Who Regulates Medi-Cal Nursing Homes in California?

Who Regulates Medi-Cal Nursing Homes in California?

By | 2018-07-25T15:16:58+00:00 Friday, July 27th, 2018|Seniors|0 Comments

In June, I wrote a post on a recent report issued by the California State Auditor that found significant problems with California’s nursing homes and nursing-home regulators. One problem was that the three agencies charged with regulating nursing homes in California weren’t coordinating their efforts, causing inefficiencies in this area that cost California taxpayers.

Today, I want to briefly go over each of those three regulators, plus one more, and explain what role they play in overseeing California nursing homes.

Department of Public Health

The California Department of Public Health (CDPH) licenses nursing homes in the state. In the process, CDPH inspects nursing homes and reviews their quality-of-care records. The agency also receives reports of certain events and complaints about nursing homes and investigates them. (Of course, CDPH came in for the harshest criticism in the State Auditor’s report, but hopefully that report will spur them to improve.)

If you have a complaint about a nursing home’s quality of care, including a complaint about neglect or abuse, you can file it with CDPH’s Licensing and Certification Division. Sonoma County complaints are serviced by the Redwood Coast/Santa Rosa District Office at 2170 Northpoint Parkway in Santa Rosa, CA 95407. You can contact them by phone at (707) 576-6775 or toll free at (866) 784-0703.

Department of Health Care Services

The Department of Health Care Services (DHCS) administers the long-term Medi-Cal program. This means that DHCS is in charge of creating regulations regarding the application process for individuals and nursing homes’ qualifications for participating in the program.

DHCS reviews cost and billing information provided by nursing homes and determines the appropriate payments for each long-term Medi-Cal beneficiary living there. DHCS’ Audits & Investigations Division also investigates Medi-Cal provider fraud.

 Office of Statewide Health Planning and Development

 California’s Office of Statewide Health Planning and Development (OSHPD) serves two basic functions for Medi-Cal nursing homes. First, it collects information about the care provided by those nursing homes. This includes cost reports which are then forwarded to DHCS for their own review. Second, OSHPD monitors nursing homes’ construction, renovation, and earthquake safety.

Attorney General

Finally, the California Attorney General investigates and prosecutes elder abuse, neglect, and Medi-Cal fraud at nursing homes. Complaints on these subjects can be submitted to the Attorney General by telephone at (800) 722-0432, by email, or by letter mail to:

California Department of Justice
Bureau of Medi-Cal Fraud Elder Abuse
P.O. Box 944255
Sacramento, CA 94244-2550

Conclusion

When you are receiving long-term Medi-Cal benefits in a nursing home, you deserve to receive safe, quality care in a caring environment free of neglect or abuse. The four agencies above help to ensure that you do—but it’s important that you and your family do your part, too. If you see nursing homes violating California law, contact DPH, the Attorney General’s office and, in an emergency, the police.

About the Author:

Bridget Mackay is a Petaluma estate planning attorney who has been practicing law since 1996. She is a member of the Sonoma County Bar Association, California State Bar Association Trust and Estates Section and on the Board of the Sonoma County Women in Law. She also sits on the Board of the Cinnabar Arts Corporation in Petaluma. Connect with Bridget on Google

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