The California Department of Health has issued a new All Facilities Letter, which outlines the waiver criteria and application process for skilled nursing facilities (SNFs) seeking a waiver of the 3.5 direct care service hours requirement and/or the 2.4 certified nurse assistant (CNA) hours requirement due to workforce shortages. Effective July 1, 2018, all freestanding SNFs must increase staffing from the current 3.2 nursing hours per patient day requirement to 3.5 direct care service hours per patient day, with CNAs performing a minimum of 2.4 hours per patient day. To apply for a waiver, SNFs must submit evidence of efforts to address the workforce shortage, provide a detailed plan for resident care, and post a notice of a pending waiver application in a public location within the facility. The Department of Health will evaluate waiver applications based on factors such as the facility's compliance with state and federal regulations, recruitment and retention efforts, and ability to meet residents' needs despite workforce shortages. Facilities must reapply annually for waiver renewals and may not receive more than two consecutive waiver renewals. If a waiver is approved, the facility must not staff below 3.2 direct care service hours for the duration of the waiver.

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