Please contact the Network to discuss what options there are for patients.  The Network can assist with the Second Chance Trial Program.