Skip Navigation LinksAFL-24-01

State of Cal Logo
EDMUND G. BROWN JR.
Governor

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


AFL 24-01
January 3, 2024


TO:
Home Health Agencies (HHA)

SUBJECT:
Program Flexibility for HHA Nursing Experience Requirements
(This AFL supersedes AFL 12-03 )

​​​​​​



​All Fa​cilities Letter (AFL) Summary

This AFL outlines the requirements for requesting an individual or agency-wide program flexibility for a registered nurse (RN) or licensed vocational nurse (LVN).

​The California Department of Public Health (CDPH), Center for Health Care Quality, has the authority to grant program flexibility from regulatory requirements if statutory requirements are met. This AFL provides direction for requesting program flexibility for the professional nursing experience requirements for a home health agency (HHA).

Title 22 CCR sections 74707(c) and (d) requires that all RNs and LVNs have one year of professional nursing experience before providing services in a patient's temporary or permanent place of residence through a HHA.

CDPH remains focused on ensuring that the care of patients is not compromised. However, CDPH recognizes that HHAs may have difficulty recruiting RNs and/or LVNs with the required one year of professional nursing experience. Title 22 CCR section 74689(a) allows CDPH to grant HHAs flexibility for the professional nursing experience requirement provided that patient safety and quality of care are not jeopardized.

HHAs requesting program flexibility must complete the online application and provide supporting documentation demonstrating how the agency will meet the intent of the one-year professional nursing experience requirement via an alternative concept while protecting patient safety and quality of care. Approval of this request allows RNs and/or LVNs without one year of experience an opportunity to work for a HHA for the duration of the approved flex. 

Applying for a Program Flexibility Request

HHAs may apply via the Risk & Safety Solutions (riskandsafety.com) (RSS) platform for either an individual or agency-wide program flexibility. Please refer to AFL 22-01 for more information on registering and using RSS.

HHAs submitting a program flexibility request for an individual RN or LVN who does not meet the one-year professional nursing experience requirement should indicate the additional training and supervision that will be provided to the nurse during the first year of employment.

HHAs submitting an agency-wide program flexibility request for RNs and/or LVNs who do not meet the one-year professional nursing experience requirement should include information regarding their program that includes at least 16-weeks of training and supervision provided at regular intervals over the first year of employment.

To assist CDPH in reviewing a HHA agency program flexibility request, please submit supporting documentation that addresses the following areas with the request:

  • Program leadership/oversight
  • Program overview
  • General orientation provided by HHA
  • Competency evaluations and training/skill assessments
  • Monitoring plan
  • Quality assurance assessment and review
  • If contracting with an educational company, provide a copy of the agreement.

Program flexibility requests approved for an individual will be valid for one year and an agency-wide program flex will be valid for three years. Any requests for renewal should be submitted at least 60 days in advance of the expiration date. 

For questions regarding the content of this AFL, please contact the Centralized Program Flex Unit by email at CentralizedProgramFlex@cdph.ca.gov.

 ​

Sincerely,

Original signed by Cassie Dunham

Cassie Dunham

Deputy Director​


Page Last Updated :