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Health Department submits revised waiver to CMS to restore Laguna Honda
Summary
San FranciscoDepartment of Public Health filed a 119page waiver asking CMS to allow Laguna Honda Hospital to keep 120 skilled nursing beds that CMS previously declined to certify; Director Daniel Tsai told the Health Commission the city is awaiting CMSresponse and may pursue further steps if denied.
San Francisco Department of Public Health Director Daniel Tsai told the Health Commission that the department resubmitted a 119-page waiver request to the Centers for Medicare & Medicaid Services seeking approval to bring 120 Laguna Honda Hospital (LHH) skilled-nursing beds back online after a prior CMS denial. Tsai said the letter argues that Laguna Honda was certified before the February 2016 CMS rule limiting room occupancy and that, even if the rule applied, the facilitymeets or exceeds the ruletests.
Why it matters: The 120 beds have been offline since decertification and recertification issues; the department says restoring them is a priority to reduce out-of-county discharges and improve local skilled-nursing capacity. Tsai emphasized the city made a detailed legal and factual case and has provided exhibits to CMS.
Details: Tsai told commissioners the department has had numerous discussions with CMS and on a recent Friday submitted an updated waiver that outlines both legal and programmatic arguments in support of the 120 beds. He said the letter explains why the 2016 regulation should not be applied retroactively to Laguna Honda and provides documentation about room sizes, clinical benefits for residents with behavioral-health needs and other supporting exhibits. Tsai said there is no formal timeline for a CMS response and that the department will follow up if it does not hear back promptly.
Commissioners praised the resubmitted letter as thorough. Commissioner Ed Chow and President Green both described the cover letter and exhibits as well crafted and said they increased optimism that CMS will approve the waiver. The commission asked the department to keep the commission informed of any CMS reply.
Public comments: Dr. Teresa Palmer, speaking remotely, thanked the Laguna Honda team and asked the department to provide a census update for Laguna Honda at every commission meeting so families and referral sources know current bed availability. Another public commenter, who identified himself as having filed public records requests, said San Francisco advocates believed the 120 beds were always "grandfathered" and urged the city to consider litigation if CMS again refuses the waiver.
What the city said it might do next: Speakers at public comment and some commissioners said the resubmitted waiver positions the city to pursue further action, including legal options, if CMS again denies the request. The department reiterated CMS is the federal authority and that appeals outside of CMS are limited, but staff said they will continue pressing the case.
Ending: The commission did not take a formal vote on this update; staff said they will return with further updates when CMS responds and will continue to brief the Laguna Honda Joint Conference Committee and the full commission as developments occur.
