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Licensing and certification Program

All Facilities Letters - 2020

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*All Facilities Letters are listed in ascending order by release date, with updated AFLs listed directly after their original version

Bulletin NumberFacility Type Affected Subject Release Date
AFL 20-01 (PDF)Skilled Nursing FacilitiesReminder of Mandatory use of “Census and Direct Care Service Hours Per Patient Day (DHPPD)” (CDPH Form 612) and “Nursing Staffing Assignment and Sign-in Sheet (DHPPD Salaried/Dual Role/Nurse Assistant)” (CDPH Form 530) 01/06/2020
AFL 20-02 (PDF) All FacilitiesChanges to the Application Review Process01/06/2020
AFL 20-03 (PDF) Skilled Nursing FacilitiesAnnouncement: Online Application Period for Patient Needs Waiver (PNW) and Workforce Shortage Waiver (WSW)01/06/2020
AFL 20-04 
(Superseded - see AFL 23-27​)
General Acute Care Hospitals​Notice of New Penalties for Violating Nurse to Patient Staffing Ratios​01/16/2020​
​AFL 20-05 (PDF)​General Acute Care Hospitals​Medical Evidentiary Examinations and Reporting ​01/17/2020
AFL 20-06 (PDF)​General Acute Care Hospitals ,
Acute Psychiatric Hospitals,
Special Hospitals,
Hospice Facilities
​Senate Bill (SB) 322: Health Facilities: Inspections: Employee Reporting​01/17/2020
AFL 20-07 (PDF)​General Acute Care Hospitals,
Alternative Birth Centers,
Primary Care Clinics
California Dignity in Pregnancy and Childbirth Act​​01/17/2020
​AFL 20-08 (PDF)
​General Acute Care Hospitals​Notice of Stakeholder Meeting for GACH Administration, Licensure, Medical Services, and Records and Reporting Regulations (GACH Administration) ​01/17/2020
AFL 20-09​
​All Facilities
​Health Update and Interim Guidance – 2019 Novel Coronavirus (nCoV)​01/23/2020
AFL 20-10
​All Facilities
​Healthcare Facility Resources for the 2019 Novel Coronavirus (2019-nCoV)​01/27/2020
AFL 20-11
​All Facilities​Updated 2019 Novel Coronavirus Information (2019-nCoV), Including Patient Under Investigation (PUI) Guidance from the Centers for Disease Control and Prevention (CDC)​01/31/2020
AFL 20-12 (PDF)​All Facilities​Change of Ownership Procedural Requirements ​02/03/2020
AFL 20-13
​All Facilities​2019 Novel Coronavirus Interim Guidance for Risk Assessment and Health Management of Healthcare Personnel with Potential Exposure​02/10/2020
AFL 20-14
​All Facilities​Environmental Infection Control for the Coronavirus Disease 2019 (COVID-19)​02/19/2020
AFL 20-15.1
All Facilities​Infection Control Recommendations for Facilities with Suspect Coronavirus (COVID-19) Patients​02/28/2020​
AFL 20-16.1
(Supersedes AFL 20-16)
​All FacilitiesNotice of Stakeholder Meeting for GACH Cardiac Catheterization Laboratory Service Regulations ​03/25/2020
AFL 20-17
​All Facilities​Guidance for Healthcare Facilities on Preparing for Coronavirus Disease 2019 (COVID-19) ​03/03/2020
AFL 20-18
Hospitals​​Hospital Resources Survey to Assess Surge Capacity Regarding Coronavirus Disease 2019 (COVID-19)03/08/2020​
AFL 20-20 ​All Facilities​ 2020 Census Workers: Group Quarters Enumeration​03/11/2020
AFL 20-21Hospitals and Critical Access Hospitals with Psychiatric or Rehabilitative Distinct Part UnitsNew Electronic Process for Hospitals to Report a Death Associated with Restraint or Seclusion​03/11/2020
AFL 20-22.9 
(Superseded - see
AFL 22-07)
Skilled Nursing Facilities
​Guidance for Limiting the Transmission of COVID-19 in Skilled Nursing Facilities
​AFL 20-23
​All FacilitiesCalifornia Coronavirus Disease 2019 (COVID-19) Health Care System Mitigation Playbook ​03/20/2020
​AFL 20-24
​All Facilities​Guidance for Procedures and Transfer of Deceased Persons with Confirmed or Suspected Coronavirus Disease 2019 (COVID-19)0​3/16/2020
AFL 20-25.2
​Skilled Nursing Facilities
​Preparing for Coronavirus Disease 2019 (COVID-19) in California Skilled Nursing Facilities​04/15/2020
AFL 20-26.13 
​General Acute Care Hospitals​Suspension of Regulatory Enforcement of Hospital Requirements
AFL 20-27.1
​Adult Day Health Centers
​Guidance for Limiting the Transmission of Coronavirus Disease 2019 (COVID-19) in Adult Day Health Centers


AFL 20-28​Skilled Nursing FacilitiesAnnouncement: Extension of the Deadline to Apply for Patient Needs and Workforce Shortage Waivers​03/23/2020
AFL 20-29​Adult Day Health Centers (ADHC)
Home Health Agencies (HHA)
Intermediate Care Facilities (ICF)
ICF/Developmentally Disabled (ICF/DD)
Referral Agencies

​Regulatory Update for Social Worker Definition and Services

​AFL 20-30.9 
​Primary Care Clinics (PCCs)

Mobile Health Care Units (MHCUs)

​Suspension of Regulatory Enforcement of Specified PCC and MHCU Requirements06/30/2022
AFL 20-31.6​
General Acute Care Hospitals (GACHs)​GACH Coronavirus Disease (COVID-19) Daily Reporting​

AFL 20-32.3
(Superseded - see AFL 21-36)

​Skilled Nursing Facilities​Suspension of Regulatory Enforcement of Specified Skilled Nursing Facility Requirements06/02/2021
AFL 20-33.2
​Skilled Nursing Facilities
​Interim Guidance for Transfer of Residents with Suspected or Confirmed Coronavirus Disease (COVID-19)

​AFL 20-34.7 
​Adult Day Health Care Centers (ADHCs) Suspension of Regulatory Enforcement of Specified ADHC Requirements
AFL 20-35.8 
​All Facilities​Suspension of Professional Certification Requirements for Certified Nurse Assistants (CNAs) ​07/05/2022
AFL 20-36.3

​General Acute Care Hospitals
Skilled Nursing Facilities

​Guidance for Decontamination and Reuse of N95 Filtering Facepiece Respirators​06/16/2020
​AFL 20​-37
Ambulatory Surgery Centers (ASCs)​ASC Ventilator Inventory Survey ​04/08/2020
AFL 20-38.7
​All Facilities
​Visitor Limitations Guidance
AFL 20-39
​All Facilities​Coronavirus Disease 2019 (COVID-19) Optimizing the Use of Personal Protective Equipment (PPE)            ​04/13/2020
AFL 20-40.5 
​ All Facilities
Nurse Assistant Training Programs
​Suspension of Specified Regulatory Requirements for Nurse Assistant Training Programs (NATPs)06/30/2022
AFL 20-41​All Facilities​Prohibition on charging for federally supplied assets or pharmaceuticals from the Strategic National Stockpile (SNS)​04/16/2020
​AFL 20-42
​Acute Psychiatric Hospitals (APHs)​Coronavirus Disease (COVID-19) APH Reporting​04/17/2020
​AFL 20-43.4​
(Supersedes AFL 20-43.3)
​Skilled Nursing Facilities (SNFs)​SNF Coronavirus Disease 2019 (COVID-19) Daily Reporting ​05/11/2023

​AFL 20-44.1

​All Facilities​Expanding Access to Testing: Updated Interim Guidance on Prioritization for Coronavirus Disease 2019 (COVID-19) Laboratory Testing​05/02/2020
​AFL 20-45
​All FacilitiesHotels for Healthcare Workers ​04/20/2020
AFL 20-46.3
​All FacilitiesRequests for Urgent Staffing Resources for COVID-19​09/07/2021​
AFL 20-47.2  
​Hospice ProvidersSuspension of Regulatory Enforcement of Hospice Requirements07/16/2021
AFL 20-48.3
​All Facilities​Transfers to Low Acuity Alternate Care Sites During Coronavirus Disease 2019 (COVID-19) Pandemic ​12/16/2020
​AFL 20-49.6
​All Facilities​Suspension of Professional Certification Requirements for Home Health Aides (HHAs) 06/30/2022
​AFL 20-50.1 
(Supersedes AFL 20-50) 
​Skilled Nursing FacilitiesSkilled Nursing Facility Infection Prevention Meetings​06/22/2020
​AFL 20-51
​All Facilities​Updated Coronavirus Disease 2019 (COVID-19) Symptoms​05/09/2020
​AFL 20-52
​Skilled Nursing Facilities ​Coronavirus Disease 2019 (COVID-19) Mitigation Plan Implementation and Submission Requirements for Skilled Nursing Facilities (SNF) and Infection Control Guidance for Health Care Personnel (HCP)​05/11/2020

AFL 20-53.6 
(Superseded - see AFL 22-13)

Skilled Nursing Facilities​
​COVID-19 Mitigation Plan Recommendations for Testing of HCP and Residents at SNF 12/27/2021
AFL 20-54​All Facilities​Hot Summer Weather Advisory​05/27/2020
AFL 20-55
​Skilled Nursing Facilities​SNF Coronavirus Disease 2019 (COVID-19) Baseline Testing Reporting​06/02/2020
AFL 20-56​All Facilities​Request for Interest in Serving as a Temporary Manager ​06/12/2020
​AFL 20-57.5
​All Facilities
​Suspension of Professional Certification Requirements for Home Health Aide Training Programs (HHA Training Programs)06/30/2022
AFL 20-58​All Facilities​Fiscal Year (FY) 2020-21 Health Care Facility License Fee Schedule​07/07/2020
AFL 20-59​All Facilities​Public Safety Power Shutoff Power Outage Reporting​07/13/2020
​AFL 20-60
​Skilled Nursing Facilities​SNF Weekly Reporting of Coronavirus Disease 2019 (COVID-19) Surveillance/Response-Driven Testing​07/17/2020
​AFL 20-61
​Skilled Nursing Facilities​Dialysis Transportation for Coronavirus Disease 2019 (COVID-19) Positive Residents​07/21/2020
AFL 20-62
​Intermediate Care Facilities (ICF), Intermediate Care Facilities/Developmentally Disabled (ICF/DD), Intermediate Care Facilities/Developmentally Disabled – Habilitative (ICF/DD-H), Intermediate Care Facilities/Developmentally Disabled – Nursing (ICF/DD-N), Intermediate Care Facilities/Developmentally Disabled – Continuous Nursing (ICF/DD-CN)​ICF Coronavirus Disease 2019 (COVID-19) Daily Reporting​07/25/2020
AFL 20-63.1
(Supersedes AFL 20-63)
​​Skilled Nursing Facilities​Deployment of Online Survey Application for Coronavirus Disease 2019 (COVID-19) SNF Mitigation Surveys​08/07/2020
AFL 20-64​Skilled Nursing Facilities​Staffing Data Submission through the Payroll-Based Journal (PBJ) System​08/13/2020
AFL 20-65​All Facilities​Level II Extreme Heat Alert08/13/2020​
AFL 20-66.1 
(Supersedes AFL 20-66)
Skilled Nursing Facilities,
Distinct Part Skilled Nursing Facilities,
End Stage Renal Disease Dialysis Facilities,
Chronic Dialysis Clinics​
Updated Guidance for Provision of Home Dialysis Services in a Skilled Nursing Facility​03/08/2021
AFL 20-67
​Skilled Nursing FacilitiesEmergency Resident Transfers during the Coronavirus Disease 2019 (COVID-19) Pandemic​08/20/2020
​AFL 20-68​Nursing Homes​Health Services Advisory Group (HSAG) Centers for Medicare and Medicaid Services (CMS) Initiatives to Support Nursing Home Quality Improvement ​09/03/2020
AFL 20-69.1
​All Facilities​Survey Priorities during the Coronavirus Disease 2019 (COVID-19) Pandemic03/01/2021
AFL 20-70
​Skilled Nursing Facilities​Non-Emergency Transportation during the Coronavirus Disease 2019 (COVID-19) Pandemic​09/14/2020
AFL 20-71​All Facilities​Recall Notice of Advoque Safeguard N95 Particulate Filtering Respirator​09/14/2020
AFL 20-72.1 
​Home Health Agencies​Suspension of Regulatory Enforcement of Home Health Agency Requirements
(See Frequently Asked Questions for additional guidance)
AFL 20-73
​​Skilled Nursing Facilities​Advance Care Planning, Physician’s Order for Life Sustaining Treatment (POLST) and Coronavirus Disease 2019 (COVID-19) ​09/22/2020
AFL 20-74.1 
(Superseded - See AFL 23-12)
​​Skilled Nursing Facilities​Coronavirus Disease 2019 (COVID-19) Recommendations for Personal Protective Equipment (PPE), Resident Placement/Movement, and Staffing in Skilled Nursing Facilities ​​07/22/2021
AFL 20-75.1 
(Superseded - See AFL 23-09)
​All Facilities​Coronavirus Disease 2019 (COVID-19) Outbreak Investigation and Reporting Thresholds​​07/22/2021
​AFL 20-76
(Superseded - See AFL 23-32​)
​Skilled Nursing Facilities (SNF)
Nursing Facilities (NF)
Intermediate Care Facilities
Swing Bed Hospitals
​Changes on the Minimum Data Set (MDS) 3.0 v1.17.2​09/29/2020
​AFL 20-77​Skilled Nursing Facilities
Nursing Facilities
​Notice of Grant Opportunity to Benefit Nursing Facility Residents to Support In-Person Visitation​10/02/2020
AFL 20-78
​Skilled Nursing Facilities​November 3, 2020 Election: Voting During the COVID-19 Pandemic​10/05/2020
AFL 20-79​General Acute Care Hospitals​Access to Salesforce for Resource Requests​10/09/2020
​AFL 20-80
(Superseded - See AFL 21-44​)
​​Skilled Nursing Facilities
​Recommendations for the Prevention and Control of Influenza during the Coronavirus Disease 2019 (COVID-19) Pandemic​10/12/2020
​AFL 20-81
​General Acute Care Hospitals
GACH Coronavirus Disease 2019 (COVID-19) Vaccination Survey​10/12/2020
AFL 20-82
​All Facilities​California Department of Public Health (CDPH) Influenza Vaccination and Masking Policy ​10/30/2020
​AFL 20-83.2 
(Supersedes AFL 20-83.1)
​Skilled Nursing Facilities
Intermediate Care Facilities

Interdisciplinary Team (IDT) Authorized Medical Interventions for Residents Unable to Provide Informed Consent and Without a Health Care Decision Maker

​AFL 20-84​Skilled Nursing Facilities​Infection Prevention Recommendations and Incorporation into the Quality and Accountability Supplemental Payment (QASP) Program​11/04/2020
AFL 20-85​​Skilled Nursing Facilities
​Assembly Bill (AB) 2644 – Skilled Nursing Facilities: Infection Preventionists and Communicable Disease Reporting​11/09/2020
AFL 20-86.1
​Long-Term Care Facilities​Coronavirus Disease 2019 (COVID-19) Infection Control Recommendations during Holiday Celebrations
​AFL 20-87.1 
(Superseded - see AFL 22-31)
​Skilled Nursing Facilities
General Acute Care Hospitals
​Movement of Patients/Residents in the Healthcare Continuum During Seasonal Surges and the Coronavirus Disease 2019 (COVID-19) Pandemic​11/15/2021
AFL 20-88.4 
​General Acute Care Hospitals

Coronavirus Disease 2019 (COVID-19) Testing Recommendations for Patients and Health Care Personnel (HCP) at General Acute Care Hospitals (GACHs)

AFL 20-89.1
(Supersedes AFL 20-89)
​Skilled Nursing Facilities
Intermediate Care Facilities
Educational Institutions
Requirements for Application Submission for Online or Distance Learning Nurse Assistant Training Programs (NATPs)06/07/2021
​AFL 20-90
​General Acute Care Hospitals​Program Flexibility Requirement for General Acute Care Hospitals (GACH) Before Providing Acute Hospital Care at Home Services ​12/23/2020
AFL 20-91
​​General Acute Care Hospitals​California Crisis Care Continuum Guidelines: Implementing During the Surge of Coronavirus Disease 2019 (COVID-19) Cases​12/28/2020
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