California

The grounds, as California describes them

22 CCR 72527(a) (govt.westlaw.com/calregs, last substantively amended June 23, 2011, database current through August 28, 2026, retrieved 2026-09-04) opens: "(a) Patients have the rights enumerated in this section and the facility shall ensure that these rights are not violated. The facility shall establish and implement written policies and procedures which include these rights and shall make a copy of these policies available to the patient and to any representative of the patient. The policies shall be accessible to the public upon request. Patients shall have the right:"

Among the rights it enumerates, (a)(6) states:

"To be transferred or discharged only for medical reasons, or the patient's welfare or that of other patients or for nonpayment for his or her stay and to be given reasonable advance notice to ensure orderly transfer or discharge. Such actions shall be documented in the patient's health record."

This is California's own regulation naming the grounds, phrased — like the federal enumeration — as a resident's right rather than as a list of facility-permitted reasons. Its four categories (medical reasons, the patient's own welfare, the welfare of other patients, nonpayment) are narrower and differently grouped than the six-item enumeration at 42 CFR 483.15(c)(1)(i)(A)-(F), quoted on the federal page. CDPH's AFL 25-17 separately directs a facility's notice to state "The specific reason for the transfer or discharge, including the basis under Title 42 CFR section 483.15(c)(1)(i)(A)-(F)." — the federal categories, not 72527(a)(6)'s own — so the notice a resident actually receives is keyed to a different enumeration than the one California's own patients'-rights regulation states. All three texts are quoted from their own publishers; none is reconciled with another here.

The published process

Requesting 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, or by using the OAHA E-Filing Portal." No filing deadline and no street address for filing are stated in the sources reviewed; OAHA states that "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."

The pendency analogue is stated only for the refusal-to-readmit case. Health and Safety Code section 1599.1(h): when a hospitalized resident's facility refuses to readmit them, "The refusal of the facility, as described in this subdivision, shall be treated as if it were an involuntary transfer under federal law, and the rights and procedures that apply to appeals of transfers and discharges of nursing facility residents shall apply to the resident's appeal under this subdivision." For a Medi-Cal-eligible resident, "the resident shall remain in the hospital and the hospital may be reimbursed at the administrative day rate, pending the final determination of the hearing officer, unless the resident agrees to placement in another facility." For a resident not eligible under Medi-Cal, "the resident shall remain in the hospital if other payment is available, pending the final determination of the hearing officer, unless the resident agrees to placement in another facility." Where a hospitalized resident "is not eligible for participation in the Medi-Cal program and has no other source of payment, the hearing and final determination shall be made within 48 hours."

No comparable pendency statement — whether a resident stays in the nursing facility itself while an ordinary transfer-or-discharge appeal, as opposed to a refusal-to-readmit appeal, is pending — was found in any captured California source. Searched: Health and Safety Code section 1599.1 in full, sections 1599.2 through 1599.4, Welfare and Institutions Code section 14126.029, the DHCS OAHA page, and 22 CCR 72527, 72520 and 72519. Not stated in the sources reviewed.

Once OAHA decides, Welfare and Institutions Code section 14126.029 governs what happens next for both kinds of appeal alike. A long-term health care facility "shall timely comply with a hearing decision, as issued by the department's Office of Administrative Hearings and Appeals pursuant to Section 1396r(e)(3) of Title 42 of the United States Code and Section 1599.1 of the Health and Safety Code, that finds that the long-term health care facility improperly transferred, discharged, or refused to readmit a resident." The statute defines the term: "“Timely” means within three calendar days of a long-term health care facility being served a hearing decision." A facility that misses the window is subject to a penalty: "Commencing on the fourth calendar day after the date of service of the hearing decision, the department may assess a penalty of seven hundred fifty dollars ($750) for each calendar day the facility fails to comply with the hearing decision." The statute caps the total: "the department shall not assess aggregate penalties that exceed seventy-five thousand dollars ($75,000)" for any one hearing decision. The facility must also file "a certification of compliance with the department within three calendar days of the date the hearing decision is served on that facility, in a form and manner as established by the department." The same statute requires that a hearing decision "be made by a hearing officer trained to consider and apply the procedural and substantive requirements of all applicable federal and state laws and regulations governing the transfer and discharge process." It also requires that the hearing itself "afford the resident and facility due process, including, but not limited to, allowing the direct and cross-examination of witnesses under oath, allowing the presentation of documents as exhibits, and making a recording of all sessions of the proceedings of sufficient quality to allow for the preparation of a written transcript" — consistent with OAHA's own description that the hearing officer "digitally records the hearing". Section 14126.029's own closing line states it is "Conditionally inoperative as provided in subd. (a) of Section 14126.035." and "Inoperative after December 31, 2027, pursuant to Section 14126.036." — quoted as published; whether the underlying operative condition is currently satisfied is not a fact this page can verify.

The notice's required contents

AFL 25-17 states the facility's notice "must include all of the following at the time notice is provided": "The specific reason for the transfer or discharge, including the basis under Title 42 CFR section 483.15(c)(1)(i)(A)-(F)."; "The effective date of transfer or discharge."; "The specific location (such as the name of the new provider or description and/or address if the location is a residence) to which the resident is to be transferred or discharged."; "An explanation of the right to appeal the transfer or discharge to the State (Department of Health Care Services (DHCS), Office of Administrative Hearings and Appeals (OAHA))."; "The name, address (mail and email), and telephone number of the state entity which receives such appeal hearing requests (DHCS OAHA, Transfer Discharge and Refusal to Readmit Unit)."; "Information on how to obtain an appeal form."; "Information on obtaining assistance in completing and submitting the appeal hearing request."; and "The name, address (mailing and email), and phone number of the representative of the Office of the State LTC Ombudsman." For residents with intellectual, developmental, or mental-health-related disabilities, the notice must also carry the contact for the state's protection-and-advocacy agency. 22 CCR 72527(a)(6), quoted in full in section 01, states the parallel state-regulation duty in its own words: the resident is "to be given reasonable advance notice to ensure orderly transfer or discharge."

Bed-hold and return

22 CCR 72520(a): "If a patient of a skilled nursing facility is transferred to a general acute care hospital as defined in Section 1250(a) of the Health and Safety Code, the skilled nursing facility shall afford the patient a bed hold of seven (7) days, which may be exercised by the patient or the patient's representative." The patient or representative must act quickly: "Upon transfer to a general acute care hospital, the patient or the patient's representative shall notify the skilled nursing facility within twenty-four (24) hours after being informed of the right to have the bed held, if the patient desires the bed hold." Charges may apply: "Except as provided in Section 51535.1, Title 22, California Administrative Code, any patient who exercises the bedhold option shall be liable to pay reasonable charges, not to exceed the patient's daily rate for care in the facility, for bed hold days." And the seven days is not absolute: "If the patient's attending physician notifies the skilled nursing facility in writing that the patient's stay in the general acute care hospital is expected to exceed seven (7) days, the skilled nursing facility shall not be required to maintain the bed hold." A facility that fails to meet these requirements "shall offer to the patient the next available bed appropriate for the patient's needs." The section states its provisions "do not apply to patients covered only by Medicare, Title XVIII benefits pursuant to Code of Federal Regulations, Title 42, Subsection 489.22(d)(1)."

The Medi-Cal reimbursement counterpart, 22 CCR 51535.1, states the same limit for payment purposes: "Payment for bed hold days shall be limited to a maximum of seven days for each period of acute hospitalization." It adds that "The facility shall hold a bed vacant during the entire bed hold period except when notified, in writing by the attending physician that the patient requires more than seven days of hospitalization." and that "If so notified, the facility is no longer required to hold the bed available and shall not bill Medi-Cal for any remaining days of bed hold." Its own counting rule states: "The day of departure shall be counted as one day of bed hold and the day of return shall be counted as one day of inpatient care." Its own printed reimbursement-rate table names rates only for 2004-05, 2005-06 and 2006-07 ($5.07, $5.18 and $5.30) despite carrying a "Currentness" marker and a 2013-2014 amendment to the same subsection; both facts are recorded here as published, not reconciled — see the change log.

On return specifically, a facility's refusal to readmit a hospitalized resident is itself the event that opens the appeal quoted under Requesting the hearing above: Health and Safety Code section 1599.1(h) treats that refusal "as if it were an involuntary transfer under federal law," carrying the same pendency and payment consequences quoted there.

The three rows above hoist the questions a facility's counsel answers in the first fifteen minutes. They are quotations from California's published sources, not a determination that any of them applies to any situation.

Notice periods and deadlines, as stated in the sources

All quoted; none calculated.

Thirty days' advance notice — AFL 25-17: "Notice must be provided at least 30 days prior to the transfer or discharge of the resident." Four exceptions apply, in which case "the notice must be provided to the resident, resident's representative(s) if appropriate, and LTC ombudsman as soon as practicable before the transfer or discharge."

Twenty-four hours to claim a bed hold — 22 CCR 72520(a)(1), quoted in full above.

Seven days' bed hold — 22 CCR 72520(a) and 22 CCR 51535.1(b), quoted in full above.

Forty-eight hours to hearing and final determination for an unfunded hospitalized resident — Health and Safety Code section 1599.1(h)(5), quoted in full above.

Three calendar days for a facility to comply with an OAHA hearing decision, and the same three days to file a certification of compliance — Welfare and Institutions Code section 14126.029(a)(2) and (d), quoted in full above.

No filing deadline for the resident's own hearing request is stated in the sources reviewed.

What any of these periods means for a particular case is for the hearing office to determine.

Source map

Captured: all nine, in tools/packets/california-packet.txt. Pending: none currently outstanding — the two rules capture-pending since 2026-08-30 (22 CCR 72527 and 72520) and the earlier absence of any first-party Medi-Cal bed-hold statement are resolved by this pass; see the change log. Not addressed by any captured source: a pendency statement for the general (non-refusal-to-readmit) transfer-or-discharge appeal; the docket and section 02 state that absence rather than fill it.

Change log

2026-10-06 — Internet Archive captures recorded. Captures requested on 2026-09-06 by an automated capture pass and recorded this date; no human review is claimed for this entry. No quotation, date, finding or link above was changed by it. Each capture below was requested through Save Page Now and then confirmed to play back. Captures added: California Department of Aging → https://web.archive.org/web/20260906131018/https://aging.ca.gov/programs_and_services/long-term_care_ombudsman/; California Legislative Information → https://web.archive.org/web/20260906131705/https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=HSC&sectionNum=1599.1; California Legislative Information → https://web.archive.org/web/20260906131908/https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=WIC&sectionNum=14126.029; CDPH → https://web.archive.org/web/20260906131958/https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/AFL-25-17.aspx; DHCS, Office of Administrative Hearings and Appeals → https://web.archive.org/web/20260906132050/https://www.dhcs.ca.gov/forms-laws-publications/laws-and-regulations/transfer-discharge-and-refusal-to-readmit-unit/.

2026-09-25 — Correction: broken source links. The five links to the California Code of Regulations on govt.westlaw.com did not reach the regulations: each address ends in "contextData=(sc.Default)", and this site's own renderer ended every link at the first closing parenthesis, so the published links stopped at "(sc.Default" and a stray ")" was printed after each. That was our error, not the publisher's. The renderer (tools/render-state.py) now accepts one level of parentheses in an address, and the page was re-rendered from this file; the links now carry the full addresses written here. No source was re-captured and no wording on this page changed. Reviewer: Carrie Schluter, reviewed 2026-09-25. Corrections: hello@fieldassembly.net.

2026-09-04 — Deepened from the 2026-08-30 baseline to a full page: section 01 (the grounds, as California describes them) and section 02 (the published process, including the notice's required contents, bed-hold and return, and the notice-periods register) are newly written. All nine sources are captured first-party through tools/recipes/california.json (python3 tools/capture.py california): five sources are new (22 CCR 72527, 72520, 72519 and 51535.1, and Welfare and Institutions Code section 14126.029), and the original four are re-captured by the same recipe-driven method rather than the session's HTTP fetch tool the 2026-08-30 packet used. Findings: (7) 22 CCR 72527 (Patients' Rights) is now captured; DHCS's own page links a stale Westlaw document address that returns "Document not found" from a live browser as well as from curl, and the section's current address was found by browsing govt.westlaw.com/calregs's own table of contents (Title 22 > Division 5 > Chapter 3 > Article 5), with no search box or session token involved. 72527(a)(6) is California's own regulatory statement of the grounds, in four categories narrower than the federal enumeration on the federal page and different from the federal categories AFL 25-17 directs a facility's notice to cite; all three are quoted from their own publishers and none is reconciled with another. (8) 22 CCR 72520 (Bed Hold) is now captured by the same route; it states a seven-day bed hold, a twenty-four-hour window to claim it, and a physician's-notice exception. Its Medi-Cal reimbursement counterpart, 22 CCR 51535.1, found by following 72520's own cross-reference to it, states the same seven-day cap for payment purposes; 51535.1's own printed reimbursement-rate table runs only through fiscal year 2006-07 despite carrying a "Currentness" marker and a 2013-2014 amendment to the same subsection, quoted as published and not reconciled. Together these resolve the 2026-08-30 finding that no first-party bed-hold day count or Medi-Cal payment statement had been found. (9) govt.westlaw.com/calregs is reachable by plain curl with a browser user-agent once a section's live address is found; the 2026-08-30 finding describing the host as serving rule text "only to a scripted client" was imprecise — the actual barrier was the two stale addresses DHCS's own page links, a fact about that page's links rather than about the transport. cdph.ca.gov and dhcs.ca.gov are likewise now plain curl-able with a browser user-agent; whatever produced the incomplete certificate chain and the 212-byte script shell on 2026-08-30 no longer does. (10) 22 CCR 72519 (Patient Transfer), captured while reading Article 5's own section list, cross-references "Section 72527(a)(5)" for an emergency exception to its own acknowledgment requirement; the current 72527(a)(5), after a 2011 renumbering, states the informed-consent-disclosure right rather than the transfer/discharge right, which now sits at 72527(a)(6) — a discrepancy inside the state's own current regulations, recorded rather than corrected. (11) Welfare and Institutions Code section 14126.029, found searching for any California statement of what happens after an OAHA hearing decision, states a three-calendar-day facility compliance deadline, a $750-per-day penalty capped at $75,000 aggregate, a hearing-officer training requirement, and a due-process requirement; its own closing line states it is "Conditionally inoperative as provided in subd. (a) of Section 14126.035." and "Inoperative after December 31, 2027, pursuant to Section 14126.036." — quoted as published, with no assessment here of whether the underlying operative condition is currently satisfied. (12) No statement that a resident stays in the nursing facility itself while an ordinary transfer-or-discharge appeal is pending was found in any captured California source; Health and Safety Code section 1599.1(h) states a pendency rule only for the refusal-to-readmit case. The absence is stated in the Requesting the hearing row rather than filled from federal law or another state. (13) Health and Safety Code section 1599.1(h)(5)'s 48-hour hearing-and-determination deadline for an unfunded hospitalized resident, present in the 2026-08-30 packet but not yet quoted on the baseline page, is now quoted in the deadlines register. (14) A capture-tooling defect, not a finding about California, is recorded here because it was found and fixed while building this page: tools/capture.py's HTML extractor read two things a reader never sees as though they were document text — an HTML comment (govt.westlaw.com's template opens every subdivision with an empty <!--anchor--> comment, which without a fix turned "(a)" into "anchor(a)" throughout the first capture of 22 CCR 72527) and a style="display:none" node (cdph.ca.gov's SharePoint template carries CMS field-name labels such as "LetterAuthority" in such nodes, which the first capture of AFL 25-17 read as page text). Both are fixed in tools/capture.py, each with a self-test added, and recorded in CLAUDE.md; no quotation on this page was ever built from the unfixed extraction. Capture pending: none currently outstanding; see the source map. Internet Archive: not yet submitted. Reviewer: Carrie Schluter, reviewed 2026-09-04. Corrections: hello@fieldassembly.net.

2026-08-30 — Baseline page built from the first California packet: docket, lede, source map, change log. Not yet captured or written: section 01 (the grounds, as California describes them) and section 02 (the published process, including the notice's required contents in the state's own regulatory text, bed-hold and return, and the notice-periods register). Findings: (1) California publishes its regulations through govt.westlaw.com/calregs, which serves rule bodies only to a scripted client; direct capture returns a 4.8 KB shell with no rule text, so 22 CCR 72527 and 22 CCR 72520 are capture-pending although both are named and linked by the agencies' own pages. (2) No captured California source enumerates the permissible bases for involuntary transfer or discharge; AFL 25-17 requires the notice to give the basis "under Title 42 CFR section 483.15(c)(1)(i)(A)-(F)" and points to the federal enumeration rather than restating one — the grounds row states the absence, and the federal enumeration is not borrowed onto this page. (3) The hearing route is published as a telephone, fax, email, and e-filing-portal route with no stated filing deadline and no street address; the absence is stated rather than filled. (4) Health and Safety Code section 1599.1(h) treats a facility's refusal to readmit after hospitalization as an involuntary transfer and states the resident "shall remain in the hospital and the hospital may be reimbursed at the administrative day rate, pending the final determination of the hearing officer" where the resident is Medi-Cal eligible; recorded here as captured, to be quoted in section 02 when that section is written. (5) The Department of Aging's ombudsman page states no date of its own. (6) The CDPH letter carries the masthead "EDMUND G. BROWN JR." above a document dated May 28, 2025 — the publisher's own page furniture, reproduced as published. Capture pending: per the source map. Internet Archive: not yet submitted. Reviewer: Carrie Schluter, reviewed 2026-08-30. Corrections: hello@fieldassembly.net.