Frequently Asked Questions: Laguna Honda Hospital’s Path to Recertification

These FAQs are updated as new information becomes available.

Last updated October 17, 2022

 

We know the Laguna Honda Hospital Community has many questions about Laguna Honda’s path to recertification with the federal Centers for Medicare & Medicaid Services (CMS) and the Closure and Patient Transfer and Relocation Plan (Closure Plan). We strive to keep you as updated as possible. 

Glossary:

We are all learning new words and terminology as part of the recertification process. We have included a short glossary at the end of this FAQ.  

What’s going on with Laguna Honda and its Medicare and Medicaid Certification?

The Centers for Medicare and Medicaid Services (CMS) terminated Laguna Honda Hospital’s participation in the Medicare and Medicaid Provider Participation Programs in April 2022. These programs fund the majority of resident care at Laguna Honda. Laguna Honda has an aggressive initiative in place to ensure the hospital continues to receive the vital CMS funding and is recertified in Medicare and Medicaid.

What are you doing to make sure the hospital stays open and gets recertified? 

Keeping Laguna Honda open and recertified are our highest priorities. Laguna Honda has an initiative in place to recertify the hospital. Every resource is being made available to ensure we are successful. The hospital remains open and licensed during the recertification process. We are committed to continuing to provide safe and quality healthcare to Laguna Honda residents throughout the recertification process.

Why is the hospital out of compliance with regulators?

Laguna Honda has an obligation to report many types of incidents to CDPH. This is always with the goal of improving the care we provide. In 2021, Laguna Honda self-reported two non-fatal overdoses, which resulted in several surveys. CMS, as a result of those surveys, found the hospital out of substantial compliance with the Medicare Conditions of Participation. CDPH, on behalf of CMS, set a deadline for Laguna Honda to get back into compliance or lose participation in the program.  

Laguna Honda made strides to address the issues previously raised by CDPH but was cited for new findings. At the end of the review period, Laguna Honda still had serious findings and did not meet the deadline for compliance.   

All staff at Laguna Honda are mandated reporters. If you see something or suspect something, say something. Contact any of the following: CDPH 415-330-6353 | LHH Nursing Ops 415-327-1902 | Ombudsman 415-751-9788.

What is recertification and what is the timeline and process? 

Laguna Honda is working hard to prepare for a successful recertification with CMS. The recertification process starts with submitting an application. It is followed by regulatory inspections, also known as surveys. After the initial surveys there is a period of time, called a “reasonable assurance period”, to show that Laguna Honda remains compliant. Once the compliance period ends there is a full survey. Laguna Honda hired a team of experts to lead the hospital through the recertification process. These on-site consultants have expertise in CMS regulations and CMS certification. Between our Laguna Honda staff and expert consultants, we are confident we have the team in place for a successful recertification.

What is happening with the City’s lawsuit against CMS?

The City filed a lawsuit against CMS earlier this year on behalf of Laguna Honda to ensure that CMS would continue to pay for the care of residents. A settlement agreement has been reached, which needs final approval by the Board of Supervisors and the Mayor and includes two critical elements for residents and families.

First, CMS agreed to continue paying for care at Laguna Honda until November 13, 2023. This extension adds a year of federal payments beyond the current agreement with CMS.

Second, CMS agreed to continue the pause on involuntary discharges and transfers of residents until February 2, 2023. CMS will have the option to further extend the pause date, depending on our progress, including but not limited to addressing deficiencies. During this pause, resident-initiated transfers and discharges will continue to occur, which is a right our residents are entitled to and aligned with hospital policy.

There are currently no plans for layoffs – staff is imperative to the recertification of Laguna Honda and all our efforts remain focused on recertifying the hospital. CMS extended Medicare and Medicaid payments for four months until mid-September 2022 with the possibility to extend payments for an additional two months. The CMS termination of Laguna Honda’s participation in the Medicare and Medicaid could have serious financial implications. We will keep you updated of any financial impacts to the hospital.

Are there going to be layoffs associated with this Plan? 

There are currently no plans for layoffs – staff is imperative to the recertification of Laguna Honda and all our efforts remain focused on recertifying the hospital. On August 15, 2022, Laguna Honda reached an agreement with CMS and California Department of Public Health (CDPH) to extend Medicare and Medicaid payments to Laguna Honda until November 13, 2023. The CMS termination of Laguna Honda’s participation in the Medicare and Medicaid could have serious financial implications. We will keep you updated of any financial impacts to the hospital.

Why does Laguna Honda have a Closure and Patient Transfer and Relocation Plan? Are patients being transferred out?

The Closure and Patient Transfer and Relocation Plan is currently paused until at least February 2, 2023. On October 12, 2022, the City reached a settlement with CMS and CDPH in principle to settle ongoing administrative proceedings and federal court litigation. This settlement allows Laguna Honda to continue to receive Medicare and Medicaid payments until November 13, 2023. Additionally, transfers and discharges of current residents remain paused until February 2, 2023, with a possibility of a further extension if Laguna Honda complies with its obligations under the settlement agreement

CMS initially required Laguna Honda to submit and implement a Closure and Patient Transfer and Relocation Plan in order to continue to receive funding even as we sought to recertify the hospital. The implementation of the Closure Plan began in May 2022.

Before the October 12, 2022 settlement, CMS and CDPH agreed to the City’s request to pause all transfers and discharges on July 28, 2022 and to extend that pause again on August 15, 2022.

What does the Closure and Patient Transfer and Relocation Plan include?  When does the plan go into effect? 

The Closure and Patient Transfer and Relocation Plan is currently paused until at least February 2, 2023.

The Closure and Patient Transfer and Relocation Plan included plans for notifications, resident assessments, resident and family meetings, staff meetings, discharge appeals, and resident relocation. 

Can residents move to a facility of their choice without waiting for the Laguna Honda relocation plan?

Yes, during this pause in the Closure Plan, resident-initiated transfers and discharges will continue to occur, which is a right our residents are entitled to and aligned with hospital policy.

What if a resident doesn’t want to be transferred?

Residents have the legal right to appeal any transfer and/or discharge. The Department of Health Care Services (DHCS) has an Office of Administrative Hearings and Appeals (OAHA) to hear these appeals. OAHA has a website to get more information: https://www.dhcs.ca.gov/formsandpubs/laws/Pages/Transfer-Discharge-and-Refusal-to-Readmit-Unit.aspx  

If Laguna Honda gets recertified, can the residents who transferred to other facilities return?

We will do our best to prioritize former residents who have been transferred out of Laguna Honda. However, former residents must go through the admission process and qualify for care at Laguna Honda. We must accept new admissions consistent with regulations and Laguna Honda policies.

What legal resources do Laguna Honda residents have other than the ombudsman?

A list of legal resources is included in the letter that went out to all residents dated May 16, 2022 and linked here. Other legal resources include California Advocates for Nursing Home Reform (CANHR), Bay Area Legal Aid, and Disability Rights California. 

For additional resources and other support, please contact the San Francisco Long-Term Care Ombudsman Program Director, Benson Nadell at (415) 751-9788 or Blanca Castro, the State Long Term Care Ombudsman via email at blanca.castro@aging.ca.gov or at 916-247-0300, for questions about this transition or about how the Ombudsman Program can support you. You may also call the Long-Term Care Ombudsman CRISISLine 1-800-231-4024 which is available 24/7.

For our Community:

We know the Laguna Honda Hospital Community has many questions about Laguna Honda’s path to recertification with the federal Centers for Medicare & Medicaid Services (CMS) and the Closure and Patient Transfer and Relocation Plan (Closure Plan). We strive to keep you as updated as possible. 

We hope this information is helpful. If we haven’t answered your question here, please contact your Resident Care Team or email  laguna.honda@sfdph.org

Glossary

CDPH – The California Department of Public Health (or CDPH) is the state agency that oversees licensing and certification of skilled nursing facilities like Laguna Honda. CDPH is responsible for enforcing state and federal regulations. 

CMS – The Centers for Medicare and Medicaid Services (or CMS) is a federal agency within the U.S. Department of Health and Human Services responsible for administering the country’s major healthcare programs, including the Medicare, Medicaid, and Health Insurance Marketplace. CMS runs the Medicare and Medicaid Provider Participation Programs that funds the majority of Laguna Honda’s care for our approximately 700 patients.  

ROUNDING – In-person presence to support frontline staff to ensure compliance with regulatory requirements. 

SURVEYS – Surveys are on-site inspections of health care facilities by their regulatory agencies. In the case of Laguna Honda, surveys are conducted by the California Department of Public Health, which oversees our licensing and certifications, although CMS can also conduct or participate in surveys at Laguna Honda. Surveyors look for and report on findings or deficiencies, meaning they document areas of needed improvement and places where the facility is out of compliance with state or federal regulations. 

Last updated October 17, 2022