AMENDED IN SENATE JUNE 29, 2026

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AMENDED IN ASSEMBLY APRIL 16, 2026

AMENDED IN ASSEMBLY APRIL 6, 2026

CALIFORNIA LEGISLATURE— 2025–2026 REGULAR SESSION

95

Introduced by Assembly Member Kalra

February 18, 2026

An act to amend Section 1439.6 of, and to add Section 1429.5 to, the Health and Safety Code, and to amend Section 14126.029 of the Welfare and Institutions Code, relating to public health.

Vote: majority   Appropriation: no   Fiscal committee: yes   Local program: yes

LEGISLATIVE COUNSEL’S DIGEST

(1) Existing law provides for the licensing and regulation of health facilities, including, but not limited to, long-term health care facilities, as defined, by the State Department of Health Care Services. Existing law requires a contract for admission to a long-term care facility to state that a resident shall not be involuntarily transferred within, or discharged from, a long-term health care facility unless the resident is given reasonable notice in writing, and transfer or discharge planning, as specified. Willful or repeated violations of the provisions relating to long-term health care facilities is a misdemeanor.

This bill would require long-term health care facilities to provide residents with a notice of a facility-initiated transfer or discharge at least 30 days before a resident is transferred or discharged, unless an exception applies. The bill would require the notice of transfer or discharge to be acknowledged by the signature of the resident or, if applicable, the resident’s representative. The bill would make a violation of these provisions a class “B” violation and would make knowingly making a false verification regarding the delivery of a notice of transfer or discharge a willful violation for purposes of the criminal provision described above.

The bill would require a notice of discharge or transfer to be provided to a resident and, if applicable, the resident’s representative in a translated or accessible format at the same time as the written notice in English if the resident’s primary language is not English or if the resident is vision impaired or blind, as specified. The bill would also require the translated or accessible-format notices to be made available to the local long-term care ombudsman upon request. The bill would require the translator to attest, under penalty of perjury, to the accuracy of the translation, thereby expanding the crime of perjury. The bill would require a resident’s primary language or sensory impairments to be included in the minimum dataset maintained by the facility. The bill would make a violation of these provisions a class “B” violation.

Existing law requires that a copy of the notice of transfer or discharge be sent to the local long-term care ombudsman at the same time notice is provided to the resident or the resident’s representative by facsimile machine, email, or first-class mail, as specified. Existing law requires, if a resident is subject to a facility-initiated transfer to a general acute care hospital on an emergency basis, the notice to be provided to the local long-term care ombudsman as soon as practicable.

This bill would instead require the notices described above to be sent to the long-term care ombudsman by facsimile, email, or other electronic means. For emergency transfer notices, the bill would require a copy of the notice to be provided to the local long-term care ombudsman as soon as practicable, but in no event later than 24 hours after the transfer.

Because a willful or repeated violation of long-term care facilities provisions is a crime and because the crime of perjury is expanded, the bill would impose a state-mandated local program.

(2) Existing law requires the State Department of Public Health to establish an inspection and reporting system to ensure that long-term health care facilities are in compliance with state statutes and regulations. Existing law, the Medi-Cal Long-Term Care Reimbursement Act, requires, among other things, that long-term health care facilities timely comply with hearing decisions issued by the department’s Office of Administrative Hearings and Appeals for improperly transferring, discharging, or refusing to readmit a resident. Existing law authorizes the department to assess a penalty of $750 for each calendar day a facility fails to comply with the hearing decision and caps aggregate penalties for each individual hearing decision at $75,000.

The bill would authorize the State Department of Public Health to prohibit the admission of new residents to a long-term health care facility upon notification that a facility has failed to timely comply with a hearing decision. The bill would require the prohibition to remain in effect until the facility has achieved compliance, the maximum aggregate of penalties have been collected, or the facility has formally sought judicial review of the hearing decision.

The bill would increase the daily penalty described above to $1,000 for each calendar day and increase the maximum aggregate penalty amount to $100,000.

(3) The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

The people of the State of California do enact as follows:

SECTION 1.

Section 1429.5 is added to the Health and Safety Code, to read:

1429.5.

Upon notification that a long-term health care facility has failed to timely comply with a hearing decision issued pursuant to Section 14126.029 of the Welfare and Institutions Code, the State Department of Public Health may prohibit the admission of new residents to the facility. The prohibition shall remain in effect until any of the following has occurred, as verified by the State Department of Public Health prior to lifting the prohibition:

(a) The facility has achieved compliance.

(b) The maximum aggregate amount of penalties under subdivision (c) of Section 14126.029 of the Welfare and Institutions Code has been collected.

(c) The facility has formally sought judicial review of the hearing decision.

SEC. 2.

Section 1439.6 of the Health and Safety Code is amended to read:

1439.6.

(a) Except as provided in subdivision (b), if a resident is notified in writing of a facility-initiated transfer or discharge from a long-term health care facility, the facility shall also send a copy of the notice to the local long-term care ombudsman at the same time notice is provided to the resident or the resident’s representative. Any translated or accessible-format copies of the notice provided pursuant to subdivision (k) shall be made available to the local long-term care ombudsman upon request.

(b) If a resident is subject to a facility-initiated transfer to a general acute care hospital on an emergency basis, the facility shall provide a copy of the notice to the ombudsman as soon as practicable, but in no event later than 24 hours after the transfer.

(c) The copy of the notice shall be sent by facsimile machine, email, or other electronic means to the local long-term care ombudsman. A facility’s failure to timely send a copy of the notice shall constitute a class “B” violation, as defined in subdivision (e) of Section 1424.

(d) For the purposes of this section, a “facility-initiated transfer or discharge” is a transfer or discharge that is initiated by the facility and not by the resident, whether or not the resident agrees to the facility’s decision.

(e) (1) A notice of a facility-initiated transfer or discharge shall be made by the facility at least 30 days before a resident is transferred or discharged, except as provided in paragraphs (2) and (3).

(2) A notice of transfer or discharge shall be made by the facility at least 14 days before a resident is transferred or discharged in any of the following circumstances:

(A) The resident’s health has improved sufficiently to allow a more immediate transfer or discharge.

(B) The resident has not resided in the facility for 30 days.

(3) (A) A notice of transfer or discharge shall be made as soon as practicable before a resident is transferred or discharged when the health or safety of individuals in the facility would be endangered. The following conditions must be met before notice is provided:

(i) A licensed health care practitioner acting within their scope of practice engaged with the resident and, if applicable, the resident’s representative, to address the situation that is causing the health or safety of individuals in the facility to be endangered.

(ii) The facility has documented its efforts to execute the health care practitioner’s orders regarding the modifications to the care plan to address the resident’s endangerment to the health and safety of individuals.

(B) A notice of transfer or discharge made pursuant to this paragraph shall include a description of how the health or safety of individuals in the facility would be endangered and the type of care, services, or supports the discharge location can provide that are expected to address the resident’s endangerment to the health and safety of individuals. needs.

(4) Receipt of the notice of transfer or discharge shall be acknowledged by the signature of the resident or, if applicable, the resident’s representative. If the signature of the resident or resident’s representative cannot be obtained, a facility staff member shall sign the notice and verify that they delivered the notice to the resident and, if applicable, the resident’s representative and state the name or names of the person or persons they delivered the notice to and the date or dates on which the notice was delivered. Copies of the signed notice shall be given to the resident and, if applicable, their representative.

(5) Knowingly making a false verification regarding the delivery of a notice of transfer or discharge pursuant to paragraph (4) is a willful violation subject to subdivision (c) of Section 1290.

(6) A facility’s failure to comply with this subdivision shall constitute a class “B” violation, as defined in subdivision (e) of Section 1424.

(7) Nothing in this section shall prohibit a resident who poses a danger to themselves or others from being detained pursuant to Section 5150 or 5250 of the Welfare and Institutions Code or otherwise lawfully detained.

(f) Within 48 hours of giving the written notice of a facility-initiated transfer or discharge, the facility shall provide to the resident and, if applicable, the resident’s representative a copy of both of the following:

(1) The evaluation of the resident’s discharge needs and discharge plan as required by federal law and regulations or the most current discharge care plan.

(2) In the case of the transfer or discharge being necessary for the resident’s welfare because the resident’s needs cannot be met in the facility, all of the following information if the following information is not included in the most current discharge care plan:

(A) A written description of the specific resident’s needs that cannot be met.

(B) Facility attempts to meet the resident’s needs.

(C) The services available at the receiving facility that meet the resident’s needs.

(g) Prior to the proposed transfer or discharge date, the facility shall provide to the resident and, if applicable, the resident’s representative a copy of the resident’s discharge summary.

(h) Any documents provided to the resident and, if applicable, the resident’s representative pursuant to this section shall be at no cost to the resident and, if applicable, the resident’s representative.

(i) The documents described in subdivisions (f) and (g) do not have to be provided to the resident and, if applicable, the resident’s representative if the resident or the resident’s representative request that the documents not be provided or if no discharge is proposed.

(j) If a transfer or discharge appeal hearing is requested by the resident or, if applicable, the resident’s representative, the facility shall provide to the resident or the resident’s representative the opportunity to examine, at a reasonable time before the date of the hearing, absent exigent circumstances, and during the hearing, all documents and records to be used by the facility at the hearing. The resident or, if applicable, the resident’s representative shall provide to the facility the opportunity to examine, at a reasonable time before the date of the hearing, absent exigent circumstances, and during the hearing, all documents and records to be used by the resident or, if applicable, the resident’s representative at the hearing.

(k) (1) A notice required by this section shall meet the following requirements:

(A) If the primary language of the resident is not English, the facility shall provide a written translation of the notice in the resident’s primary language. The translated notice shall be provided to the resident and, if applicable, the resident’s representative, at the same time as the written notice in English. The facility or the individual or entity providing the translation shall attest, under penalty of perjury, to the accuracy of the written translation in the translated document.

(B) If the resident is vision impaired or blind, the facility shall provide the written notice in large print or braille upon the resident’s request. The accessible-format notice shall be provided to the resident and, if applicable, the resident’s representative, at the same time as the written notice. The facility or the individual or entity providing the transcript or format conversion shall attest, under penalty of perjury, to the accuracy of the content in the accessible-format document. Braille transcriptions provided pursuant to this subparagraph shall include the complete and unabridged text of the original written notice, including all required attachments, rights statements, and appeal information. Electronic braille transcription files shall be used where applicable.

(2) The resident’s primary language and sensory impairments shall be included in the minimum dataset maintained by the facility pursuant to Section 14110.15 of the Welfare and Institutions Code.

(4) Failure to provide a translated or accessible-format copy to the resident and, if applicable, the resident’s representative pursuant to this subdivision or to the local long-term care ombudsman upon request pursuant to subdivision (a) shall constitute an automatic class “B” violation.

(l) The provisions of this section are intended to be consistent with federal law and regulations and shall not be construed to limit any greater protections provided to residents under state or federal law. This section does not limit the ability of a local long-term care ombudsman to request or receive documents necessary to investigate or advocate regarding a resident’s transfer or discharge.

SEC. 3.

Section 14126.029 of the Welfare and Institutions Code is amended to read:

14126.029.

(a) For purposes of this section, the following definitions apply:

(1) “Long-term health care facility” means a skilled nursing facility or nursing facility as those terms are defined in paragraph (1) of subdivision (c) and subdivision (k) of Section 1250 of the Health and Safety Code, respectively.

(2) “Timely” means within three calendar days of a long-term health care facility being served a hearing decision.

(b) 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.

(c) (1) Notwithstanding any other law, and in addition to any other remedial action available to the department, if a long-term health care facility fails to timely comply with a hearing decision issued by the department’s Office of Administrative Hearings and Appeals, the department may assess penalties pursuant to this subdivision.

(2) Commencing on the fourth calendar day after the date of service of the hearing decision, the department may assess a penalty of one thousand dollars ($1,000) for each calendar day the facility fails to comply with the hearing decision.

(3) For each individual hearing decision, the department shall not assess aggregate penalties that exceed one hundred thousand dollars ($100,000).

(d) To demonstrate compliance with a hearing decision, a long-term health care facility shall 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 certification shall specify the date of service of the hearing decision and the date on which the resident was readmitted or the facility otherwise complied with the hearing decision. The department shall make a certificate of compliance available on its internet website.

(e) A long-term health care facility’s failure to timely comply with the hearing decision, including, but not limited to, a failure to file the certification of compliance within three calendar days of service of the hearing decision, as described in subdivision (d), shall subject that facility to the issuance of penalties as specified in subdivision (c), except as provided in subdivision (g).

(f) (1) Notwithstanding any other law, the amount of the assessed penalties, as calculated pursuant to subdivision (c), for a long-term health care facility may be deducted by the department from any Medi-Cal payments to that facility until the penalties are paid in full. If the department deducts the penalties from the Medi-Cal payments to the facility, the department shall provide prior written notice to the facility, and, in taking into account the financial condition of the facility, may apply that deduction over a period of time.

(2) Notwithstanding any other law, if there is a merger, acquisition, or change of ownership involving a long-term health care facility that has outstanding penalties pursuant to this section, the successor long-term health care facility shall be responsible for paying to the department the full amount of outstanding penalties attributable to the facility for which it was assessed, upon the effective date of that transaction.

(g) The department may waive all or a portion of the penalties assessed under this section if a facility petitions for a waiver and the department determines, in its sole discretion, that the petitioning facility meets both of the following:

(1) The facility complied with the hearing decision or otherwise demonstrated to the department’s satisfaction that sufficient corrective action has been taken to remediate the underlying improper conduct.

(2) The facility demonstrated to the department’s satisfaction that imposing the full amount of penalties under this section has a high likelihood of creating an undue financial hardship for that facility or creates a significant difficulty in providing services to Medi-Cal beneficiaries.

(h) Any penalties collected by the department pursuant to this section shall be deposited into the General Fund, and, upon appropriation by the Legislature, shall be used to improve quality of long-term care services under the Medi-Cal program, and to fund the department’s administrative costs associated with the hearings conducted pursuant to Section 1396r(e)(3) of Title 42 of the United States Code and Section 1599.1 of the Health and Safety Code for purposes of implementing this section.

(i) Any penalty the department assesses on a long-term health care facility pursuant to this section is appealable only to the superior court of the county where the facility is located.

(j) Any penalty issued pursuant to this section shall not prohibit any state or federal enforcement action, including, but not limited to, an enforcement action by the State Department of Public Health, for a violation of improper transfer or discharge or failure to readmit requirements.

(k) Notwithstanding the rulemaking provisions of Chapter 3.5 (commencing Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section, in whole or in part, by means of information notices, provider bulletins, or other similar instructions, without taking any further regulatory action.

(l) The department shall seek any federal approvals it deems necessary to implement this section. This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is not jeopardized.

(m) In the event that the long-term health care facility seeks judicial review of the hearing decision and the hearing decision is reversed through such review, the department, after being provided a copy of the final judicial order by the facility, shall refund to the facility any penalties paid by the facility associated with the reversed hearing decision.

(n) (1) A hearing decision for a hearing described in subdivision (b) shall 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.

(2) A hearing described in subdivision (b) shall 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.

(o) If a long-term health care facility fails to timely comply with a hearing decision, the department shall promptly notify the State Department of Public Health, which may prohibit new resident admissions pursuant to Section 1429.5 of the Health and Safety Code.

SEC. 4.

No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.