Suspension of Regulatory Enforcement of Hospital Requirements

AFL 20-26.7 From the California Department of Public Health April 28, 2021 TO: General Acute Care Hospitals SUBJECT: Suspension of Regulatory Enforcement of Hospital Requirements(This AFL supersedes AFL 20-26.6) ​AUTHORITY:     Proclamation of Emergency (PDF), Executive Order N-27-20 and Executive Order N-39-20 All Facilities Letter (AFL) Summary This AFL notifies hospitals of a temporary waiver of specified regulatory requirements due to the state of emergency related to the Coronavirus Disease 2019 (COVID-19) outbreak.This AFL clarifies approval is needed if a hospital is seeking a waiver of minimum nurse-to-patient ratios.

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Temporary Waiver of Practitioner’s Order for Administration of the Coronavirus Disease 2019 (COVID-19) Vaccine

AFL 21-12 From the California Department of Public Health April 16, 2021 TO: General Acute Care Hospitals SUBJECT: Temporary Waiver of Practitioner’s Order for Administration of the Coronavirus Disease 2019 (COVID-19) Vaccine ​AUTHORITY:     Proclamation of Emergency (PDF), Executive Order N-27-20, Executive Order N-39-20All Facilities Letter (AFL) Summary This AFL notifies hospitals of a temporary waiver of specified regulatory requirements due to the state of emergency related to the Coronavirus Disease 2019 (COVID-19) outbreak.This AFL temporarily waives Title 22 California Code of Regulations (CCR) section 70263(g) for administration of COVID-19 vaccinations.

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Guidance for Limiting the Transmission of COVID-19 in Long-Term Care Facilities

AFL 21-22.7 From the California Department of Public Health April 16, 2021 TO: Long-Term Care Facilities SUBJECT: Guidance for Limiting the Transmission of COVID-19 in Long-Term Care Facilities (This AFL supersedes guidance provided in AFL 20-22.6) All Facilities Letter (AFL) Summary This AFL notifies long-term care (LTC) facilities of the Centers for Medicare and Medicaid Services (CMS) and Centers for Disease Control and Prevention (CDC) guidance for improving their infection control and prevention practices to prevent the transmission of COVID-19, including guidance for visitation.This AFL authorizes LTC facilities to temporarily modify their facility’s visitation policies in accordance with CMS and CDC COVID-19 guidance when necessary to protect the health and safety of residents, staff, and the public.This AFL provides the California Department of Public Health’s (CDPH’s) visitation guidance for expanded opportunities for indoor in-room visitation and physical touch and infection control measures for fully vaccinated residents and visitors.This revision includes additional visitation guidelines for pediatric residents.  Background On March 11, 2020, CDPH issued AFL 20-22, authorizing LTC facilities to temporarily modify their visitation policies in accordance with CMS and CDC COVID-19 guidance when necessary to protect the health and safety of residents, staff, and the public.

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Guidance on Quarantine for Health Care Personnel (HCP) Exposed to SARS-CoV-2

AFL 21-08.2 From the California Department of Public Health March 23, 2021 TO: General Acute Care Hospitals (GACHs) Acute Psychiatric Hospitals (APHs) Skilled Nursing Facilities (SNFs) SUBJECT: Guidance on Quarantine for Health Care Personnel (HCP) Exposed to SARS-CoV-2 (This AFL supersedes AFL 21-08.1) All Facilities Letter (AFL) Summary The purpose of this AFL is to provide health care facilities with updated guidance on exposure risk assessment and the duration of quarantine for SARS-CoV-2 exposed HCP working in hospitals and SNFs and SNF residents.This revision includes updated risk assessment and quarantine guidance from the Centers for Disease Control and Prevention (CDC) for HCP working in hospitals and SNFs and SNF residents who have been fully vaccinated against SARS-CoV-2.

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Guidelines for 3.5 Direct Care Service Hours Per Patient Day (DHPPD) Staffing Audits

AFL 21-11 From the California Department of Public Health March 17, 2021 TO: Skilled Nursing Facilities (SNFs) SUBJECT: Guidelines for 3.5 Direct Care Service Hours Per Patient Day (DHPPD) Staffing Audits (This AFL supersedes AFL 19-16) AUTHORITY:     Health and Safety Code (HSC) sections 1276.5 and 1276.65 and                             Welfare and Institutions Code (W&I) section 14126.022 All Facilities Letter (AFL) Summary In accordance with HSC sections 1276.5 and 1276.65, and W&I section 14126.022, this notice provides updated guidelines for facility requirements during state audits for compliance with the 3.5 DHPPD staffing requirements, of which a minimum of 2.4 DHPPD shall be performed by certified nurse assistants (CNAs).The California Department of Public Health (CDPH) is replacing AFL 19-16 with AFL 21-11 to clarify the requirements and guidelines for the 3.5 and/or 2.4 (CNA) DHPPD staffing requirements in skilled nursing facilities (SNFs).

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Visitor Limitations Guidance

AFL 20-38.6 From the California Department of Public Health TO: All FacilitiesSUBJECT: Visitor Limitations Guidance (This AFL supersedes AFL 20-38.5) All Facilities Letter (AFL) Summary AFL 20-38.6 expands California Department of Public Health’s (CDPH’s) visitation guidance allowing facilities with substantial or lower Coronavirus Disease 2019 (COVID-19) county positivity rates to encourage safely getting more visitors to the bedside and updating prior recommendations for visitation, effective March 23, 2021 (one week from the release of this AFL).This AFL also provides expanded visitation guidelines for certain individuals, regardless of the COVID-19 county positivity rate effective March 23, 2021 (one week from the release of this AFL):Pediatric patientsPatients in labor and deliveryNeonatal intensive care unit (NICU) patientsPediatric intensive care unit (PICU) patientsPatients at end-of-lifePatients with physical, intellectual, and/or developmental disabilities and patients with cognitive impairmentsStudents obtaining clinical experienceSurgery patientsLong-term care (LTC) facilities should refer to AFL 20-22.6 for updated LTC visitation guidance.

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Updated Guidance for the Provision of Home Dialysis Services in a Skilled Nursing Facility

AFL 20-66.1 From the California Department of Public Health March 8, 2021 TO: Skilled Nursing Facilities Distinct Part Skilled Nursing Facilities End Stage Renal Disease Dialysis Facilities Chronic Dialysis Clinics SUBJECT: Updated Guidance for the Provision of Home Dialysis Services in a Skilled Nursing Facility (This AFL supersedes AFL 20-66) AUTHORITY:     Title 42 Code of Federal Regulations (CFR) Part 494                            Health and Safety Code section 1225(c)(1)                             Title 22 California Code of Regulations (CCR) section 72401 All Facilities Letter (AFL) Summary This AFL notifies skilled nursing facilities (SNFs) and dialysis clinics of updated guidance from the Centers for Medicare and Medicaid Services (CMS) regarding the provision of dialysis services to SNF residents through a collaborative arrangement between the SNF and a qualified dialysis facility.This revision clarifies that dialysis services in SNFs can only be administered at the resident’s bedside and that any Office of Statewide Health Planning and Development (OSHPD) clearances must be received prior to providing dialysis services.

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Guidance for Limiting the Transmission of COVID-19 in Long-Term Care Facilities

AFL 20-22.6 From the California Department of Public Health March 8, 2021 TO: Long-Term Care Facilities SUBJECT:Guidance for Limiting the Transmission of COVID-19 in Long-Term Care Facilities (This AFL supersedes guidance provided in AFL 20-22.5) All Facilities Letter (AFL) Summary This AFL notifies long-term care (LTC) facilities of the Centers for Medicare and Medicaid Services (CMS) and Centers for Disease Control and Prevention (CDC) guidance for improving their infection control and prevention practices to prevent the transmission of COVID-19, including guidance for visitation.This AFL authorizes LTC facilities to temporarily modify their facility’s visitation policies in accordance with CMS and CDC COVID-19 guidance when necessary to protect the health and safety of residents, staff, and the public.This revision updates the California Department of Public Health’s (CDPH’s) visitation guidance, including:Expanded opportunities for indoor, in-room visitation and physical touchInfection control measures for fully vaccinated residents and visitors Background On March 11, 2020, CDPH issued AFL 20-22, authorizing LTC facilities to temporarily modify their visitation policies in accordance with CMS and CDC COVID-19 guidance when necessary to protect the health and safety of residents, staff, and the public.

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Guidance on Quarantine for Health Care Personnel (HCP) Exposed to SARS-CoV-2

AFL 21-08.1 From the California Department of Public Health March 5, 2021 TO: General Acute Care Hospitals (GACHs) Acute Psychiatric Hospitals (APHs) Skilled Nursing Facilities (SNFs) SUBJECT: Guidance on Quarantine for Health Care Personnel (HCP) Exposed to SARS-CoV-2 (This AFL supersedes AFL 21-08) All Facilities Letter (AFL) Summary The purpose of this AFL is to provide health care facilities with updated guidance on exposure risk assessment and the duration of quarantine for SARS-CoV-2 exposed HCP working in hospitals and SNFs and SNF residents.This revision includes updated risk assessment and quarantine guidance from the Centers for Disease Control and Prevention (CDC) for HCP working in hospitals and SNFs and SNF residents who have been fully vaccinated against SARS-CoV-2.

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Suspension of Regulatory Enforcement of Specified PCC and MHCU Requirements

AFL 20-30.3 From the California Department of Public Health  March 3, 2021 TO: Primary Care Clinics (PCCs) Mobile Health Care Units (MHCUs) SUBJECT: Suspension of Regulatory Enforcement of Specified PCC and MHCU Requirements (This AFL supersedes AFL 20-30.2) ​AUTHORITY:     Executive Order N-35-20 All Facilities Letter (AFL) Summary This AFL notifies PCCs and MHCUs of a temporary waiver of specified regulatory requirements due to the state of emergency related to the Coronavirus Disease 2019 (COVID-19) outbreak.This revision extends the waiver for all clinics until April 1, 2021.

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