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State of California—Health and Human Services Agency
California Department of Public Health

AFL 20-26.11
November 12, 2021

General Acute Care Hospitals

Suspension of Regulatory Enforcement of Hospital Requirements
(This AFL supersedes AFL 20-26.10)

AUTHORITY:     Proclamation of Emergency, Executive Orders: N-39-20 (PDF), N-08-21 (PDF), N-12-21 (PDF), and N-21-21 (PDF)

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.
  • In accordance with the Executive Order N-21-21 (PDF), issued November 10, 2021, this AFL extends the temporary waiver related to space requirements until March 31, 2022.  


Pursuant to the Governor's declaration of a state of emergency related to COVID-19, the Director of CDPH may waive any of the licensing requirements of Chapter 2 of Division 2 of the Health and Safety Code (HSC) and accompanying regulations with respect to any hospital or health facility identified in HSC section 1250. CDPH is temporarily waiving specified hospital licensing requirements and suspending regulatory enforcement of the following requirement as specified in this AFL.

Due to increasing circulation of more transmissible variants of the SARS-CoV-2 virus  and the ongoing incidence of COVID-19 in California, and in compliance with Executive Order N-21-21 (PDF), the temporary waiver contained in this AFL has been extended and will expire March 31, 2022.

Hospitals that have a continued need for flexibility beyond March 31, 2022 can submit form CDPH 5000-A (PDF) emergency program flexibility request to or form CDPH 5000 (PDF) program flexibility request to their local district office.  


All statutory and regulatory provisions related to the configuration and use of physical space and classification of beds in a hospital. Hospitals may reconfigure space as needed to accommodate observed or predicted patient surge, patient cohorting, modified infection and source control procedures, and other COVID-19 related mitigation strategies.

Temporary changes of use or modification to the physical environment must be restored to original conditions following expiration of a waiver. Where such temporary changes are to be made permanent, projects must be submitted for Office of Statewide Health Planning and Development's (OSHPDs) review and approval (whether the changes involve construction or not) no later than two weeks after waiver expiration. Permanent modifications to the physical environment or changes of use must be submitted to OSHPD as projects for review and approval (whether the changes involve construction or not) immediately.

This statewide waiver is approved under the following conditions:

  • Hospitals shall continue to comply with adverse event and unusual occurrence reporting requirements specified in HSC section 1279.1 and Title 22 CCR section 70737(a).
  • Hospitals shall report any substantial staffing or supply shortages that jeopardize patient care or disrupt operations.
  • Hospitals shall continue to provide necessary care in accordance with patient needs and make all reasonable efforts to act in the best interest of patients.
  • Hospitals shall follow their disaster response plan.
  • Hospitals shall follow infection control guidelines from the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) related to COVID-19.
  • Hospitals shall comply with directives from their local public health department, to the extent that there is no conflict with federal or state law or directives or CDPH AFLs.

The space waiver, as specified above, is currently set to expire on March 31, 2022.

If you have any questions about this AFL, please contact your local district office.



Original signed by Cassie Dunham

Cassie Dunham

Acting Deputy Director



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