Section 408.432 - Discharge Procedures(A) A member must be discharged by the AFC provider upon the member's request, or if the member ceases to benefit from AFC, including the following circumstances: (1) the member no longer meets the clinical eligibility criteria for AFC;(2) the member demonstrates behavioral or other problems that may endanger the member, the AFC caregiver, or AFC provider staff;(3) the member's clinical needs are beyond the scope of AFC;(4) the member's needs cannot be met by the AFC provider;(5) the member does not reside in an AFC-qualified setting;(6) the member selects another service that is duplicative of AFC; or(7) the member transitions to another AFC provider.(B) For all discharges, the AFC provider must(1) develop a discharge and transition plan that must(a) include the date and reason for discharge;(b) identify any referrals by the AFC provider to other appropriate service providers for any health or social services required by the member;(c) ensure continuity of care by the member, including during transitions of care as specified in the AFC plan of care;(d) be dated and signed by the AFC registered nurse, the AFC care manager, and the member; and(e) require at least one follow-up telephone call within 30 business days after discharge to determine the member's post-discharge status and condition;(2) provide assistance to the member in identifying and locating another provider;(3) arrange for the member to be discharged and transitioned to the provider identified in 130 CMR 408.432(B)(2);(4) coordinate the discharge and transition with the member, member's family or legal guardian, and staff of the program or agency to which the member is to be transferred; and (5) maintain current level of services until the member is admitted with a new provider.Amended by Mass Register Issue 1338, eff. 5/5/2017.Amended by Mass Register Issue 1472, eff. 7/1/2022.Amended by Mass Register Issue 1520, eff. 4/26/2024.