A resident of a skilled nursing facility, who elected hospice care through a provider under contract to the facility, experienced a psychotic episode, and the hospice provider directed that she be transferred to an acute care hospital for evaluation and treatment. When her treatment was concluded, the skilled nursing facility refused to readmit her. Primary issue was whether the refusal of readmission constituted an involuntary transfer of the resident under 42 Code of Federal Regulations, part 483.12, thus requiring various findings and documentation.
A health care service plan rescinded plaintiff’s contract for coverage prior to required surgery, based on alleged misrepresentations about her health she had made in her application to the plan. Plaintiff sued the plan, alleging claims for breach of contract, breach of the duty of good faith and fair dealing, and declaratory relief. Primary issue was whether Health & Saf. Code, §1389.3 precluded the plan from rescinding the contract unless it could demonstrate either that the misrepresentations were willful or that it had made reasonable efforts to ensure the accuracy and completeness of the application before issuing the contract.
Health care company received permission from the Attorney General of California, who has supervisorial authority over such matters under the Nonprofit Hospital Transfer Statute (Corp. Code, §§ 5914-5925), to purchase a hospital from a nonprofit corporation. The permission required the hospital to continue to provide a minimum level of "charity care" services for six years, and to make up for any deficiency in such services by making monetary contributions to a nonprofit corporation providing medical care. Later, the health care company sought to modify this condition, contending that the enactment of the Patient Protection and Affordable Care Act (ACA), colloquially known as "Obamacare," reduced the number of uninsured persons in the community, making it impossible for the hospital to provide the level of charity care services required by the grant of permission. Primary issue involved whether, as required by applicable law, the company demonstrated that the ACA was a reasonably unforeseeable change in circumstances at the time the sale was permitted, and that it had taken efforts to avoid the need for a modification.
Hon. Thomas L. Willhite, Jr. (Ret.)
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