How to transfer a patient from one nursing home to another: the steps and who pays for the ride

A resident, or the person who holds legal authority for them, chooses the new nursing home. The new home agrees to admit the resident and holds a bed. The current home prepares a discharge summary, a medication list and the care plan, and they should reach the new home before the resident does. The ride comes last, after the bed and the arrival time are confirmed. This guide covers a planned move between two homes. Moves out of a hospital are covered in hospital discharge transportation, and the rules that decide who pays for nursing home rides are in skilled nursing facility transportation.

Who decides, and what the current home still owes the resident

The resident decides, and the current home has to help. Federal rules separate a discharge the home starts from a move the resident asks for. The 30-day written notice, the list of allowed reasons and the appeal rights in 42 CFR 483.15(c) govern the first kind. CMS’s survey guidance, in its section on hospice services, says that when a resident or representative requests and starts a discharge to another facility or location, the home is not required to give a transfer or discharge notice, because the home did not start the move. Put the request and the move date in writing, and keep a copy.

The current home still has duties. Its discharge planning rule in 42 CFR 483.21(c) requires a discharge summary whenever it anticipates a discharge. For a resident moving to another skilled nursing facility, the home must help the resident and representative choose by using comparison data such as standardized assessment data, quality measures and resource use. CMS’s examples of preparation include telling the resident where they are going and working with family so possessions are not left behind.

How to choose the new home

Start with the five-star ratings, then visit. CMS gives each nursing home an overall rating plus separate ratings for health inspections, staffing and quality measures. CMS also cautions that no rating covers everything that matters to one person. It names specialty care such as rehabilitation or dementia care, and how easy it is for family to visit. Its page says a home that is very close may be a better pick than a higher-rated one that is far away, because visits improve a resident’s quality of life and care. CMS suggests pairing the ratings with a visit and with the State ombudsman program.

Ask each home on your list four things:

• Which payers does it take, and is a bed open for this one? Some homes are certified for Medicare and Medicaid, some for Medicaid only, and some for neither, according to CMS’s consolidated billing rules.
• Can it meet this resident’s needs? Ask about the specific care, such as dementia care or daily rehabilitation.
• Does the resident’s Medicare Advantage plan cover a stay there, if the resident has a plan? Medicare.gov says plan members may owe copayments in the first 20 days, and the plan sets its own rules, so call the plan first.
• What does its admission agreement list as extra charges?

Before settling on another nursing home, ask the social worker about returning to the community. The home must document that each resident was asked about their interest in returning to the community and, if they said yes, record its referrals to local contact agencies.

What the new home can and cannot require

The new home decides whom it admits, within limits the federal rules set. CMS tells surveyors that homes must work out the care they can provide through a facility assessment and should not admit residents whose needs they cannot meet. Under 42 CFR 483.15(a), the home:

• cannot require a resident or applicant to waive Medicare or Medicaid rights, or ask for assurance that they will not apply for either;
• cannot require a third party to guarantee payment, though it may ask a representative who has legal access to the resident’s income or resources to sign a contract to pay from those funds without personal liability;
• cannot charge, accept or solicit a gift or donation as a condition of admission for a Medicaid-eligible resident;
• must disclose special characteristics or service limitations of the home before admission.

An admission contract also cannot conflict with these rules, according to 42 CFR 483.10(g)(18). Read it before the move date, not at the door.

The screening for mental illness or intellectual disability

Under federal rules a move from one nursing home to another is handled as an annual resident review, not a new preadmission screening, and it matters only for a resident with a serious mental illness or an intellectual disability. The federal screening is called Preadmission Screening and Resident Review (PASRR). Under 42 CFR 483.106(b)(4), a move from one nursing facility to another, with or without a hospital stay in between, is an interfacility transfer, and those are subject to annual resident review rather than preadmission screening. The rule in 42 CFR 483.102 covers anyone with a mental illness or intellectual disability who applies to or lives in a Medicaid-certified nursing facility, whoever pays. A primary diagnosis of dementia does not count as serious mental illness for this purpose.

For these residents, 42 CFR 483.106(b)(4)(ii) makes the sending home responsible for seeing that copies of the most recent PASRR and resident assessment reports go with the resident. The determinations come from the state mental health or intellectual disability authority, not from the nursing home. If the resident has a PASRR on file, ask the current home for it early.

Records that should travel with the resident

The discharge summary is the core record, and it should be in hand before move day. The rule for homes that start a transfer lists what the receiving provider must get, and that list works as a checklist for any move:

• contact information for the practitioner responsible for the resident’s care;
• the resident representative’s contact information;
• advance directive information;
• special instructions or precautions for ongoing care;
• the goals in the comprehensive care plan.

The discharge summary itself, under 42 CFR 483.21(c)(2), has four parts: a recap of the stay with diagnoses, treatment and pertinent lab, radiology and consultation results; a final summary of the resident’s status; a reconciliation of every pre-discharge medication, prescribed and over the counter, with the post-discharge list; and a post-discharge plan of care. Check the medication reconciliation line by line against what the resident takes now. On move day, the driver carries this packet sealed and hands it to the receiving nurse, as described in nursing home pickups and returns.

What the current home owes when the resident leaves

The current home owes refunds and any personal funds within 30 days. Three rules in 42 CFR 483.10 apply:

• A resident who is transferred and does not return gets back any deposit or charges already paid, less the home’s per diem rate for the days the resident lived there or reserved or kept a bed, regardless of any minimum stay or notice requirement.
• Refunds due to the resident must be paid within 30 days of the discharge date.
• Personal funds the resident deposited with the home must be conveyed within 30 days, with a final accounting.

Ask for the final accounting in writing.

How Medicare carries across the move

A covered Medicare skilled nursing stay can continue in the new home without a new three-day hospital stay, if the resident is admitted to the new home within 30 days and still needs skilled care. Medicare’s basic rule in 42 CFR 409.30(b) is that skilled care must begin within 30 days after a qualifying hospital stay. The Medicare Benefit Policy Manual (Chapter 8, section 20.2.3) says a resident who leaves a skilled nursing facility and is readmitted to the same or any other participating one for further covered care within 30 days has met that 30-day transfer requirement. The Claims Processing Manual (Chapter 6, section 40.3.2) puts it the other way: the patient is deemed not to have been discharged, and more than 30 days without skilled care means a new qualifying hospital stay is needed.

Two details catch families. First, the day of departure counts as a covered Part A day only if the resident is admitted to the new home before the following midnight (Claims Processing Manual, Chapter 6, section 20.3.1). Schedule the ride to land the same day. Second, the first-days presumption of coverage that CMS gives a resident admitted straight from a qualifying hospital stay does not apply to a transfer between skilled nursing facilities. Coverage in the new home depends on the resident’s actual need for skilled care.

The benefit limits count per benefit period, not per home. Medicare.gov gives the 2026 figures: days 1 to 20 cost nothing once the $1,736 deductible is paid, days 21 to 100 carry a $217 daily charge, and the resident pays everything beyond day 100.

If the new home is in another state

Apply for Medicaid in the new state. For an adult in a nursing home who can say where they intend to live, the state of residence is where they live and intend to stay, and under 42 CFR 435.403(j) the new state may not deny eligibility because the person has not lived there for a set time. A different rule applies when a state agency arranged the placement. Our guide to moving an elderly parent to another city explains which state’s Medicaid pays after the move and covers the travel side.

The ride and who pays for it

For a move the family chooses, the family usually pays for the ride. Original Medicare covers no ambulette, wheelchair van or litter van trips at all, and its ambulance benefit has a narrow test. Who pays depends on why the resident is moving:

• A move by choice, in a wheelchair or stretcher van. The resident or family pays. Medicare covers no non-ambulance transportation.
• A move by choice, in an ambulance. The resident or family pays. Medicare covers an ambulance only to the nearest appropriate facility, not a move to be closer to family.
• A move during a covered stay because the old home cannot provide care the resident needs. The sending home pays from its daily Medicare payment, when the trip is medically necessary and the new home admits the resident before the next midnight. The rules for that case are in skilled nursing facility transportation.
• A Medicaid resident. The state decides, as described below.

Medicare’s ambulance booklet says Medicare covers ambulance service only when other transportation could endanger the patient’s health, and only to the nearest appropriate facility that can give the needed care. Its example of a denial notice reads “Transportation to a facility to be closer to a home or family is not covered.” CMS says a transfer between two skilled nursing facilities that is driven by the resident’s preference, not by care the first home cannot provide, is not reasonable and necessary and is not charged back to the sending home. When an ambulance company thinks Medicare may not pay for a non-emergency trip it would usually cover, it must give the patient an Advance Beneficiary Notice of Noncoverage before it can bill them, and for a trip Medicare never covers it may hand over a voluntary notice. If the doctor says a stretcher is required, our guide to NEMT or ambulance explains where the line falls, and the price pages for wheelchair transportation and stretcher transport show what private pay runs.

Medicaid is the least predictable payer for this ride. CMS’s 2023 Medicaid transportation guide addresses nursing facility to nursing facility trips in its disaster policy section, where it says a state must cover moving a beneficiary from one nursing facility to another to obtain services. The same passage says NEMT is not available to move someone between community settings for personal reasons, such as to be closer to family or friends. The guide does not say Medicaid pays for a move a family chose, so ask the state Medicaid agency, or the resident’s managed care plan, before booking.

Book the ride last. Confirm the bed, the admission time and the transfer of records first, then give the ride company the resident’s mobility needs, oxygen needs and the arrival window.

When the move hits a snag

Call the state long-term care ombudsman. The Administration for Community Living describes ombudsman programs as resolving problems with the health, safety, welfare and rights of people in nursing homes and other long-term care facilities, and they take complaints from residents, families and other concerned people. CMS’s survey guidance tells nursing home staff to let residents know the local ombudsman can provide information and help with transitions. Every home must also post a list of State agencies and a statement that residents can file a complaint with the State Survey Agency (42 CFR 483.10(g)(5)).

For the ride company handling the move

A transfer is a one-time booking with a fixed arrival window and specific mobility needs. In HealthRide, wheelchair, stretcher and oxygen needs are matched to the right vehicle, and the facility can request the ride and follow the van live from its portal. Riders and families can follow their driver live from a text link on move day. See the live map.