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Licensing and certification Program

All Facilities Letters - 2021

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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 Number​Facility Type Affected​Subject​Release Date
AFL 21-01​Skilled Nursing Facilities​Annual Announcement: Online Application Period for Patient Needs Waiver (PNW) and Workforce Shortage Waiver (WSW) 01/11/2021
​AFL 21-02
​General Acute Care Hospitals​Residential Alternate Care Site (R-ACS) Option to Increase Bed Capacity Due to Anticipated Surge in Coronavirus Disease 2019 (COVID-19)​01/12/2021
AFL 21-03​Primary Care Clinics (PCCs),
Adult Day Health Centers (ADHCs),
Home Health Agencies (HHAs)
​Implementation of Assembly Bill (AB) 1128 – Program of All-Inclusive Care for the Elderly (PACE): Facility Licensing Exemption​01/12/2021
AFL 21-04

General Acute Care Hospitals,
Acute Psychiatric Hospitals

​AB 2037 - Updated Notice Timelines for Hospital Closure, Reduction or Elimination of Emergency Medical Service, and Relocation or Elimination of Supplemental Services​01/13/2021
AFL 21-05​Skilled Nursing Facilities ​Process for Fit-testing Resource Requests​01/13/2021
​AFL 21-06​Skilled Nursing Facilities (SNF),
Intermediate Care Facilities (ICF)
​Survey on the Use of Interdisciplinary Teams (IDT) for Unrepresented Residents​01/20/2021
AFL 21-07
​Skilled Nursing Facilities,
General Acute Care Hospitals
​ Maintain Efforts to Increase Staffing Levels ​01/24/2021
​AFL 21-08.9 
(Supersedes AFL 21-08.8)
​General Acute Care Hospitals,
Acute Psychiatric Hospitals,
Skilled Nursing Facilities
​Guidance on Quarantine and Isolation for Health Care Personnel (HCP) Exposed to SARS-CoV-2 and Return to Work for HCP with COVID-19
​AFL 21-09
​General Acute Care Hospitals
​Additional Temporary Waivers Tied to the Hospital Surge Public Health Order
​AFL 21-10
​All Facilities
​Change to Health Care Facility License Issuance
​AFL 21-11
​Skilled Nursing Facilities (SNFs)
​Guidelines for 3.5 Direct Care Service Hours Per Patient Day (DHPPD) Staffing Audits
​AFL 21-12
​General Acute Care Hospitals
​Temporary Waiver of Practitioner’s Order for Administration of the Coronavirus Disease 2019 (COVID-19) Vaccine
​AFL 21-13 
​Skilled Nursing Facilities (SNFs)
​Personal Protective Equipment (PPE) Push Pack Distribution
​AFL 21-14.2 
​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)
​Visitation Guidance for ICF/DD-H-N-CN Facilities During the Coronavirus Disease-2019 (COVID-19) Pandemic
​AFL 21-15
​All Facilities
​Request for 30-day Sustainment Supply of the State’s Personal Protective Equipment (PPE) Inventory
​AFL 21-16
​All Facilities
​Hot Summer Weather Advisory
​AFL 21-17
​Skilled Nursing Facilities
​Expiration of Concentra Contract for Fit-Testing
AFL 21-18
General Acute Care Hospitals (GACH)

​GACH Reporting Requirements of Specified Health-Associated Infections (HAI) 
AFL 21-19
​Skilled Nursing Facilities
Nursing Facilities
​Annual Notice of Grant Opportunity to Benefit Nursing Facility Residents and Update to Application Requirements
AFL 21-20.2​
(Superseded - see AFL 23-33​​)
​General Acute Care Hospitals (GACHs)
Acute Psychiatric Hospitals (APHs)
​Coronavirus Disease 2019 (COVID-19) Vaccine Recommendations for Eligible Individuals Prior to Discharge
AFL 21-21 
​All Facilities
​Regulatory Update for Medical Information Breach Administrative Penalties and Reporting Requirements
AFL 21-22 
​All Facilities
​Fiscal Year (FY) 2021-22 Health Care Facility License Fee Schedule
​AFL 21-23 
​Skilled Nursing Facilities (SNF)
Nursing Facilities (NF)
Swing Bed Hospitals
​Ending of the Emergency Blanket Waiver of Minimum Data Set (MDS) Timeframe Requirements
​AFL 21-24 
​General Acute Care Hospitals
Acute Psychiatric Hospitals
​Call for Specimens from Hospitalized Coronavirus Disease 2019 (COVID-19) Patients
AFL 21-25
​General Acute Care Hospitals
​Weekly Reporting Related to Patient Discharges with Coronavirus Disease 2019 (COVID-19) 
​AFL 21-26 
Adult Day Health Center, Congregate Living Health Facility, Intermediate Care Facility, Intermediate Care Facility/Developmentally Disabled, Intermediate Care Facility/Developmentally Disabled-Continuous Nursing, Intermediate Care Facility/Developmentally Disabled-Habilitative, Intermediate Care Facility/Developmentally Disabled-Nursing, Nursing Facility, Skilled Nursing Facility
​Mandated Reporting Requirements of Potential Abuse, Neglect, Exploitation, or Mistreatment of Elders or Dependent Adults
​AFL 21-27.3 
​General Acute Care Hospitals
​Coronavirus Disease 2019 (COVID-19) Testing, Vaccination Verification and Personal Protective Equipment (PPE) for Health Care Personnel (HCP) at General Acute Care Hospitals (GACHs)
​AFL 21-28.3 
​Skilled Nursing Facilities
​Coronavirus Disease 2019 (COVID-19) Testing, Vaccination Verification and Personal Protective Equipment for Health Care Personnel (HCP) at Skilled Nursing Facilities (SNF)
AFL 21-29.3 
All Clinics,
Adult Day Health Care Centers,
Acute Psychiatric Hospitals,
Ambulatory Surgery Centers,
Chemical Dependency Recovery Hospitals,
Chronic Dialysis Clinics,
Congregate Living Health Facilities,
Comprehensive Outpatient Rehabilitation Facilities,
Correctional Treatment Centers,
End Stage Renal Disease Dialysis Facilities,
Hospice Facilities,
Pediatric Day Health & Respite Care Facilities,
Rehabilitation Clinics
Coronavirus Disease 2019 (COVID-19) Testing, Vaccination Verification and Personal Protective Equipment for Health Care Personnel (HCP) at Health Care Facilities
AFL 21-30.3 
​Intermediate Care Facility (ICF),
ICF/Developmentally Disabled,
ICF/Developmentally Disabled – Continuous Nursing,
ICF/Developmentally Disabled – Habilitative,
ICF/Developmentally Disabled – Nursing
Coronavirus Disease 2019 (COVID-19) Testing, Vaccination Verification and Personal Protective Equipment for Health Care Personnel (HCP) at the Various Types of Intermediate Care Facilities

​AFL 21-31.2 
​General Acute Care Hospitals
Visitor Guidance at General Acute Care Hospitals (GACHs)
​AFL 21-32 
​All Facilities
​Change to Distribution of Health Care Facility Certification Correspondence
​AFL 21-33 
​All Facilities
​Facility Emergency Contact and All Facilities Letter Recipient Information
AFL 21-34.5 
​All Facilities
​Coronavirus Disease 2019 (COVID-19) Vaccine Requirement for Healthcare Personnel (HCP)
​AFL 21-35 
Adult Day Health Centers (ADHCs)
​Guidance for In-Center Services and Operation of ADHCs during the Coronavirus Disease 2019 (COVID-19) Pandemic
AFL 21-36.3 
Skilled Nursing Facilities
​Suspension of Regulatory Enforcement of Specified Skilled Nursing Facility Requirements
AFL 21-37 
​All Facilities​BYD Field Action Notification​09/22/2021
​AFL 21-38 
​General Acute Care Hospitals (GACHs)
​Request for Stakeholder Input in Amending GACH Regulations Specific to the Coronary Care Service, Dental Service, Intensive Care Service, Distinct Part Intermediate Care Service, and Distinct Part Skilled Nursing Service
​AFL 21-39 
​Skilled Nursing Facilities and Other Interested Stakeholders
​Notice of Stakeholder Meeting for the Quality and Accountability Supplemental Payment (QASP) Program
​AFL 21-40 
General Acute Care Hospitals (GACHs)
Acute Psychiatric Hospitals (APHs)

​Regulatory Update for Adverse Events Reporting
​AFL 21-41 
​Certified Hemodialysis Technician Training Program Providers,
Chronic Dialysis Clinics,
End Stage Renal Disease Facilities
​Notice of Stakeholder Meeting for Certified Hemodialysis Technician Training Program Regulations
​AFL 21-42 
​Skilled Nursing Facilities (SNF)
Coronavirus Disease 2019 (COVID-19) Vaccination and Booster Dose Guidance
AFL 21-43 
​General Acute Care Hospitals (GACHs)
Acute Psychiatric Facilities (APHs)
Assembly Bill (AB) 451 - Treatment of Psychiatric Emergency Medical Conditions
AFL 21- 44 
(Superseded - See AFL 23-10​)
​Skilled Nursing Facilities
​Recommendations for the Prevention and Control of Influenza in California Skilled Nursing Facilities for the 2021-2022 season during the Coronavirus Disease 2019 (COVID-19) Pandemic
AFL 21-45 
Long-term Care Facilities (LTC)
​​Assembly Bill (AB) 323 - Citation Criteria and Civil Penalty Increases
​AFL 21-46 
​Skilled Nursing Facilities (SNFs)
​Assembly Bill (AB) 749 - Medical Director Certification
AFL 21-47 
​Skilled Nursing Facilities

Intermediate Care Facilities

​Assembly Bill (AB) 849 – Liability for Damages
AFL 21-48 
​Assembly Bill (AB) 1280 – Hospice Patient Recruiting and Referral
​AFL 21-49 
​Long-Term Care Facilities
​Coronavirus Disease 2019 (COVID-19) Infection Control Recommendations during the 2021 Holiday Season
​AFL 21-50 
​Primary Care Clinics (PCC)
General Acute Care Hospitals (GACH)
​Assembly Bill (AB) 789 - Testing for Hepatitis B and Hepatitis C
​AFL 21-51 
​Skilled Nursing Facilities (SNFs)

​Assembly Bill (AB) 1585 – Expansion of SNF Infection Preventionist (IP) Minimum Qualifications
​AFL 21-52 
​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)
​Guidance for Residents/Clients to Safely Participate in Day Programs
​AFL 21-53 
​Hospice Providers
​Senate Bill (SB) 664 - Hospice Licensure: Moratorium on New Licenses
AFL 21-54 
​General Acute Care Hospitals (GACH)
​Assembly Bill (AB) 532 and AB 1020 - Health Care Debt and Fair Billing Policies
​AFL 21-55 
​​Skilled Nursing Facilities (SNFs)
​Deployment of Risk and Safety Solutions (RSS) for Complaint/Facility Reported Incident (FRI) Investigations
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