Transfer Discharge and Refusal to Readmit Unit
The Office of Administrative Hearings and Appeals (OAHA) is responsible for adjudicating appeals of residents who face a facility-initiated transfer or discharge from their nursing facility, or whose nursing facility has refused to readmit the resident following a period of hospitalization or therapeutic leave.
Transfer or Discharge Appeals (TDA)
Under federal and state law, when a nursing 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 resident's authorized representative 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.
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Refusal to Readmit (RTR) Appeals
Under federal and state law, when a resident is transferred to the hospital or approved for therapeutic leave, they have a right to return to the nursing facility after they are hospitalized or when the period of therapeutic leave has concluded. When the resident is hospitalized and the nursing facility refuses to readmit the resident, the resident may request a hearing. Only the resident or a resident's authorized representative may request a RTR hearing. Preferably, an RTR hearing request is submitted to OAHA while the resident is still hospitalized. OAHA conducts RTR hearings only for those residents who wish to return to their nursing facility.
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TDA and RTR Hearings
OAHA's hearing officers conduct the TDA and RTR hearings. Generally, the hearing is held via telephone. The resident or his/her authorized representative must be present at the hearing.
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 nursing facility to present evidence to support that its action is appropriate and in compliance with prevailing federal and state law. The 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. 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 and outline the remedy that has been ordered. RTR hearings that are granted in favor of the resident will require the facility to submit a Certification of Compliance with the Department of Health Care Services.
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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 nursing facility 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, it is preferable to 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, provide the date of your transfer from the nursing facility to the hospital and the date(s) that the nursing facility refused to readmit you.
A hearing request is complete when all the necessary information is received. OAHA will notify the resident and the nursing facility in writing of the time, date, and location of the hearing.
To request a hearing, residents or their authorized representative can contact OAHA via telephone at (916) 445-9775, fax at (916) 440-5105, or email at OAHAefax@dhcs.ca.gov.
