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

AFL 22-01
January 7, 2022

All Facilities

Centralization of Program Flexibility Application Process

All Facilities Letter (AFL) Summary

  • This AFL provides the rollout schedule for centralization of the program flexibility process by district office and prioritization criteria for registering users for the online application.
  • This AFL announces the new online application for Program Flexibility and Patient Needs Waiver and Workforce Shortage Waiver Applications and provides information on how to register as a user.

The California Department of Public Health (CDPH) Center for Health Care Quality (CHCQ) is centralizing and automating the program flexibility process for all facilities requesting program flexibility and for skilled nursing facilities (SNF) requesting Workforce Shortage Waivers (WSW) and Patient Needs Waivers (PNW).

The new online application tool is called Risk and Safety Solutions (RSS). CDPH believes the transition to an online platform as well as having the Centralized Program Flex Unit (CPFU), a centralized team, dedicated to this process will increase efficiency and consistency in the review process. CDPH is transitioning from Adobe Exchange Manager (AEM), the system used by SNF's for WSW and PNW applications.

To provide a smooth transition and mitigate delays in responding to requests, CHCQ has developed an implementation plan. The first step in implementation is registering for access to the application for SNFs preparing to submit PNW or WSW due to the timeframe requirements for those programs and all facilities with program flexes scheduled to expire during the transition.

The online registration process is now available to SNFs. CDPH will send out an email to the facility representative email addresses on file with a link to further instructions on registering for the RSS system. 

Beginning January 1, 2022, the SNFs will use the RSS online platform to submit PNW and WSW applications. SNFs may already have an account to access RSS due to the mitigation survey platform available in RSS.

The registration rollout for program flexibility is scheduled by district office.  Facilities will be invited to register based on the district office where the facility is located. For hospital systems, once registration opens in the first district office where a hospital is located, the entire system will be invited to register. The following table includes the rollout schedule:

Facilities/District OfficesStart Date
All SNFs submitting PNW & WSW
December 13, 2021
Fresno, Riverside, Chico, and San FranciscoJanuary 18, 2022
Bakersfield, Sacramento, and San Bernardino
February 2022
Ventura, East Bay, and Santa RosaMarch 2022
OrangeJuly 2022
San Diego, San Jose, and LA Region 1August 2022
LA Region 2, LA Region 3, State Facilities, and LAAUSeptember 2022


Facilities with known program flexes scheduled to expire will be contacted 90 days prior to the expiration date separately via email to facilitate registration.

Once registered with a role assigned and after successfully submitting an online application, the system will send a confirmation e-mail with an identification number (tracking ID number) to the point of contact listed on the application. All correspondence regarding the application will be sent to the point of contact.  

User guides and training resources will be available at the CPFU website.

Any questions regarding this AFL should be directed to CPFU by email at



Original signed by Cassie Dunham

Cassie Dunham

Acting Deputy Director

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