Transfer Discharge and Refusal to Readmit Unit
The Office of Administrative Hearings and Appeals (OAHA) is responsible for adjudicating appeals of residents who face involuntary transfer or discharge from their skilled nursing facility (SNF or nursing home) or whose SNF has refused to readmit the resident following a period of hospitalization or pre-approved therapeutic leave.
Transfer or Discharge (TDA) Appeals
Under federal and state law, when a facility initiates the transfer or discharge of a nursing home resident, the resident has established rights that must be addressed in order to ensure that the discharge is fair and appropriate. An essential component to these rights is the right to request a hearing. Only the resident or a person authorized by the resident, such as a family member or Ombudsman, may request a transfer/discharge hearing. Residents desiring a hearing should submit a request as soon as possible in order for a decision in the matter to be rendered before the proposed date of discharge.
Refusal to Readmit (RTR) Appeals
Under federal and state law, when a resident is transferred to the hospital or approved for therapeutic leave, the resident has a right to return to the facility upon approval for discharge from the hospital or when the period of therapeutic leave has concluded. When the resident is hospitalized and the SNF refuses to readmit the resident, the resident may request a hearing. Only the resident or a person authorized by the resident, such as a family member or hospital social worker, may request a readmission hearing. Preferably, a hearing request is submitted to OAHA while the resident is still hospitalized in order for OAHA to determine the resident’s eligibility for the hearing. OAHA conducts RTR hearings only for those residents who wish to return to their former SNF.
TDA and RTR Hearings
OAHA’s TDA/RTR Unit hearing officers conduct informal TDA and RTR hearings statewide. Generally, the hearing is held at the health facility where the resident resides (e.g. skilled nursing facility, hospital) in order to obtain testimony from witnesses and to examine pertinent clinical evidence needed to make a determination whether the SNF’s action is appropriate and in compliance with prevailing federal and state law. The resident or his/her legal representative must appear at the hearing, or authorize a representative to appear.
The hearing officer controls the course of the proceedings, digitally records the hearing, and takes sworn testimony from participants who are in attendance. The burden of proof is on the SNF to present evidence to support that its action is appropriate and in compliance with prevailing federal and state law. The appellant (resident or his/her representative) will have the opportunity to present testimony, including from witnesses that they compel to appear at the hearing. Only testimony that is relevant to the action will be allowed, at the hearing officer’s discretion. If the SNF fails to appear, the hearing will continue in resident/appellant’s absence. If the resident or the representative who is appearing on behalf of the resident fails to appear at hearing, the case will be dismissed. After conclusion of the hearing, the hearing officer writes the final administrative decision of the Department, known as a Decision & Order. The Decision & Order will either “grant,” “deny,” or “dismiss” the residents’ appeal request and outline the remedy that has been ordered.
REQUESTING A HEARING
When submitting a hearing request, an OAHA representative will ask you a series of questions. To avoid unnecessary delay, please have the following information available before making your request:
- Full name and date of birth of the affected resident
- The name of the resident’s SNF and address (if you have it)
- The name of the hospital if the resident is currently an inpatient
- If filing an appeal on behalf of a resident, be prepared to provide your contact information and information to demonstrate that you are authorized to make the hearing request, for example, the resident asked you to request the hearing on his or her behalf, or you have a Durable Power of Attorney for the resident’s health care.
- For TDA requests, have the written Notice of Transfer/Discharge available at the time of your call. If the SNF did not provide you with a written notice, ask them to do so.
- For RTR requests, document the date of your transfer from the SNF to the hospital and the date(s) that the SNF refused to readmit you.
A hearing request is complete when all the necessary information is received. An OAHA representative will review the completed request and may contact parties for additional clarification or documentation, if needed. OAHA will inform the SNF of the appeal. OAHA will notify both parties in writing of the time, date, and location of the hearing.
To request a hearing, residents or their authorized representative can contact OAHA’s TDA/RTR Unit via telephone at (916) 445-9775, fax at (916) 440-5105, or email at OAHAefax@dhcs.ca.gov.