Berkeley Municipal Code Ch. 12.88 Transfer of Medi-Cal Conversion Patients from Intermediate Care…

After public hearings and consideration of testimony and documentary evidence, the council finds that nursing homes in Berkeley discriminate against Medi-Cal patients by imposing a quota on the number of such patients who may be admitted and by prohibiting such patients from remaining in the nursing home if they convert to Medi-Cal. The council finds further that such practices pose a substantial threat to the health, safety and general welfare of this community and create an undue hardship on those who could otherwise not afford nursing home care. The council finds further there is no existing state legislation which safeguards nursing home patients in this community from such arbitrary removal. It is therefore necessary and proper to enact local regulations adopted to the special circumstances which exist in this City. (Ord. 5604-NS § 1, 1984)

A. "Skilled nursing facility" means a health facility which provides the following basic services: skilled nursing care and supportive care to patients whose primary need is for availability of skilled nursing care on an extended basis.

B. "Intermediate care facility" means a health facility which provides the following basic services: inpatient care to ambulatory or semiambulatory patients who have recurring need for skilled nursing supervision and need supportive care, but who do not require availability of continuous skilled nursing care.

C. "Health facility" and all other terms related to the organization, maintenance, and operation of health facilities shall have the same definitions as such terms are defined in California Health and Safety Code Sections 1250 et seq. (Ord. 5604-NS § 1, 1984)

It is unlawful for the owner, operator, administrator, lessor, lessee, sublessee, assignee, or other person having the right of ownership, the right of possession or authority to determine admission to a nursing home or any agent or employee of such person to transfer, evict or in any other way remove from a nursing home a person who changes their status from that of a private paying patient to a Medi-Cal recipient (i.e., through the Medi-Cal program).

The foregoing provisions shall not apply to any transfers permitted under the Patient’s Bill of Rights under Title 22, California Administrative Code sections 72527(a)(5) and 73523(a)(5). (Ord. 5604-NS § 3, 1984)

This chapter, as adopted, applies only to intermediate care facilities and skilled nursing facilities which have a Medi-Cal Program provider agreement as set forth in Title 22 of the California Administrative Code. (Ord. 5604-NS § 4, 1984)

Any person who violates the provisions of this chapter or who aids in the violation of any provisions of this chapter shall be liable to each person injured by such violation in addition to any other damages allowed by law, damages in the amount of five hundred dollars, and such reasonable attorneys fees and costs as may be determined by the court in an action to enforce any rights under this chapter. (Ord. 5604-NS § 5, 1984)

A. Civil Action. Any aggrieved person may enforce the provisions of this chapter by means of a civil action.

B. Injunction.

1. Any person who commits, or proposes to commit, an action in violation of this chapter may be enjoined therefrom by any court of competent jurisdiction.

2. Action for injunction under this subsection may be brought by any aggrieved person, by the District Attorney, or by any person or entity which will fairly and adequately represent the interest of the patient. (Ord. 5604-NS § 6, 1984)

Actions under this chapter must be filed within one year of the alleged discriminatory act(s). (Ord. 5604-NS § 7, 1984)