The California Department of Health has issued a new All Facilities Letter requiring skilled nursing facilities (SNFs) to provide a minimum of 3.5 direct care service hours per patient day, effective July 1, 2018. At least 2.4 of these hours must be performed by certified nurse assistants. The department will develop and adopt emergency regulations by July 1, 2018, to implement these requirements, and will provide notice at least 90 days prior to adopting regulations. SNFs must apply for a waiver to address individual patient needs, and the department will review waivers annually. Facilities seeking a waiver renewal must reapply annually, and approved waivers are subject to revocation. The department will also develop a schedule to issue penalties for violations of staffing requirements that lead to harm. Facilities that meet a minimum of 3.2 nursing hours per patient day remain eligible for Quality and Accountability Supplemental Payments. The department is hosting stakeholder meetings to inform the standards to implement these changes.

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