Laguna Honda Hospital (LHH) lost its certification, what does this mean for you?

On April 14, 2022, Laguna Honda Hospital (LHH) lost its ability to get paid by Medi-Cal and Medicare due to quality-of-care violations.1 Medi-Cal and Medicare pay for most patient care at LHH (over 90%).2 This resulted in LHH beginning to transfer patients in accordance with a closure plan required by the Centers for Medicare & Medicaid Services (CMS).3 But on October 12, 2022 an agreement was reached to continue payments and pause resident transfers and discharges.4  

As of the date of this publication, Medi-Cal has restored funding for Laguna Honda, while Medicare funding is pending, and there are no plans to resume forced transfers and discharges of LHH patients at this time.5 However, LHH is not admitting new patients and hospital officials have said that LHH will only readmit patients once Medicare funding is restored.6

We want you to know your rights when and if LHH resumes transfers, discharges, and re-admissions. First, you have choice in where you go. LHH should not discharge you to a homeless shelter or the streets.7 By law, you should be transferred to an appropriate setting with similar care that you receive now.8 However, because skilled nursing facility beds are so limited in San Francisco County, LHH may try and transfer you out-of-county or even out-of-state. These types of transitions can be difficult and traumatic; you have the right to appeal and ask for and receive proper physical, mental, psychological, and person-centered discharge care and planning from LHH.9 We discuss your appeal rights in more detail below.

Can Laguna Honda Hospital transfer me to another skilled nursing facility?

Yes, but you have legal rights and a choice in where you go and LHH must follow certain rules.10 LHH cannot ask you to waive your rights.11 A team of doctors, nurses, social workers, family, and/or representatives must meet with you at least once to discuss your transfer and discharge options.12 You can also request that the state long-term care ombudsperson be present at any transfer/discharge meetings with staff.13

You are entitled to at least 60 days advance written notice of any transfer or discharge when a facility is closing.14 You are also entitled to at least 30 days notice of transfer or discharge. The 30 day notice must say the recommended discharge plan and the reasons for the move.15 If LHH transfers you to another facility, they must arrange transportation and send your medications, personal belongings, and any patient funds. They will also notify the Social Security Administration of your new address.16

Can Laguna Honda Hospital help me move into a home, apartment, or similar setting?

Yes, you have the right to ask that you be transferred to a community-based setting. LHH must ensure that you are discharged back to the community with proper supports, including plans for follow-up care, discharge medications, and any necessary equipment and supplies for 30 days.17

What if I don’t want to leave Laguna Honda Hospital?

If you receive notice of a transfer or discharge and you want to remain at LHH, it is important that you appeal this notice. The benefits of appealing are getting more time, either to arrange an appropriate place to go or to see if the facility gets on track to regain certification. This is because, in most circumstances, requesting an appeal pauses your transfer or discharge, until the appeal is decided. If you lose your appeal, however, you may be transferred right away.18

It is also possible that you could request to be transferred back to LHH if it becomes recertified with Medicare. Hospital officials have said they will prioritize former LHH patients who still need skilled nursing care.19 You should also keep in mind that if LHH is not recertified, you may not have an appropriate place to be discharged. This means that you should carefully consider your options if LHH offers you a placement that is near your family and support system, and you feel it is an acceptable placement for you. Filing for an appeal will not stop LHH from closing, and there is no guarantee of the outcome of an appeal. Keep in mind that appeals are generally decided on a fast timeline.

What if I don’t agree with the transfer to another facility

You have the right to appeal a transfer and/or discharge and have a hearing. The Department of Health Care Services (DHCS) has an Office of Administrative Hearings and Appeals (OAHA) to hear these appeals.20 You should appeal as soon as possible. However, if LHH does close, you won’t be allowed to remain at LHH past the closure date.21

While your request for hearing is pending, Laguna Honda generally cannot discharge or transfer you.22 LHH can only discharge you sooner than 30 days, or while your appeal is pending, if they’re able to show that your presence at LHH is dangerous to the health and safety of yourself or others.23

To appeal a Transfer or Discharge Notice, contact DHCS by phone, fax, or email at:

Office of Administrative Hearings and Appeals
Department of Health Care Services
(916) 445-9775 or (916) 322-5603 (phone)
(916) 440-5105 (fax)
OAHAefax@dhcs.ca.gov (email)

Please also see the enclosed sample appeal form and letter.

• LHH Appeal Form Template (rtf)

If you have concerns about your transfer/discharge and want help, you can contact the local and state long-term care ombudsperson at:

San Francisco LTC Ombudsperson Program c/o Felton Institute
6221 Geary Boulevard, 3rd Floor
San Francisco, CA 94121
(415) 751-9788 (phone)
(800) 231-4024 (after hours crisis line)
ombudsman@felton.org 

You can also contact the State Department of Public Health at:

150 North Hill Drive, Suite 22
Brisbane, CA 94005
(415) 330-6353 (phone)
(415) 330-6350 (fax)
CDPH-LNC-DALYCITY@cdph.ca.gov

Finally, you may contact Disability Rights California at:
(800) 776-5746 (phone)
services@DisabilityRightsCa.org 

• 1. 42 U.S.C.A. §§ 1395i-3(c)(2)(A), 1396r(c)(2)(A); LAGUNA HONDA HOSPITAL AND REHABILITATION CENTER NOTIFICATION OF CLOSURE AND PATIENT TRANSFER AND RELOCATION PLAN (“LHH PLAN”), page 2, , available at https://sf.gov/sites/default/files/2022-05/Laguna%20Honda%20Hospital%20and%20Rehabilitation%20Center%20Notification%20of%20Closure%20and%20Patient%20Transfer%20and%20Relocation%20Plan.pdf.
• 2. LHH PLAN, page 9.
• 3. See generally LHH PLAN.
• 4. https://sf.gov/information/laguna-honda-hospital-closure-and-patient-transfer-and-relocation-plan; https://www.kqed.org/news/11950092/san-francisco-laguna-honda-hospital-granted-extension.
• 5. https://www.kqed.org/news/11958392/medi-cal-reinstates-laguna-honda-in-major-win-for-the-states-largest-public-nursing-home; https://www.kqed.org/news/11960974/laguna-honda-hospital-needs-28-4-million-in-emergency-repairs.
• 6. https://www.kqed.org/news/11960974/laguna-honda-hospital-needs-28-4-million-in-emergency-repairs.
• 7. 42 U.S.C.A. § 1396r(b)(2); 42 C.F.R. § 483.24.
• 8. 42 C.F.R. §§ 483.70(l), 483.15(c)(8).
• 9. H&S Code, § 1336.2; 42 C.F.R. § 483.15(c); LHH PLAN, page 13.
• 10. 42 C.F.R. § 483.15(c); H&S Code, § 1336.2.
• 11. 42 C.F.R. § 483.15(a)(1)(i).
• 12. H&S Code, § 1336.2.
  (i) Ensure that the discharge needs of each resident are identified and result in the development of a discharge plan for each resident.
  (ii) Include regular re-evaluation of residents to identify changes that require modification of the discharge plan. The discharge plan must be updated, as needed, to reflect these changes.
  (iii) Involve the interdisciplinary team, as defined by § 483.21(b)(2)(ii), in the ongoing process of developing the discharge plan.
  (iv) Consider caregiver/support person availability and the resident's or caregiver's/support person(s) capacity and capability to perform required care, as part of the identification of discharge needs.
  (v) Involve the resident and resident representative in the development of the discharge plan and inform the resident and resident representative of the final plan.
  (vi) Address the resident's goals of care and treatment preferences.
  (vii) Document that a resident has been asked about their interest in receiving information regarding returning to the community.
  (A) If the resident indicates an interest in returning to the community, the facility must document any referrals to local contact agencies or other appropriate entities made for this purpose.
  (B) Facilities must update a resident's comprehensive care plan and discharge plan, as appropriate, in response to information received from referrals to local contact agencies or other appropriate entities.
  (C) If discharge to the community is determined to not be feasible, the facility must document who made the determination and why.
  (viii) For residents who are transferred to another SNF or who are discharged to a HHA, IRF, or LTCH, assist residents and their resident representatives in selecting a post-acute care provider by using data that includes, but is not limited to SNF, HHA, IRF, or LTCH standardized patient assessment data, data on quality measures, and data on resource use to the extent the data is available. The facility must ensure that the post-acute care standardized patient assessment data, data on quality measures, and data on resource use is relevant and applicable to the resident's goals of care and treatment preferences.
• 13. LHH PLAN, page 8; 42 C.F.R. section § 483.15(c)(3)(i).
• 14. H&S Code, § 1336.2(a)(4) (“At least 60 days in advance of the transfer,[the facility must] inform the resident or the resident's representative of alternative facilities that are available and adequate to meet resident and family needs.”); 42 C.F.R. § 483.15(c)(2)-(6).
• 15. 42 C.F.R. § 483.15(c)(5).
• 16. LHH PLAN, page 13.
• 17. 42 C.F.R. § 483.21(c); H&S Code, § 1418.8; LHH PLAN, page 13.
• 18. 42 C.F.R. § 483.15(c)(1)(i)-(ii).
• 19. https://www.kqed.org/news/11960974/laguna-honda-hospital-needs-28-4-million-in-emergency-repairs.
• 20. Notice of Actions are appealed to the California Department of Social Services, State Hearings Division. Appeals of a Transfer or Discharge Notice are appealed to the DHCS Office of Administrative Hearings and Appeals. Information regarding appeal rights and how to file an appeal are included with a Notice of Action or a Transfer or Discharge Notice.
• 21. LHH PLAN, page 4.
• 22. 42 C.F.R. § 483.15(c)(1)(ii); LHH PLAN, page 12.
• 23. 42 C.F.R. §§ 483.15(c)(1)(C)-(D), 483.15(c)(1)(ii); LHH PLAN, page 12