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

AFL 20-68
September 3, 2020

Nursing Homes

Health Services Advisory Group (HSAG) Centers for Medicare and Medicaid Services (CMS) Initiatives to Support Nursing Home Quality Improvement

All Facilities Letter (AFL) Summary

  • This AFL notifies nursing homes that the California Department of Public Health (CDPH) encourages nursing homes to participate in HSAG's quality improvement initiatives sponsored by CMS to achieve large-scale improvements throughout California.
  • HSAG provides COVID-19 data reports and resources to nursing homes in COVID-19 hot spot areas.
  • CDPH urges facilities to confer Center for Disease Control and Prevention (CDC) National Health Safety Network (NHSN) rights to HSAG.

HSAG, the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for California (, is directed by CMS to partner with nursing homes to achieve large-scale improvements throughout California. To support this effort, HSAG offers real-time data to nursing homes to help prevent and mitigate the spread of COVID-19.

Access COVID-19 Trend Reports and Confer NHSN Rights to HSAG
Due to the concerning trend of increasing COVID-19 transmission, HSAG has created COVID-19 trend reports for all nursing homes in the state using data from NHSN. The data reports will be updated in HSAG's Quality Improvement and Innovation Portal (QIIP) every Monday with the new week's data. To access your facility's data report, please complete the HSAG QIIP Administrator Form. To ensure your facility's data report is updated, CDPH requests that all nursing homes confer rights to HSAG to view data in NHSN by September 30, 2020. Please do not select the option to allow HSAG to upload data as this will interfere with the daily COVID-19 daily reporting. Refer to the HSAG Instructions on how to confer NHSN rights.

HSAG is also partnering with nursing homes on two CMS initiatives, including the CMS COVID-19 Targeted Referral Quality Improvement Initiative (TRQII) and the CMS Healthy Communities Nursing Home Initiative. Details about these two initiatives are below. There is no cost to participate with HSAG.

Since May 2020, CMS has directed HSAG to partner with over 300 nursing homes in California that have had previous infection control deficiencies or COVID-19 positive residents or staff members. In July 2020, with a sense of urgency to protect the vulnerable elderly and those with chronic medical conditions, CMS identified the state of California as a COVID-19 hot spot area and is working directly with HSAG to assist targeted nursing homes. When an HSAG representative contacts you, CDPH is requesting that your nursing home administrator (NHA) responds to them immediately to ensure CMS deadlines and requirements are met (CMS July 10, 2020 press release).

CMS Healthy Communities Nursing Home Initiative
Nursing homes are asked to partner with HSAG to support CMS' national nursing home goals, including increasing quality scores, improving infection prevention, decreasing opioid misuse, preventing adverse drug events, improving quality of care transitions, and preventing avoidable readmissions. CMS has directed HSAG to gain commitment from specific nursing homes to improve these quality indicators in their facilities. If an HSAG representative contacts you, CDPH is requesting that your NHA responds timely to ensure you gain access to HSAG's resources and trainings. Nursing homes will greatly benefit from HSAG's expertise in quality improvement and infection control and will receive customized tools, data reports, and resources at no cost to support best practices implementation to improve quality and manage and prevent the spread of diseases, such as COVID-19.

If you have any questions about this AFL, please contact Rose Chen, Director, HSAG, via email at or by phone at 818.653.9380.

CDPH supports these important CMS quality initiatives and requests nursing homes to participate with HSAG to improve care for residents.



Original signed by Heidi W. Steinecker 

Heidi W. Steinecker
Deputy Director



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