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licensing and certification program

Centralized Program Flex Unit

ATTENTION FACILITIES: Patient Needs and Workforce Shortage Waivers will be posted July 30, 2022. For current status on a waiver application, log in to your Risk and Safety Solutions (RSS) account. Instructions on creating or logging into an RSS account are available at this link: Innovative Solutions for Complaints, Facility Reported Incidents, Waivers, and Program Flexibility


The Centralized Program Flex Unit reviews, analyzes, and research requests for program flexibility submitted by health care facilities. Section staff perform independent research and analysis, consult with medical consultants, program subject matter experts (SMEs), other department representatives, field office representatives, and other external and internal stakeholders and will provide recommendations to grant program flexibility from regulatory requirements if the facility requesting the program flexibility demonstrates its ability to meet statutory requirements without compromising patient care.  CPFU evaluates workforce shortage waiver (WSW) and patient needs waiver (PNW) applications submitted by skilled nursing facilities. The CPFU team is responsible for uniform evaluation of supporting documentation and information submitted in support of the WSW and PNW requests.  

Updates and News

RSS will be live by January 1 for skilled nursing facilities (SNFs) planning to submit Patient Needs Waiver or Workforce Shortage Waiver applications. Emails noting this development will be sent in the near future.

Workforce Shortage Waiver (WSW) A nurse with other nurses in the background.

A SNF may apply for a waiver of the 3.5 direct care service hours requirement and/or the 2.4 CNA hours requirement due to a workforce shortage of available and appropriate health care professionals and direct care givers.

Patient Needs Waiver (PNW) Hands over a stack of paper.

A SNF may apply for a waiver of the 2.4 CNA requirement to meet individual patient needs but will provide a minimum of 3.5 direct care service hours. 

Program Flexibility (PF)Hands typing in front of a computer screen.

A health care facility may apply for a program flexibility and/or an emergency program flexibility when seeking a temporary need to comply with licensing requirements by using alternative concepts, methods, procedures, techniques, equipment, or personnel.


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