The California Department of Health has issued a new All Facilities Letter (AFL) updating penalties and appeal rights for skilled nursing facilities (SNFs) that fail to comply with direct care service hours per patient day (DHPPD) requirements. SNFs found non-compliant on fewer than 5% of audited days now have the right to request an administrative appeal, though they are not subject to penalties. Non-compliant SNFs will face increased penalties of $25,000 for 5-49% non-compliant days and $50,000 for over 49% non-compliant days. The AFL provides guidelines for SNFs to appeal penalties assessed due to staffing audits for compliance with DHPPD requirements. SNFs must submit a written request for a hearing within 15 business days of receiving written notice of audit findings. The hearing process includes limited discovery, exchange of relevant documents, and testimony under oath. The hearing officer's decision is final, with no further administrative appeal available.

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